血液透析继发甲状旁腺功能亢进患者甲状旁腺病变的MRI特征
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摘要
目的探讨维持性血液透析(MHD)继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺病变的MRI特征。资料与方法回顾性分析有MHD病史且符合SHPT临床诊断,行甲状旁腺全切术并经术后病理结果证实的29例患者,均于术前行MRI常规序列扫描,22例同时行分段读出成像技术(RESOLVE)扩散加权成像(DWI)序列检查。以术后病理结果作为"金标准",观察增生的甲状旁腺的MRI表现(形态、边缘、平扫信号、DWI信号特征、强化特征等),并对DWI图像质量进行评分,测量病灶最大层面的表观扩散系数值及DWI信号强度。结果 29例患者中,手术病理证实共107个增生的甲状旁腺。102个病灶形态规则,呈类圆形、类椭圆形、类三角形或结节形;5个无固定形态。平扫T2WI-Dixon图像上,52个呈均匀高信号,55个呈不均匀高信号;37个可见"大理石纹征"。T2WI-Dixon反相位图像上,81个病灶周围见低信号勾边的"界面征"。22例患者病理证实共80个病灶。76个可显示的病灶中,呈稍高信号25个,高信号46个,等信号5个。图像质量平均3.01分。DWI上测得病灶信号强度为89.56±10.65,邻近正常甲状腺DWI信号强度为35.32±20.88,差异有统计学意义(P=0.016)。测得病灶ADC值为(1.20±0.43)×10~(-3) mm~2/s,邻近正常甲状腺ADC值为(2.00±0.37)×10~(-3) mm~2/s,差异有统计学意义(P=0.000)。结论 MHD继发SHPT患者增生的甲状旁腺在MRI常规序列及DWI上有其特征性信号表现。
Purpose To evaluate MRI features of parathyroid lesions in maintenance hemodialysis(MHD) patients with secondary hyperparathyroidism(SHPT). Materials and Methods Twenty-nine patients with MHD history combined with SHPT received total parathyroidectomy and proved with postoperative pathology were retrospectively analyzed. All patients received preoperative MRI conventional sequential scanning and 22 patients received segmental readout imaging technique(RESOLVE)-diffusion weighted imaging(DWI) sequence examination and with postoperative pathology as golden standards, MRI representations including morphology, edges,plain scanning signals, DWI signals features and enhancement features, etc of hyperplastic parathyroids were observed and scored quality of DWI images. Apparent diffusion coefficient value and DWI sign amplitude of lesions with largest slice were measured. Results Among the 29 patients, 107 hyperplastic parathyroids were proved with surgical pathology. 102 lesions were with regular morphology,in quasi-circular, quasi-oval, quasi-triangle or nodules and five were with no fixed morphology. On plain scanned T2 WI-Dixon images,52 were balanced hyperintensity and 55 were imbalanced hyperintensity. 37 were visible with marble signs. On T2 WI-Dixon antiphase images, 81 lesions were seen surrounded by hypointensity contoured by interface signs. In the 22 patients, there were 80 lesions confirmed through pathology. Among the 76 displayable lesions, 25 were with slight hyperintensity, 46 hyperintensity and 5 equisignal. Average score of image quality was 3.01. Signal strength of lesions measured on DWI was 89.56±10.65 and DWI signal strength of adjacent normal thyroids were 35.32±20.88. The difference was of statistical significance(P=0.016). Measured ADC value of lesions was(1.20±0.43)×10~(-3) mm~2/s and that of adjacent normal thyroids was(2.00±0.37)×10~(-3) mm~2/s. The difference was of statistical significance(P=0.000). Conclusion Hyperplastic parathyroids in MHD secondary SHPT patients are of featured signal representation in MRI conventional sequence and DWI.
Purpose To evaluate MRI features of parathyroid lesions in maintenance hemodialysis(MHD) patients with secondary hyperparathyroidism(SHPT). Materials and Methods Twenty-nine patients with MHD history combined with SHPT received total parathyroidectomy and proved with postoperative pathology were retrospectively analyzed. All patients received preoperative MRI conventional sequential scanning and 22 patients received segmental readout imaging technique(RESOLVE)-diffusion weighted imaging(DWI) sequence examination and with postoperative pathology as golden standards, MRI representations including morphology, edges,plain scanning signals, DWI signals features and enhancement features, etc of hyperplastic parathyroids were observed and scored quality of DWI images. Apparent diffusion coefficient value and DWI sign amplitude of lesions with largest slice were measured. Results Among the 29 patients, 107 hyperplastic parathyroids were proved with surgical pathology. 102 lesions were with regular morphology,in quasi-circular, quasi-oval, quasi-triangle or nodules and five were with no fixed morphology. On plain scanned T2 WI-Dixon images,52 were balanced hyperintensity and 55 were imbalanced hyperintensity. 37 were visible with marble signs. On T2 WI-Dixon antiphase images, 81 lesions were seen surrounded by hypointensity contoured by interface signs. In the 22 patients, there were 80 lesions confirmed through pathology. Among the 76 displayable lesions, 25 were with slight hyperintensity, 46 hyperintensity and 5 equisignal. Average score of image quality was 3.01. Signal strength of lesions measured on DWI was 89.56±10.65 and DWI signal strength of adjacent normal thyroids were 35.32±20.88. The difference was of statistical significance(P=0.016). Measured ADC value of lesions was(1.20±0.43)×10~(-3) mm~2/s and that of adjacent normal thyroids was(2.00±0.37)×10~(-3) mm~2/s. The difference was of statistical significance(P=0.000). Conclusion Hyperplastic parathyroids in MHD secondary SHPT patients are of featured signal representation in MRI conventional sequence and DWI.
引文
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[7]Zhao M,Liu Z,Sha Y,et al.Readout-segmented echo-planar imaging in the evaluation of sinonasal lesions:a comprehensive comparison of image quality in single-shot echo-planar imaging.Magn Reson Imaging,2016,34(2):166-172.
[8]胡畅,王迁,唐锋,等.MR对甲状旁腺机能亢进症的诊断价值.中华放射学杂志,2013,47(6):561-563.
[9]Sacconi B,ArgiròR,Diacinti D,et al.MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism:what radiologists need to know for preoperative localization.Eur Radiol,2016,26(3):664-673.
[10]杨正汉,冯逢,王霄英.磁共振成像技术指南.第2版.北京:人民军医出版社,2010:197.
[11]Kim S,Loevner L,Quon H,et al.Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck.Clin Cancer Res,2009,15(3):986-994.
[2]Vestergaard P,Thomsen S.Medical treatment of primary,secondary,and tertiary hyperparathyroidism.Curr Drug Saf,2011,6(2):108-123.
[3]Cunningham J,Locatelli F,Rodriguez M.Secondary hyperparathyroidism:pathogenesis,disease progression,and therapeutic options.Clin J Am Soc Nephrol,2011,6(4):913-921.
[4]Langdahl BL,Ralston SH.Diagnosis and management of primary hyperparathyroidism in Europe.QJM,2012,105(6):519-525.
[5]Li P,Liu Q,Tang D,et al.Lesion based diagnostic performance of dual phase 99m Tc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism.BMC Med Imaging,2017,17(1):60.
[6]汪太松,赵晋华,邢岩.99Tcm-MIBI SPECT/CT双时相显像对原发性甲状旁腺功能亢进症的诊断价值.中国医学影像学杂志,2012,20(11):855-857.
[7]Zhao M,Liu Z,Sha Y,et al.Readout-segmented echo-planar imaging in the evaluation of sinonasal lesions:a comprehensive comparison of image quality in single-shot echo-planar imaging.Magn Reson Imaging,2016,34(2):166-172.
[8]胡畅,王迁,唐锋,等.MR对甲状旁腺机能亢进症的诊断价值.中华放射学杂志,2013,47(6):561-563.
[9]Sacconi B,ArgiròR,Diacinti D,et al.MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism:what radiologists need to know for preoperative localization.Eur Radiol,2016,26(3):664-673.
[10]杨正汉,冯逢,王霄英.磁共振成像技术指南.第2版.北京:人民军医出版社,2010:197.
[11]Kim S,Loevner L,Quon H,et al.Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck.Clin Cancer Res,2009,15(3):986-994.