甲状旁腺功能亢进症高频超声联合^(99m)Tc-MIBI显像与血清甲状旁腺激素相关性研究

Correlation between high frequency ultrasound combined with ^(99m)Tc-MIBI imaging and serum parathyroid hormone in hyperparathyroidism

目的:探讨甲状旁腺功能亢进患者血清甲状旁腺激素与高频超声特征及^(99m)Tc-MIBI SPECT/CT显像半定量参数T/NT的相关性,提示多种影像学联合对甲状旁腺功能亢进程度的预测价值。方法:回顾性分析70例依据手术病理或指南定性诊断为甲状旁腺功能亢进症并均行高频超声及^(99m)Tc-MIBI SPECT/CT显像检查的患者,评价甲状旁腺功能亢进患者高频超声特征、^(99m)Tc-MIBI SPECT/CT显像半定量参数T/NT与血清甲状旁腺激素的相关性,并探讨二者对甲状旁腺功能亢进程度的预测价值。结果:70例研究对象中,原发性甲状旁腺功能亢进症(PHPT)和继发性甲状旁腺功能亢进症(SHPT)患者两组间T/NT值、血流半定量评分差异无统计学意义(P均>0.05)。高频超声检出病变甲状旁腺腺体个数与血清甲状旁腺激素(PTH)的一致性较差,血清PTH与病变腺体总体积、高频超声血流半定量评分、T/NT值相关性系数分别为0.289、0.460、0.453,相关性具有统计学意义(P均<0.05);T/NT值与病变腺体总体积、高频超声血流半定量评分无相关性(P均>0.05)。以血清PTH=300 pg/mL作为判断亢进程度为重度和非重度的截断值,绘制腺体体积、血流评分及T/NT值的ROC曲线:腺体体积、血流评分、^(99m)Tc-MIBI SPECT/CT显像T/NT值曲线下面积分别为0.824、0.831、0.702,敏感度分别为92.3%、80.8%、60.1%,特异度分别为65.9%、68.2%、88.9%;三种指标联合诊断曲线下面积0.865,敏感度72.0%,特异度91.1%(P均<0.05)。结论:病变甲状旁腺体积、血流半定量评分、^(99m)Tc-MIBI SPECT/CT显像半定量参数T/NT值对血清PTH水平升高程度均有较好的预测价值,多指标联合更准确地反映了病变甲状旁腺功能亢进程度,可为治疗方式的选择提供有益补充。

Objective:To investigate the correlation between serum parathyroid hormone and high-frequency ultrasound features and ^(99m)Tc-MIBI SPECT/CT imaging semi-quantitative parameters T/NT in patients with hyperparathyroidism,suggesting the value of multiple imaging indicators combined in predicting the degree of hyperparathyroidism.Methods:A retrospective analysis was performed on 70 patients with hyperparathyroidism qualitatively diagnosed according to surgical pathology or guidelines and who underwent high-frequency ultrasound and ^(99m)Tc-MIBI SPECT/CT imaging.To evaluate the correlation of high-frequency ultrasound features,^(99m)Tc-MIBI SPECT/CT imaging semi-quantitative parameters T/NT and serum parathyroid hormone in patients with hyperparathyroidism,and to explore the predictive value of both on the degree of hyperparathyroidism.Results:Among the 70 subjects,there was no significant difference in T/NT value and semi-quantitative blood flow score between primary hyperparathyroidism(PHPT)and secondary hyperparathyroidism(SHPT)patients(P>0.05).There was poor consistency between the number of diseased parathyroid glands detected by high-frequency ultrasound and serum PTH,and the correlation coefficients between serum parathyroid hormone(PTH)and the total volume of diseased glands,the semi-quantitative score of high-frequency ultrasound blood flow,and T/NT value were 0.289,0.460 and 0.453,respectively,with statistical significance(P<0.05).There was no correlation between T/NT value and the total volume of the lesion and the semi-quantitative score of high-frequency ultrasound blood flow(P>0.05).Serum PTH=300 pg/mL was used as the cut-off value to judge the degree of hyperactivity as severe and non-severe,and ROC curves of gland volume,blood flow score and T/NT value were drawn:Gland volume,blood flow score,area under T/NT curve of 99nTc-MIBI SPECT/CT imaging were 0.824,0.831,0.702,sensitivity were 92.3%,80.8%,60.1%,specificity were 65.9%,68.2%,88.9%,respectively.The area under the combined diagnosis curve of the three indexes was 0.865,the sensitivity was 72.0%,and the specificity was 91.1%(P<0.05).Conclusion:Pathological parathyroid volume,blood flow semiquantitative score and ^(99m)Tc-MIBI SPECT/CT imaging semiquantitative parameter T/NT value have good predictive value for serum PTH level increase,and the combination of multiple indicators can more accurately reflect the degree of pathological hyperparathyroidism,which can provide a beneficial supplement for the selection of treatment.