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甲状旁腺功能亢进症(hyperparathyroidism,HPT)是由于甲状旁腺分泌甲状旁腺激素(parathyroid hormone,PTH)过多继发钙磷代谢紊乱,累及多个器官和系统的一种常见内分泌疾病。血清PTH水平明显升高是诊断HPT的主要依据,影像学定位及定性诊断一般在其基础上进行。99Tcm-MIBI双时相平面显像扫描野大,操作简单,是传统的HPT影像学检查方法[1],但单纯的核素平面显像无法进行精准的解剖定位,而SPECT/CT能够实现功能图像和解剖图像的同机融合,为鉴定病灶来源和检出小病灶提供了帮助,降低了对HPT的误诊率和漏诊率,明显提高了对甲状旁腺病灶的定位以及定性的诊断效能[2]。所以,99Tcm-MIBI SPECT/CT断层融合显像已成为目前HPT术前最主要的影像学检查手段之一。目前有关HPT病灶重量对核素显像影响的研究较少,本研究通过回顾性分析22例HPT患者的99Tcm-MIBI双时相平面显像和99Tcm-MIBI SPECT/CT早期断层融合显像资料,探讨甲状旁腺病灶重量对两种显像方法诊断灵敏度的影响。
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22例患者共切除58个病变甲状旁腺组织,以术后病理学结果作为“金标准”,共检出49个真阳性病灶,其中3个病理学诊断结果为腺瘤伴不典型增生、7个为良性腺瘤、39个为增生。3个假阳性病灶为甲状腺结节,6个真阴性病灶为正常甲状旁腺组织。另外,术中还发现,全部病理学诊断结果为阳性的患者中有4例同时伴甲状腺内病变(3例为结节性甲状腺肿、1例为结节性甲状腺肿伴囊性变)。99Tcm-MIBI双时相平面显像和99Tcm-MIBI SPECT/CT早期断层融合显像诊断结果为真阳性、假阴性、假阳性、真阴性的病灶数分别为32、16、4、6和41、9、2、6。
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切除的58个甲状旁腺病灶的重量为0.09~9.78(1.54±1.33)g。其中A组共有病灶30个,B组共有病灶28个。99Tcm-MIBI双时相平面显像对A、B两组的诊断灵敏度分别为47.83%和84.00%,差异有统计学意义(χ2=7.05,P=0.008);99Tcm-MIBI SPECT/CT早期断层融合显像对A、B两组的诊断灵敏度分别为78.26%和85.19%,差异无统计学意义(χ2=0.40,P=0.525)。99Tcm-MIBI SPECT/CT早期断层融合显像对A组的诊断灵敏度高于99Tcm-MIBI双时相平面显像,差异有统计学意义(χ2=4.57,P=0.033)。99Tcm-MIBI SPECT/CT早期断层融合显像对B组的诊断灵敏度高于99Tcm-MIBI双时相平面显像,但差异无统计学意义(χ2=0.01,P=0.906)。具体数据见表1。典型病例的99Tcm-MIBI双时相平面显像及99Tcm-MIBI SPECT/CT早期断层融合显像图像分别见图1和图2。
组别 灵敏度 特异度 准确率 显像1 A组 47.83%(11/23) 85.71%(6/7) 56.67%(17/30) B组 84.00%(21/25) − (0/3) 75.00%(21/28) 显像2 A组 78.26%(18/23) 85.71%(6/7) 80.00%(24/30) B组 85.19%(23/27) − (0/1) 82.14%(23/28) 注:表中,显像1:99Tcm-MIBI双时相平面显像;显像2:99Tcm-MIBI SPECT/CT早期断层融合显像;A组病灶重量≤1.00 g,B组病灶重量>1.00 g;−:无真阴性病灶。MIBI:甲氧基异丁基异腈;SPECT:单光子发射计算机体层摄影术;CT:计算机体层摄影术 表 1 两种显像方法在不同质量组中的灵敏度、特异度和 准确率比较
Table 1. Comparison of sensitivity, specificity and accuracy of two imaging methods in different weight groups
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对99Tcm-MIBI双时相平面显像的放射性浓聚灶浓聚情况进行统计,结果发现,A组存在早期洗脱的病灶数为9个,早期洗脱率为30.00%(9/30),B组存在早期洗脱的病灶数为2个,早期洗脱率为7.14%(2/28),两者之间的差异有统计学意义(χ2=4.92,P=0.027)。
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两种检查方法的阳性病灶横截面最大径分别为(12.83±4.18) mm和(10.38±4.51) mm,差异有统计学意义(t=2.486,P=0.018)。
甲状旁腺病灶重量对99Tcm-MIBI显像诊断灵敏度的影响
The influence of parathyroid lesion weight on diagnostic sensitivity of 99Tcm-MIBI imaging
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摘要:
目的 探讨甲状旁腺病灶重量对99Tcm-甲氧基异丁基异腈(MIBI)双时相平面显像及其 SPECT/CT早期断层融合显像诊断灵敏度的影响。 方法 收集2017年2月至2018年10月在昆山市第一人民医院经手术病理学确诊的甲状旁腺功能亢进患者22例,其中男性9例、女性13例,年龄28~73(50.77±8.79)岁。所有患者均于术前行99Tcm -MIBI双时相平面显像、99Tcm-MIBI SPECT/CT早期断层融合显像,以术后病理学结果为“金标准”。按切除的病灶重量将全部病灶分为两组,A组:病灶重量≤1.00 g,B组:病灶重量>1.00 g。采用χ2检验分析两种显像方法对不同重量组的诊断效能。 结果 22例患者中,共切除病灶58个。99Tcm-MIBI双时相平面显像对A、B两组的诊断灵敏度分别为47.83%(11/23)和84.00%(21/25),差异有统计学意义(χ2=7.05,P=0.008);99Tcm-MIBI SPECT/CT早期断层融合显像对A、B两组的诊断灵敏度分别为78.26%(18/23)和85.19%(23/27),差异无统计学意义(χ2=0.40,P=0.525)。99Tcm-MIBI SPECT/CT早期断层融合显像对A组的诊断灵敏度高于99Tcm-MIBI双时相平面显像,差异有统计学意义(χ2=4.57,P=0.033)。99Tcm-MIBI SPECT/CT早期断层融合显像对B组的诊断灵敏度高于99Tcm-MIBI双时相平面显像,但差异无统计学意义(χ2=0.01,P=0.906)。 结论 甲状旁腺病灶重量对99Tcm-MIBI双时相平面显像诊断灵敏度有影响,当病灶重量较小时,99Tcm-MIBI双时相平面显像对其的诊断灵敏度较低;而病灶重量对99Tcm-MIBI SPECT/CT早期断层融合显像的诊断灵敏度无明显影响。 -
关键词:
- 99m锝甲氧基异丁基异腈 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机 /
- 甲状旁腺功能亢进症
Abstract:Objective To investigate the effect of parathyroid lesion weight on the diagnostic sensitivity of 99Tcm-MIBI dual-phase plane imaging and 99Tcm-MIBI SPECT/CT tomography fusion imaging. Methods A total of 22 patients with hyperparathyroidism that was confirmed via operation and pathology in the First People's Hospital of Kunshan were collected from February 2017 to October 2018. The patients included 9 males and 13 females aged 28–73 (50.77±8.79) years old. All patients underwent 99Tcm-MIBI biphasic imaging and 99Tcm-MIBI SPECT/CT fusion imaging in the early stage. The gold standard was postoperative pathological results. All resected lesions were divided into two groups: group A, wherein lesion weight ≤1.00 g, and group B, wherein lesion weight >1.00 g. χ2 test was used to analyze the diagnostic efficacy of the two imaging methods in the different weight groups. Results A total of 58 lesions were removed from the 22 patients via surgical operation. The diagnostic sensitivity values of 99Tcm-MIBI dual-phase plane imaging for groups A and B were 47.83% (11/23) and 84.00% (21/25) respectively, and were statistically significantly different between the two groups (χ2=7.05, P=0.008). The diagnostic sensitivity values of 99Tcm-MIBI SPECT/CT early tomography for groups A and B were 78.26% (18/23) and 85.19% (23/27), respectively, and did not show significant differences between the two groups (χ2=0.40, P=0.525). In group A, the diagnostic sensitivity of 99Tcm-MIBI SPECT/CT early tomography was higher than that of dual-phase plane imaging; this difference was statistically significant (χ2=4.57, P=0.033). In group B, the diagnostic sensitivity of 99Tcm-MIBI SPECT/CT early tomography was higher than that of dual-phase plane imaging; however, no significant difference was observed (χ2=0.01, P=0.906). Conclusions The weight of parathyroid lesions has an effect on dual-phase planar imaging. Specifically, sensitivity decreased when the parathyroid glands were light. However, lesion weight had no significant effect on the diagnostic sensitivity of early tomographic fusion imaging. -
表 1 两种显像方法在不同质量组中的灵敏度、特异度和 准确率比较
Table 1. Comparison of sensitivity, specificity and accuracy of two imaging methods in different weight groups
组别 灵敏度 特异度 准确率 显像1 A组 47.83%(11/23) 85.71%(6/7) 56.67%(17/30) B组 84.00%(21/25) − (0/3) 75.00%(21/28) 显像2 A组 78.26%(18/23) 85.71%(6/7) 80.00%(24/30) B组 85.19%(23/27) − (0/1) 82.14%(23/28) 注:表中,显像1:99Tcm-MIBI双时相平面显像;显像2:99Tcm-MIBI SPECT/CT早期断层融合显像;A组病灶重量≤1.00 g,B组病灶重量>1.00 g;−:无真阴性病灶。MIBI:甲氧基异丁基异腈;SPECT:单光子发射计算机体层摄影术;CT:计算机体层摄影术 -
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