针孔准直器在甲状旁腺显像诊断中的增益价值

The gain value of pinhole collimator in parathyroid imaging

目的探讨针孔准直器平面显像在甲状旁腺显像诊断中的增益价值。方法回顾性分析2017年2月-2020年7月临床诊断为甲状旁腺功能亢进症(hyperparathyroidism,HPT)且均行手术治疗的患者55例。所有患者均行99m锝-甲氧基异丁基异腈(99m Tc-sestamibi,99m Tc-MIBI)双时相平面显像(针孔准直器、平行孔准直器)联合延迟相单光子发射计算机断层显像/计算机断层显像(single photon emission computed tomography/computed tomography,SPECT/CT)。以手术病理结果为“金标准”,采用SPSS 26.0统计软件分别计算平行孔平面显像(A组)、SPECT/CT(B组)、平行孔+SPECT/CT(C组)、针孔平面显像(D组)、针孔+平行孔+SPECT/CT(E组)5组检查方法检出甲状旁腺病灶的灵敏度、特异度及准确率,采用χ2检验比较各组的诊断效能。结果55例HPT患者术后病理共发现甲状旁腺病灶79个,其中40例为单发病灶,15例为多发病灶。79个甲状旁腺病灶包含腺瘤29个、腺瘤样增生15个、增生35个;其中2个为异位病灶(1个胸骨后腺瘤,1个胸骨后增生)。有11例患者合并甲状腺病灶11个,伴甲状腺乳头状癌4个,甲状腺腺瘤2个,甲状腺腺瘤样增生1个,结节性甲状腺肿4个。C组共发现阳性病灶53个,加用针孔平面显像后额外发现阳性病灶14个。E组的灵敏度及准确率均明显高于A组(χ2=64.168,P<0.001;χ2=45.182,P<0.001)、B组(χ2=50.452,P<0.001;χ2=36.847,P<0.001)和C组(χ2=43.636,P<0.001;χ2=20.502,P<0.001);E组与D组的灵敏度及准确率差异均无统计学意义(P>0.05);5组的特异度差异均无统计学意义(P>0.05)。结论加用针孔准直器平面显像能提高甲状旁腺显像诊断的灵敏度及准确率。

Objective To explore the gain value of pinhole collimator planar imaging in the diagnosis of parathyroid imaging.Methods Retrospective analysis was performed on 55 patients with clinically diagnosed hyperparathyroidism(HPT)who underwent surgical treatment from July 2017 to July 2019.All patients underwent 99m Tc-sestamibi(99m Tc-MIBI)dual phase planar imaging(pinhole collimator,parallel hole collimator)combined with delayed phase single photon emission computed tomography/computed tomography(SPECT/CT)imaging.With surgical pathological results as the“gold standard”,the sensitivity,specificity and accuracy of detecting parathyroid lesions in parallel hole plane imaging(group A),SPECT/CT(group B),parallel hole+SPECT/CT(group C),pinhole plane imaging(group D),and pinhole+parallel hole+SPECT/CT(group E)were calculated by SPSS 26.0 statistical software.The diagnostic efficacy of each group was compared by χ^(2) test.Results A total of 79 parathyroid lesions were found in 55 hyperparathyroidism patients,of which 40 were single lesions and 15 were multiple lesions.The 79 parathyroid lesions included 29 adenomas,15 adenomatous hyperplasia,and 35 hyperplasia;two of these lesions were ectopic(1 retrosternal adenoma and 1 retrosternal hyperplasia);the 11 patients had 11 thyroid lesions,4 papillary thyroid carcinoma,2 thyroid adenomas,1 thyroid adenomatous hyperplasia,and 4 nodular goiter.A total of 53 positive lesions were found in parallel hole C group,and 14 additional positive lesions were found after pinhole plane imaging.The sensitivity and accuracy of group E were significantly higher than those of group A(χ^(2)=64.168,P<0.001;χ^(2)=45.182,P<0.001),group B(χ2=50.452,P<0.001;χ2=36.847,P<0.001),and group C(χ^(2)=43.636,P<0.001;χ^(2)=20.502,P<0.001);there was no statistical difference in sensitivity and accuracy between group E and group D(P>0.05);there was no statistical difference in specificity between the 5 groups(P>0.05).Conclusion The pinhole collimator planar imaging could improve the sensitivity and accuracy of parathyroid imaging.