^(99)Tc^(m)-MIBI SPECT/CT显像联合超声在5例原发性甲状旁腺功能亢进症合并甲状旁腺危象术前定位诊断中的应用

Application of^(99)Tc^(m)-MIBI SPECT/CT imaging combined with ultrasound in preoperative localization and diagnosis in 5 cases of primary hyperparathyroidism complicated with parathyroid crisis

目的:探讨^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)SPECT/CT显像联合超声(US)在原发性甲状旁腺功能亢进症(PHPT)合并甲状旁腺危象(HC)术前定位诊断中的应用价值。方法:回顾性分析2015年9月—2021年7月南通大学附属江阴医院收治的5例经手术及病理证实为PHPT合并HC患者的影像学资料,由多学科团队(MDT)分析^(99)Tc^(m)-MIBI SPECT/CT显像及US表现。结果:5例PHPT合并HC患者中,男4例,女1例,年龄52~68岁,中位年龄59岁。其中,1例为右下甲状旁腺癌(PC)术后、右颈部转移性PC二次术后复诊患者,行保守治疗;另外4例手术治疗,术中各检出1枚病灶,均为左下甲状旁腺,病理显示PC 1例,腺瘤(PA)2例,增生1例,有1例PA合并瘤内出血。^(99)Tc^(m)-MIBI SPECT/CT显像检出4例原发甲状旁腺病变、1例右颈部转移性PC及肺转移病灶,US检出4例原发甲状旁腺病变及1例右颈部转移性PC病灶,有1例PA误诊为甲状腺腺瘤,经MDT后由经验丰富的医师重新阅片后修正诊断。1例PC患者合并同侧甲状腺微小乳头状癌,该甲状腺病变术前由US检出,1例合并多发肋骨棕色瘤,由SPECT/CT检出。结论:^(99)Tc^(m)-MIBI SPECT/CT显像联合US能精确定位PHPT合并HC的病变甲状旁腺,同时检出合并的甲状腺病变及伴发病变,有助于制定精细化的治疗方案。

Objective To investigate clinical value of^(99)Tc^(m)-methoxyisobutyl isonitrile(MIBI)SPECT/CT and Ultrasonography(US)in preoperatively localization parathyroid lesion in patient with primary hyperparathyroidism(PHPT)with hyperparathyroid crisis(HC).Methods Retrospective analysis of imaging data of 5 patients with PHPT and HC confirmed by surgery and pathology admitted to Affiliated Jiangyin Hospital of Nantong University from September 2015 to July 2021.^(99)Tc^(m)-MIBI SPECT/CT and US features of PHPT with HC confirmed by histopathology were analyzed by amultiple disciplinary team(MDT).Results Totally 5 patients(4 males and 1 female,aged 52-68 years old,median age 59 years old),1 patient had right lower parathyroid carcinoma(PC)and right neck PC mass resection,received conservative treatment,4 patients accepted PTX,1 parathyroid lesion was resected for each patient during operation which were left lower parathyroid gland.Pathology showed 1 PC,2 parathyroid adenomas(PA),and 1 parathyroid hyperplasia,1 PA presented intra-adenoma hemorrhage.^(99)Tc^(m)-MIBI SPECT/CT detected 4 cases of parathyroid lesions,1 cases of metastatic PC lesion in right neck and lung metastasis,US detected 4 cases of parathyroid lesions and 1 case of metastatic PC lesion in right neck,whereas 1 PA misdiagnosed thyroid adenoma,revising diagnosis by experienced US sonographer of the MDT.1 patient with ipsilateral thyroid micropapillary carcinoma only detected by US,1 patient with multiple rid brown tumor detected by SPECT/CT.Conclusions Establishing a long-term and closely cooperative mode of MDT,combined^(99)Tc^(m)-MIBI SPECT/CT and US played an important role in preoperative localization of PHPT with HC,also attributed to concomitant thyroid lesion,coexistent lesions and formulate precise treatment.