～（131）I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症的临床价值
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摘要
[目的]：
评价~(131)I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症的临床价值，提高临床对~(131)I-MIBG肾上腺髓质显像诊断价值的认识。
[方法]：
以1997-2002年在我院接受~(131)I-MIBG肾上腺髓质显像检查的59例临床疑诊儿茶酚胺增多症患者作为研究对象。59例研究对象被分成两组：儿茶酚胺增多症组(24例)和非儿茶酚胺增多症组(35例)。24例儿茶酚胺增多症患者均由术后病理诊断证实；35例非儿茶酚胺增多症患者中，10例由术后病理诊断证实，25例由临床随访10个月以上证实。在59例研究对象中，接受X线计算机断层(CT)检查38例，超声(USG)检查38例，核磁共振(MRI)检查10例。对所有研究对象的四种影像学检查诊断结果进行回顾性比较分析，评价~(131)I-MIBG显像的诊断效能。
[结果]：
1．~(131)I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症的灵敏度为95.8％，特异性为82.9％，准确率为88.1％；诊断PHEO和AMH的灵敏度分别为100％，92.3％。
2．USG、CT、MRI诊断儿茶酚胺增多症的灵敏度分别为72.7％，80.0％，80.0％，特异性为87.5％，77.8％，60.0％，准确率为78.9％，78.9％，70．0％；
’”’I－MIBG肾上腺髓质显 断儿莎酚肢增多症的临床价值
诊断 PHEO的灵敏度分别为 SO刀％，71．4％，SO．O％；诊断 AMH的灵敏度分别
为 81．8％，83．3％，SO刀％。
3．‘nI－MIBG显脚 CT、MRI、USG之间诊断）底酚胺增多症的灵敏度、
特异性和准确率均无明显统计学差别仔＞O刀5入诊断AM H的胸度也无明显统
计学差别（P＞O刀5＊‘”1－＊18G和＊T、＊m之间诊断PH＊O的胸度也无明
显统计学差别（P＞O．05人’”‘I－MIBG和 USG之间诊断 PHEO的灵敏度有明显
统计学差别（P＜0＊5）。
4．＊’I－MIBG显像鞭）搽酚胺增多症（朗 PHEO＋AMH）的正确率为
23／24（95．8O）；CT为 10／ZO（SO．Oo）；USG为7／22（31．8o）；MRI为
O／6（O％）。
l结论］：
‘刀I－MIBG肾上腺魄腿像和MRI、CT、USG一样，都是诊断J搽酚胺增
多症有价值的影像学方法，但其定性诊断价值高于CT、MRI、USG。
To evaluate clinical value of 131I-MIBG adrenomedullary scintigraphy in diagnosing catecholaminemia. [Methods]
For 59 patients with clinical findings suggestive of catecholaminemia, the results of imaging procedures, i.e. 131I meta-iodobenzylguanidine (MIBG) scintigraphy, computed tomography(CT), magnetic resonance imaging(MRI) and ultrasonography(USG) were reviewed. We laied stress on 131I MIBG scintigraphy . The final diagnosis of 24 patients with catecholaminemia were confirmed by operation and pathologic examination ; 10 of 35 cases without catecholaminemia were confirmed by operation , the other 25 cases without catecholaminemia were confirmed by clinical diagnosis. This is a retrospective comparison study. [Results]
1. The diagnostic sensitivity, specificity and accuracy for catecholaminemia of 131I-MIBG scintigraphy was 95.8 %, 82.9%, 88.1%,
respectively , sensitivity for pheochromocytoma (PHEO) was 100 %, sensitivity for adrenal medullary hyperplasia (AMH) was 92.3%.
2. The diagnostic sensitivity, specificity and accuracy for catecholaminemia of CT was 80.0%, 77.8%, 78.9% , respectively; USG was 72.7%, 87.5%, 78.9% , respectively; MRI was 80.0%, 60.0%, 70.0% , respectively. The diagnostic sensitivity for PHEO of CT was 71.4%, USG was 50.0%, MRI was 50.0%. The diagnostic sensitivity for AMH of CT was 83.3%, USG was 81.8%, MRI was 50.0%.
3. Between 131I-MIBG scintigraphy and CT, MRI, USG, there was no obvious statistical difference (P>0.05) in sensitivity, specificity and accuracy for diagnosing catecholaminemia and AMH. Between 131I-MIBG scintigraphy and CT, MRI , there was no obvious statistical difference
(P>0.05) in sensitivity for diagnosing PHEO. Between 131I-MIBG scintigraphy and USG, there was obvious statistical difference (P<0.05) in sensitivity for diagnosing AMH.
4. The rate of characteristic diagnosis for catecholaminemia correctly of 131I-MIBG scintigraphy, CT, MRI and USG was 23/24 (95.8%), 10/20 (50.0%) ,7/22 (31.8%) ,0/6 (0%).
[Conclusion]
131I-MIBG scintigraphy is the same valuable in diagnosing catecholaminemia as CT, MRI and USG , but 131I-MIBG is super than CT, MRI and USG in characteristic diagnosis for catecholaminemia.
评价~(131)I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症的临床价值，提高临床对~(131)I-MIBG肾上腺髓质显像诊断价值的认识。
[方法]：
以1997-2002年在我院接受~(131)I-MIBG肾上腺髓质显像检查的59例临床疑诊儿茶酚胺增多症患者作为研究对象。59例研究对象被分成两组：儿茶酚胺增多症组(24例)和非儿茶酚胺增多症组(35例)。24例儿茶酚胺增多症患者均由术后病理诊断证实；35例非儿茶酚胺增多症患者中，10例由术后病理诊断证实，25例由临床随访10个月以上证实。在59例研究对象中，接受X线计算机断层(CT)检查38例，超声(USG)检查38例，核磁共振(MRI)检查10例。对所有研究对象的四种影像学检查诊断结果进行回顾性比较分析，评价~(131)I-MIBG显像的诊断效能。
[结果]：
1．~(131)I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症的灵敏度为95.8％，特异性为82.9％，准确率为88.1％；诊断PHEO和AMH的灵敏度分别为100％，92.3％。
2．USG、CT、MRI诊断儿茶酚胺增多症的灵敏度分别为72.7％，80.0％，80.0％，特异性为87.5％，77.8％，60.0％，准确率为78.9％，78.9％，70．0％；
’”’I－MIBG肾上腺髓质显 断儿莎酚肢增多症的临床价值
诊断 PHEO的灵敏度分别为 SO刀％，71．4％，SO．O％；诊断 AMH的灵敏度分别
为 81．8％，83．3％，SO刀％。
3．‘nI－MIBG显脚 CT、MRI、USG之间诊断）底酚胺增多症的灵敏度、
特异性和准确率均无明显统计学差别仔＞O刀5入诊断AM H的胸度也无明显统
计学差别（P＞O刀5＊‘”1－＊18G和＊T、＊m之间诊断PH＊O的胸度也无明
显统计学差别（P＞O．05人’”‘I－MIBG和 USG之间诊断 PHEO的灵敏度有明显
统计学差别（P＜0＊5）。
4．＊’I－MIBG显像鞭）搽酚胺增多症（朗 PHEO＋AMH）的正确率为
23／24（95．8O）；CT为 10／ZO（SO．Oo）；USG为7／22（31．8o）；MRI为
O／6（O％）。
l结论］：
‘刀I－MIBG肾上腺魄腿像和MRI、CT、USG一样，都是诊断J搽酚胺增
多症有价值的影像学方法，但其定性诊断价值高于CT、MRI、USG。
To evaluate clinical value of 131I-MIBG adrenomedullary scintigraphy in diagnosing catecholaminemia. [Methods]
For 59 patients with clinical findings suggestive of catecholaminemia, the results of imaging procedures, i.e. 131I meta-iodobenzylguanidine (MIBG) scintigraphy, computed tomography(CT), magnetic resonance imaging(MRI) and ultrasonography(USG) were reviewed. We laied stress on 131I MIBG scintigraphy . The final diagnosis of 24 patients with catecholaminemia were confirmed by operation and pathologic examination ; 10 of 35 cases without catecholaminemia were confirmed by operation , the other 25 cases without catecholaminemia were confirmed by clinical diagnosis. This is a retrospective comparison study. [Results]
1. The diagnostic sensitivity, specificity and accuracy for catecholaminemia of 131I-MIBG scintigraphy was 95.8 %, 82.9%, 88.1%,
respectively , sensitivity for pheochromocytoma (PHEO) was 100 %, sensitivity for adrenal medullary hyperplasia (AMH) was 92.3%.
2. The diagnostic sensitivity, specificity and accuracy for catecholaminemia of CT was 80.0%, 77.8%, 78.9% , respectively; USG was 72.7%, 87.5%, 78.9% , respectively; MRI was 80.0%, 60.0%, 70.0% , respectively. The diagnostic sensitivity for PHEO of CT was 71.4%, USG was 50.0%, MRI was 50.0%. The diagnostic sensitivity for AMH of CT was 83.3%, USG was 81.8%, MRI was 50.0%.
3. Between 131I-MIBG scintigraphy and CT, MRI, USG, there was no obvious statistical difference (P>0.05) in sensitivity, specificity and accuracy for diagnosing catecholaminemia and AMH. Between 131I-MIBG scintigraphy and CT, MRI , there was no obvious statistical difference
(P>0.05) in sensitivity for diagnosing PHEO. Between 131I-MIBG scintigraphy and USG, there was obvious statistical difference (P<0.05) in sensitivity for diagnosing AMH.
4. The rate of characteristic diagnosis for catecholaminemia correctly of 131I-MIBG scintigraphy, CT, MRI and USG was 23/24 (95.8%), 10/20 (50.0%) ,7/22 (31.8%) ,0/6 (0%).
[Conclusion]
131I-MIBG scintigraphy is the same valuable in diagnosing catecholaminemia as CT, MRI and USG , but 131I-MIBG is super than CT, MRI and USG in characteristic diagnosis for catecholaminemia.
引文
1．吴阶平．肾上腺髓质增生．中华医学杂志[J]，1977，57：331-333．
2. Witteles RM, et al. Sensitivity of diagnostic and localization tests for pheochromocytoma in clinical practice .Arch Intern Med [J],2000; 160(16):2521-2524.
3. Salvador J, et al. Clonal patterns in phaeochromocytomas and MEN-2A adrenal medullary hyperplasias:histological and kinetic correlates. J of pathology[J], 2000;192:221-228.
4．胡卫列．肾上腺髓质增生症的诊断与治疗(附8例报告)．第一军医大学学报[J]，2002，22(9)：849-850．
5. William W, et al. State-of-the-art adrenal imaging. Radiographics[J], 2001;21:995-1012.
6. Moreira SG, et al. Evaluation and management of adrenal masses. Cancer control[J], 2002;9(4):326-334.
7. Werbel SS, et al. Pheochromocytoma:update on diagnosis, localization, and management. Medical Clinics of North America[J], 1995:79(1):131-153.
8. Lenders JW, et al. New advances in the biochemical diagnosis of pheochromocytoma:moving beyond catecholamines. Annals of the New York academy of sciences[J], 2002;970:29-40.
9. Smythe GA, et al. Biochemical diagnosis of pheochromocytoma by simultaneous measurement of urinary excretion of epinephrine and norepinephrine. Clin Chem[J], 1992;38:486.
10. Candito M, et al. Biochemical diagnosis of pheochromocytoma and neuroblastomas. Ann Bio Clin[J] ,2002;60(1):15-36.
11. Glazer G, et al. Imagine of the adrenal glands. Invest Radiol[J], 1988;23:3-11.
12. Francis IR, et al. Pheochromocytoma. Radiol Clin North Am[J], 1996;34:1101.
13. Lockhart ME, et al. Imaging of adrnnal masses. Eur J Radiol [J],2002;41(2):95-112.
14. Gooding GAW, et al. Adrenal,pancreatic,and scrotal ultrasound in endocrine disease. Radiol Clin North Am [J], 1993;31:1069-1083.
15. Neumann K, et al. Imaging methods in diagnosis of pheochromocytoma. Zentraibl Chir[J], 1997; 122(6):438-42.
16. Roelants .V, et al. Iodine-131-MIBG Scintigraphy in Adults:Interpretation Revisited? .The Journal of Nuclear Medicine[J], 1998;39(6):120-113.
17. Siperstein AE, et al. Lapparoscopic posterior adrenalectomy:technical comsiderations. Arch Surg[J], 2000; 135:967-971.
18. Witteles RM, et al. 131I-MIBG scintigraphy for diagnosis and follow-up of pheochromocytoma. J Nucl Med [J],1985;42:993-997.
19. Shapiro B. Imaging of catecholamine-secreting tumours:uses of MIBG in diagnosis and treatment. Baillieres Clin Endocrinol Metab[J], 1993;7(2):491-507.
20. Babington C.K. Sporadic bilateral adrenal medullary hyperplasia:apparent false positive MIBG scan and expected MRI findings. European Journal of Radiology [J], 2000;36:28-31.
21. Farahati J, et al. Nuclear medicine diagnosis of pheochromocytoma. Zentralblatt fur chirurgie[J], 1997; 122(6):443-446.
22. Patel AD, et al. MIBG Imaging. J Nucl Cardiol[J], 2002;9(1):75-94.
23. McEwan AJ, Shapiro B Chromogranin A, et al. 131I-MIBG scintigraphy for diagnosis and follow-up of pheochromocytoma. J Nucl Med [J],1985;42:993-997.
24. Norman W. Thompson ,et al. Extra-adrenal and metastatic pheochromocytoma :the role of
131I-MIBG in localization and management. World J.Surg[J], 1984;8:605-611.
25. Thompson .NW, et al. Limating of 131I-MIBG scintigraphy in locating pheochromocytomas. Surgery[J], 1985;4:235-239
26. Bormanji J, et al. Quantitation iokine-123 MIBGuptake by normal adrenal medulla in hypertensive patients. J Nucl Med [J], 1987;28:319-324.
27. Lamberts SWJ, et al. Somatostatin-receptor imaging in the localization of endocrine tumors. N Engl J Med[J], 1990;323:1246-1249.
28. Krenning EP, et al. Somatostatin receptor scintigraphy. In:Freeman LM,ed. Nuclear Medicine Annual[J], 1995;1:11-50.
29. Simone Maurea, et al. Imaging of adrenal tumors using FDG PET:comparison of benign and malignant lesions. AJR[J], 1999;173:25-29.
30．缪思满等．131I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症．中华泌尿外科杂志[J]，2001,22(11)：654-656．
31．马寄晓．131I-MIBG肾上腺髓质显像的临床评价．中华泌尿外科杂志[J]，1988,9(1)：3-6
32．李少林主编．核医学．第5版．北京：人民卫生出版社，2002．132．
33．杨东益．肾上腺髓质增生和嗜铬细胞瘤的CT诊断．临床放射学杂志[J]，1995,14(5)：285-287．
34．吴阶平主编．泌尿外科．第1版．北京：人民卫生出版社，1993．1002-1010
35．孙则禹，肾上腺髓质增生与肾上腺嗜铬细胞瘤．中华外科杂志[J]，1992，30：228．
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46. Thompson NW, et al. Extra-adrenal and metastatic pheochromocytoma:the role of 131I-MIBG in localization and management. World J. Surg[J], 1984;8:605-611
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51．谢志淳．131I-MIBG诊断嗜铬细胞瘤．福建医科大学学报[J]，1997,4：211-213．
52. Chatal JF, et al. Can we agree on the best image procedure for the localisation of pheochromocytoma. J Nucl Med[J],1993;34:180-181.
53．孙浩然．嗜铬细胞瘤的MRI诊断．临床放射学杂志[J]，2000,19(3)：155-158．
54. Lenz T, et al. Diagnosis of pheochromocytoma. Clinical laboratory [J],2002;48(1-2):5-18.
55. Warren MJ, et al. 131I-MIBG for the localization of suspected pheochromocytoma. Nucl Med Commun[J], 1989;10(7):467-475.
56. Gross JF, et al. Scintigraphic evaluation of clinically silent adrenal masses. J Nucl Med [J], 1994;35(7):1145-1152.
57. Dwamena BA, et al. Diagnostic evaluation of the adrenal incidentaloma:decision and cost-effectiveness analyses. J Nucl Med[J] ,1998;39(4):707-712.
2. Witteles RM, et al. Sensitivity of diagnostic and localization tests for pheochromocytoma in clinical practice .Arch Intern Med [J],2000; 160(16):2521-2524.
3. Salvador J, et al. Clonal patterns in phaeochromocytomas and MEN-2A adrenal medullary hyperplasias:histological and kinetic correlates. J of pathology[J], 2000;192:221-228.
4．胡卫列．肾上腺髓质增生症的诊断与治疗(附8例报告)．第一军医大学学报[J]，2002，22(9)：849-850．
5. William W, et al. State-of-the-art adrenal imaging. Radiographics[J], 2001;21:995-1012.
6. Moreira SG, et al. Evaluation and management of adrenal masses. Cancer control[J], 2002;9(4):326-334.
7. Werbel SS, et al. Pheochromocytoma:update on diagnosis, localization, and management. Medical Clinics of North America[J], 1995:79(1):131-153.
8. Lenders JW, et al. New advances in the biochemical diagnosis of pheochromocytoma:moving beyond catecholamines. Annals of the New York academy of sciences[J], 2002;970:29-40.
9. Smythe GA, et al. Biochemical diagnosis of pheochromocytoma by simultaneous measurement of urinary excretion of epinephrine and norepinephrine. Clin Chem[J], 1992;38:486.
10. Candito M, et al. Biochemical diagnosis of pheochromocytoma and neuroblastomas. Ann Bio Clin[J] ,2002;60(1):15-36.
11. Glazer G, et al. Imagine of the adrenal glands. Invest Radiol[J], 1988;23:3-11.
12. Francis IR, et al. Pheochromocytoma. Radiol Clin North Am[J], 1996;34:1101.
13. Lockhart ME, et al. Imaging of adrnnal masses. Eur J Radiol [J],2002;41(2):95-112.
14. Gooding GAW, et al. Adrenal,pancreatic,and scrotal ultrasound in endocrine disease. Radiol Clin North Am [J], 1993;31:1069-1083.
15. Neumann K, et al. Imaging methods in diagnosis of pheochromocytoma. Zentraibl Chir[J], 1997; 122(6):438-42.
16. Roelants .V, et al. Iodine-131-MIBG Scintigraphy in Adults:Interpretation Revisited? .The Journal of Nuclear Medicine[J], 1998;39(6):120-113.
17. Siperstein AE, et al. Lapparoscopic posterior adrenalectomy:technical comsiderations. Arch Surg[J], 2000; 135:967-971.
18. Witteles RM, et al. 131I-MIBG scintigraphy for diagnosis and follow-up of pheochromocytoma. J Nucl Med [J],1985;42:993-997.
19. Shapiro B. Imaging of catecholamine-secreting tumours:uses of MIBG in diagnosis and treatment. Baillieres Clin Endocrinol Metab[J], 1993;7(2):491-507.
20. Babington C.K. Sporadic bilateral adrenal medullary hyperplasia:apparent false positive MIBG scan and expected MRI findings. European Journal of Radiology [J], 2000;36:28-31.
21. Farahati J, et al. Nuclear medicine diagnosis of pheochromocytoma. Zentralblatt fur chirurgie[J], 1997; 122(6):443-446.
22. Patel AD, et al. MIBG Imaging. J Nucl Cardiol[J], 2002;9(1):75-94.
23. McEwan AJ, Shapiro B Chromogranin A, et al. 131I-MIBG scintigraphy for diagnosis and follow-up of pheochromocytoma. J Nucl Med [J],1985;42:993-997.
24. Norman W. Thompson ,et al. Extra-adrenal and metastatic pheochromocytoma :the role of
131I-MIBG in localization and management. World J.Surg[J], 1984;8:605-611.
25. Thompson .NW, et al. Limating of 131I-MIBG scintigraphy in locating pheochromocytomas. Surgery[J], 1985;4:235-239
26. Bormanji J, et al. Quantitation iokine-123 MIBGuptake by normal adrenal medulla in hypertensive patients. J Nucl Med [J], 1987;28:319-324.
27. Lamberts SWJ, et al. Somatostatin-receptor imaging in the localization of endocrine tumors. N Engl J Med[J], 1990;323:1246-1249.
28. Krenning EP, et al. Somatostatin receptor scintigraphy. In:Freeman LM,ed. Nuclear Medicine Annual[J], 1995;1:11-50.
29. Simone Maurea, et al. Imaging of adrenal tumors using FDG PET:comparison of benign and malignant lesions. AJR[J], 1999;173:25-29.
30．缪思满等．131I-MIBG肾上腺髓质显像诊断儿茶酚胺增多症．中华泌尿外科杂志[J]，2001,22(11)：654-656．
31．马寄晓．131I-MIBG肾上腺髓质显像的临床评价．中华泌尿外科杂志[J]，1988,9(1)：3-6
32．李少林主编．核医学．第5版．北京：人民卫生出版社，2002．132．
33．杨东益．肾上腺髓质增生和嗜铬细胞瘤的CT诊断．临床放射学杂志[J]，1995,14(5)：285-287．
34．吴阶平主编．泌尿外科．第1版．北京：人民卫生出版社，1993．1002-1010
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