~(99)Tc~m-MIBI SPECT/CT显像在原发性甲状旁腺功能亢进症诊断中的价值讨论
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摘要
目的探讨~(99)Tc~m-MIBI SPECT/CT显像在原发性甲状旁腺功能亢进症(PHPT)中的诊断价值。方法回顾性分析为诊断PHPT而行~(99)Tc~m-MIBI SPECT/CT显像检查的57例患者的临床资料,以术后病理诊断为金标准,与高频超声、CT结果对比,分别统计三种检查方法的灵敏度、特异度、诊断符合率,将三种检查方法的灵敏度、特异度、诊断符合率加以对比分析。结果 57例病人经手术及病理检查共确诊76个PHPT病灶。~(99)Tc~m-MIBI SPECT/CT显像、高频超声、CT敏感度分别为75%、69.73%、50.94%;特异度分别为93.75%、96.07%、95.08%;诊断符合率分别为83.57%、80.31%、74.56%。~(99)Tc~m-MIBI SPECT/CT显像敏感度、诊断符合率高于CT(P<0.05),~(99)Tc~m-MIBI SPECT/CT显像对异位PHPT病灶诊断的敏感度为100%。结论 ~(99)Tc~m-MIBI SPECT/CT显像在PHPT病灶的定位中有较高的价值,是术前定位的较好方法。
Objective To evaluate the clinical value of ~(99)Tc~m-MIBI SPECT/CT in diagnosis of primary hyperparathyroidism(PHPT).Methods Clinical data of 57 patients who underwent ~(99)Tc~m-MIBI SPECT/CT for the diagnosis of PHPT were retrospectively analyzed, postoperative pathological diagnosis was taken as the gold standard, and the results were compared with high frequency ultrasound and CT, in the respects of sensitivity, specificity and diagnostic coincidence rate.Results A total of 76 PHPT lesions were diagnosed by operation and pathology in 57 patients. The sensitivities of ~(99)Tc~m-MIBI SPECT/CT, high frequency ultrasound and CT were 75%, 69.73% and 50.94%.The specificities were 93.75%, 96.07% and 95.08%.The diagnostic coincidence rates were 83.57%, 80.31% and 74.56%. The sensitivity and diagnostic coincidence rate of ~(99)Tc~m-MIBI SPECT/CT were higher than CT(P<0.05),and the sensitivity of~(99)Tc~m-MIBI SPECT/CT to the diagnosis of ectopic PHPT lesion was 100%.Conclusion ~(99)Tc~m-MIBI SPECT/CT has a high value in the localization of PHPT lesions and is a good method for preoperative localization.
Objective To evaluate the clinical value of ~(99)Tc~m-MIBI SPECT/CT in diagnosis of primary hyperparathyroidism(PHPT).Methods Clinical data of 57 patients who underwent ~(99)Tc~m-MIBI SPECT/CT for the diagnosis of PHPT were retrospectively analyzed, postoperative pathological diagnosis was taken as the gold standard, and the results were compared with high frequency ultrasound and CT, in the respects of sensitivity, specificity and diagnostic coincidence rate.Results A total of 76 PHPT lesions were diagnosed by operation and pathology in 57 patients. The sensitivities of ~(99)Tc~m-MIBI SPECT/CT, high frequency ultrasound and CT were 75%, 69.73% and 50.94%.The specificities were 93.75%, 96.07% and 95.08%.The diagnostic coincidence rates were 83.57%, 80.31% and 74.56%. The sensitivity and diagnostic coincidence rate of ~(99)Tc~m-MIBI SPECT/CT were higher than CT(P<0.05),and the sensitivity of~(99)Tc~m-MIBI SPECT/CT to the diagnosis of ectopic PHPT lesion was 100%.Conclusion ~(99)Tc~m-MIBI SPECT/CT has a high value in the localization of PHPT lesions and is a good method for preoperative localization.
引文
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[3] 黎俊,李莉,林华.99Tcm-MIBI双时相显像与SPECT/CT融合显像对原发性甲状旁腺功能亢进症的诊断价值[J].医学影像学杂志,2017,27(6):1063-1067.
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[10] Traub-Weidinger T,Mayerhoefer M E,Koperek O,et al.11C-methionine PET/CT imaging of99Tcm-MIBI-SPECT/CT-negative patients with primary hyperparathyroidism and previous neck surgery[J].The Journal of Clinical Endocrinology & Metabolism,2014,99(11):4199-4205.
[11] 池晓华,王全师,李贵平,等.99Tcm-MIBI双时相显像在甲状旁腺素增高患者中的应用[J].中华全科医学,2017,15(2):202-205.
[12] 黄甜,洪文明,季丽华,等.误诊为甲状腺微小乳头状癌的良性小结节超声与病理结果对比分析[J].中国辐射卫生,2017,26(6):723-725,729.
[13] 陆凤华,张琍萍,张雅红.高频超声对甲状旁腺功能亢进的诊断价值[J].现代实用医学,2017,29(3):385-386.
[14] 白永利,王林,董莉.99Tcm-MIBI显像在原发性甲状旁腺功能亢进定位诊断中的应用价值[J].现代肿瘤医学,2016,24(9):1368-1371.
[15] Kim Y I,Jung Y H,Hwang K T,et al.Efficacy of 99Tcm-sestamibi SPECT/CT for minimally invasive parathyroidectomy:comparative study with 99Tcm-sestamibi scintigraphy,SPECT,US and CT[J].Ann Nucl Med,2012,26(10):804-810.
[16] 张永强,王昀璐,梁琰,等.18F-FDG SPECT/CT与64排CT异机融合在结直肠癌诊断中的应用[J].中国辐射卫生,2018,27(1):81-84.
[17] 宁玉东,王田田,薄少军,等.磁共振成像在继发性甲状旁腺功能亢进症术前定位的诊断价值[J].中国耳鼻咽喉头颈外科,2017,24(10):497-500.
[2] Yeh M W,Ituarte P H,Zhou H C,et al.Incidence and prevalence of primary hyperparathyroidism in a racially mixed population[J].The Journal of Clinical Endocrinology & Metabolism,2013,98(3):1122-1129.
[3] 黎俊,李莉,林华.99Tcm-MIBI双时相显像与SPECT/CT融合显像对原发性甲状旁腺功能亢进症的诊断价值[J].医学影像学杂志,2017,27(6):1063-1067.
[4] 朱进,柴雪红.高频彩超联合99Tcm-MIBI双时显像诊断原发性甲状旁腺功能亢进的价值[J].中国医学工程,2015,23(1):17-18.
[5] 卢峰,宋钢,李全太,等.SPECT设备性能测试及结果分析[J].中国辐射卫生,2014,23(1):26-28.
[6] 陈维安,崔颖鹏,李春亿,等.99Tcm-MIBI双时相显像诊断甲状旁腺功能亢进的临床价值[J].中国临床医学影像杂志,2006,17(3):146-147,157.
[7] Piga M,Bolasco P,Satta L,et al.Double phase parathyroid technetium-99m-MIBI scintigraphy to identify functional autonomy in secondary hyperparathyroidism[J].J Nucl Med,1996,37(4):565-569.
[8] Hetrakul N,Civelek A C,Stagg C A,et al.In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria[J].Surgery,2001,130(6):1011-1018.
[9] Turgut B,Elagoz S,Erselcan T,et al.Preoperative localization of parathyroid adenomas with technetium-99m methoxyisobutylisonitrile imaging:relationship with P-glycoprotein expression,oxyphilic cell content,and tumoral tissue volume[J].Cancer Biotherapy and Radiopharmaceuticals,2006,21(6):579-590.
[10] Traub-Weidinger T,Mayerhoefer M E,Koperek O,et al.11C-methionine PET/CT imaging of99Tcm-MIBI-SPECT/CT-negative patients with primary hyperparathyroidism and previous neck surgery[J].The Journal of Clinical Endocrinology & Metabolism,2014,99(11):4199-4205.
[11] 池晓华,王全师,李贵平,等.99Tcm-MIBI双时相显像在甲状旁腺素增高患者中的应用[J].中华全科医学,2017,15(2):202-205.
[12] 黄甜,洪文明,季丽华,等.误诊为甲状腺微小乳头状癌的良性小结节超声与病理结果对比分析[J].中国辐射卫生,2017,26(6):723-725,729.
[13] 陆凤华,张琍萍,张雅红.高频超声对甲状旁腺功能亢进的诊断价值[J].现代实用医学,2017,29(3):385-386.
[14] 白永利,王林,董莉.99Tcm-MIBI显像在原发性甲状旁腺功能亢进定位诊断中的应用价值[J].现代肿瘤医学,2016,24(9):1368-1371.
[15] Kim Y I,Jung Y H,Hwang K T,et al.Efficacy of 99Tcm-sestamibi SPECT/CT for minimally invasive parathyroidectomy:comparative study with 99Tcm-sestamibi scintigraphy,SPECT,US and CT[J].Ann Nucl Med,2012,26(10):804-810.
[16] 张永强,王昀璐,梁琰,等.18F-FDG SPECT/CT与64排CT异机融合在结直肠癌诊断中的应用[J].中国辐射卫生,2018,27(1):81-84.
[17] 宁玉东,王田田,薄少军,等.磁共振成像在继发性甲状旁腺功能亢进症术前定位的诊断价值[J].中国耳鼻咽喉头颈外科,2017,24(10):497-500.