核素显像在甲状旁腺功能亢进诊断中的价值

Clinical Value of Radionuclide Parathyroid Imaging in Hyperparathyroidism

目的 本文探讨甲状旁腺核素显像在诊断甲状旁腺功能亢进 (下称甲旁亢 )中的作用 ,并与其他影像检查方法进行比较。方法 3 2例临床考虑甲旁亢患者分别进行了99Tcm MIBI核素显像、B超检查 ,其中 13例做了CT检查 ,5例做了MRI检查。结果 3 2例患者中 ,PTH增高 12例 ,以PTH结果为诊断标准 ,核素检查阳性 13例 ,灵敏度 91.7% ,特异性90 % ,准确性 90 .6% ;B超检出 10例 ,阴性 2 0例 ,其灵敏度 83 .3 % ,特异性 10 0 % ,准确性 93 .8% ;CT阳性 11例 ,MRI阳性 3例。核素检查阳性 13例患者共摘除 15枚腺瘤和 1枚增生腺体 ,均经组织病理学诊断印证 ;核素显像阴性 19例 ,B超检查均为阴性 ,CT阴性 2例 ,MRI阴性 2例。结论 99Tcm MIBI甲状旁腺核素显像是一种简单易行的方法 ,是甲旁亢辅助诊断手段之一 ,结合其他影像学检查 ,可进一步提高甲状旁腺腺瘤术前定位诊断准确率。

Objective To compare nuclear medicine examination in hyperparathyroid with B ultrasound,CT and MRI and evaluate the clinical value of SPECT imaging in the diagnosis of hyperparathyroidism.Methods Thirty-two patients with clinical diagnosis of hyperparathyroid were studied using GE startcame 3000i at 15min as early phase imaging and 120min as delay imaging postinjection of 370MBq (10mCi) of 99 Tc m-MIBI,respectively.All patients were performed with B ultrasound examination.Among them,13 and 5 patients have undergone CT and MRI,respectively.Results High level of parathyroid homone (PTH),which was considered as diagnostic standardization for hyperparathyroidism,was showed in 12 cases among 32 patients.Radionuclide parathyroid images of 13 patients were positive,with the sensitivity,specificity and accuracy of 91.7% ,90% and 90.6%,respectively.Ultrasound examination of 10 patients showed abnormal,and the sensitivity,specificity and accuracy was of 83.3%,100% and 93.8%,respectively.Eleven CT images and 3 MR images also showed positive.Fifteen adenomas and 1 hyperplastic gland histo-pathologically proved were removed from 13 patients.Conclusion SPECT imaging with 99 Tc m-MIBI,a simple and reliable detective approach,is one of the accessory methods in the diagnosis of hyperparathyroidism.Combined with other examination,SPECT imaging can improve the accuracy in distinguishing lesions in the parathyroid before surgery.