^(99m)Tc-MIBI SPECT/CT结合CT影像学特征在原发性甲状旁腺疾病中的价值

Value of ^(99m)Tc-MIBI SPECT/CT combined with CT imaging features in the diagnosis of primary parathyroid diseases

目的 探讨SPECT/CT及CT影像学特征在原发性甲状旁腺亢进症(PHPT)影像学定位不准确时的临床价值。方法 选取90例手术病理证实为PHPT的患者,根据病理结果将其分为漏诊组(n=12)和诊断正确组(n=78);患者共切除110个病灶,按照病理结果分为甲状旁腺病灶组(n=81)和甲状腺病灶组(n=29),在SPECT/CT断层融合图像上的甲状旁腺病灶区、甲状腺病灶区、甲状旁腺病灶对侧正常区勾画大小相同的感兴趣区,并记录上述不同部位的放射性计数,计算靶与非靶比值(T/NT)和靶本比(TBR);在CT病灶截面收集连续3个层面CT密度最大值(CT_(max))、最小值(CTmin)及平均值(CT_(avg))。对各组数据进行组间比较,绘制ROC曲线,评估各项数据的诊断效能。结果^(99m)Tc-MIBI SPECT/CT图像上,漏诊组病灶的T/NT、TBR、体积、直径均小于诊断正确组,两组间T/NT的差异具有统计学意义(P=0.002)且诊断效能最佳,两组间TBR、体积、直径的差异无统计学意义(P>0.05)。甲状旁腺病灶组和甲状腺病灶组比较中,两组间血钙、血磷的差异无统计学意义(P>0.05),甲状腺病灶组血清甲状旁腺素、TBR、CT_(max)、CTmin、CT_(avg)均小于甲状旁腺病灶组(P<0.05)。CT_(max)的诊断效能最优,AUC为0.623,敏感度为74.10%,特异性为62.50%。结论 SPECT/CT对PHPT进行术前定位时T/NT的诊断效能较TBR更好,可以为PHPT术前定位病灶提供更有价值的参考;与甲状腺病灶进行对TBR、CT_(max)有较好的临床价值。

Objective To investigate the clinical value of SPECT/CT and CT imaging features in primary hyperparathyroidism(PHPT)with inaccurate imaging location.Methods A total of 90 patients with PHPT confirmed by surgery and pathology were selected and divided into a missed diagnosis group(n=12)and a correct diagnosis group(n=78)according to pathological results,and a parathyroid lesion group(n=81)and a thyroid lesion group(n=29)according to pathological results.The same size areas of interest were delineated in the focal areas of parathyroid,thyroid and contralateral normal areas of parathyroid lesions on the SPECT/CT fusion images,and the radioactive counts of these different sites were recorded,and target-to-nontarget ratio(T/NT)and target-to-non-target ratio(TBR)were calculated.The mean values of maximum CT density(CT_(max)),minimum CT density(CTmin)and mean CT density(CT_(avg))were collected at three consecutive layers.The data of each group were compared between groups,the working curve of subjects was drawn,and the diagnostic efficacy of each data was evaluated.Results On ^(99m)Tc-MIBI SPECT/CT images,the T/NT,TBR,volume,and diameter of the lesions in the missed group were smaller than those in the correctly diagnosed group,and the difference in T/NT between the two groups was statistically significant(P=0.002)and the diagnostic efficiency was the best,while there was no significant difference in TBR,volume,and diameter between the two groups(P>0.05).There was no significant difference in blood Ca and blood P between the parathyroid lesion group and the thyroid lesion group(P>0.05).The parathyroid hormone,TBR,CT_(max),CTmin and CT_(avg) in the thyroid lesion group were all lower than those in the parathyroid lesion group(P<0.05).The diagnostic efficiency of CT_(max) was the best,with AUC of 0.623,sensitivity of 74.10%and specificity of 62.50%.Conclusion SPECT/CT has better diagnostic efficacy than TBR in preoperative localization of PHPT,which can provide more valuable reference for preoperative localization of PHPT.It has good clinical value to treat TBR and CT_(max) with thyroid lesions.