原发性甲状旁腺功能亢进症患者甲状旁腺显像和骨显像

Parathyroid and bone imaging in primary hyperparathyroidism

目的 探讨原发性甲状旁腺功能亢进症 (PHPT)患者行甲状旁腺显像和骨显像的价值。方法 5 9例患者中病理检查证实甲状旁腺腺瘤 4 9例 ,增生 8例 ,腺癌 2例。静脉注射 74 0～ 92 5MBq99Tcm 甲氧基异丁基异腈 (MIBI)后 15min行早期相 (EPI)甲状旁腺显像 ,2～ 3h行延迟相 (DPI)显像。然后在同一体位静脉注射 74～ 111MBq99TcmO-4后 10min行甲状腺显像 ,从DPI图中减去甲状腺图得到相减图。结果 4 9例腺瘤型PHPT中 ,4 5例甲状旁腺显像阳性 ;8例增生型显像均阴性 ;2例腺癌显像阳性。99Tcm 亚甲基二膦酸盐 (MDP)骨显像示 4 9例腺瘤型PHPT中 35例正常 ,病程 1～ 6个月 ,10例为超级 (superscan)显像 ,病程 4～ 12个月 ;2例病程 10～ 2 4个月的腺癌骨显像呈多发性放射性浓聚灶 ,为棕色瘤 ;8例增生型PHPT骨显像正常。甲状旁腺显像对PHPT诊断准确率为 79 7% (47/ 5 9例 ) ,其中腺瘤型PHPT为 91 8% (45 / 4 9例 )。PHPT99Tcm MDP骨显像可分为正常、超级显像和棕色瘤 3种。骨显像结果与骨累及程度、病程长短和病理类型相关。结论 甲状旁腺显像与骨显像联合有助于反映PHPT的病情程度和病程长短。

Objective To investigate the clinical value of parathyroid and bone imaging in the diagnosis of primary hyperparathyroidism (PHPT). Methods Among the 59 cases,23 were male and 36 female and the age ranged from 17 to 74 (average 45.1) years;49 were with pathologically proven parathyroid adenoma,8 hyperplasia and 2 adenocarcinoma. Parathyroid imaging was performed both at 15 min (early phase imaging,EPI) and 2～3 h (delayed phase imaging,DPI) after injection of 740～925 MBq 99 Tc m-methoxyisobutylisonitrile (MIBI),and followed by thyroid imaging 10 min after intravenous injection of 74～111 MBq of 99 Tc mO -_4;and the MIBI- 99 Tc mO -_4 substraction imaging was obtained by substracting thyroid imaging from DPI. Results In 49 cases of parathyroid adenoma,45 yielded positive imaging. Eight cases of hyperplasia gave negative results. The results were positive in the 2 cases of parathyroid adenocarcinoma. Results of 99 Tc m-methylene diphosphonic acid (MDP) imaging were normal in 35 cases of parathyroid adenoma with the clinical course of 1～6 months. The imaging was superscan type in 10 cases with 4～12 months of clinical course. The clinical course was 10～24 months in 2 cases of parathyroid adenocarcinoma,and brown tumor was seen on bone imaging. In 8 cases with hyperplasia of parathyroids the images were normal. In PHPT cases both the bone and kidney were involved,the diagnostic accuracy of parathyroid imaging was 79.7%,and 91.8% for parathyroid adenoma. This was of no value in the diagnosis for hyperplasia. The findings of bone imaging with 99 Tc m-MDP for imaging of PHPT were of three types (normal,superscan,and brown tumor). The results of bone imaging were relevant to the degree of bone damage,the length of clinical course and the pathological classification. Conclusion The combination of parathyroid and bone imaging may reflect the stage and progress of PHPT.