^99Tc^m-甲氧基异丁基异腈显像在104例原发性甲状旁腺功能亢进患者诊断中的应用  

Efficiency of ^99Tc^m-sestamibi in diagnosis of parathyroid diseases with primary hyperparathyroidism

作　　者：魏伯俊[1] 申虹[1] 童冠圣[1] 王仁贵[1] 昌红[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院耳鼻咽喉头颈外科,100038

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第2期123-126,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：耳鼻咽喉头颈科学教育部省部共建重点实验室开放课题（2013EBYH01）

摘　　要：目的探讨^99Tc^m-甲氧基异丁基异腈（^99Tc^m--sestamibi，简称MIBI）在原发性甲状旁腺功能亢进诊断中应用价值及其影响因素。方法回顾性分析2010年5月至2013年11月104例行MIBI定位诊断且首次手术的原发性甲状旁腺功能亢进患者的诊断治疗经过，并与病理结果对照。104例患者中男45例，女59例；年龄28～83岁，平均年龄51岁。临床表现为进行性乏力骨痛者68例，纳差或间断腹痛者16例，烦渴心悸者9例；无临床症状因体检发现者11例。单发性腺瘤91例，单发性非典型甲状旁腺腺瘤2例，多发性甲状旁腺腺瘤（2枚）者5例，甲状旁腺增生3例，甲状旁腺癌3例。术前甲状旁腺激素98—2800ng／L，血钙2．56—4．23mmol／L。结果病变甲状旁腺MIBI检查的总阳性率为84．0％（100／119），其中甲状旁腺瘤阳性率为87．1％（88／101），甲状旁腺癌阳性比例为3／3，非典型甲状旁腺瘤阳性比例为2／2，增生甲状旁腺阳性率为7／13。结论MIBI检查在原发性甲状旁腺功能亢进定位诊断中具有较高准确性，但受病变腺体大小、形态和囊性变影响，甲状腺结节是其假阳性的最常见因素之一。Objective To evaluate the efficiency of 99Tcm-sestamibi （MIBI） in the diagnosis of parathyroid diseases with primary hyperparathyroidism. Methods One hundred and four cases with primary hyperparathyroidism underwent MIBI and parathyroidectomy between May 2010 to November 2013 were reviewed. With MIBI, single adenoma was found in 91 cases, two adenomas in 5 cases, carcinoma and hyperplasia in 3 cases respectively. Primary hyperparathyroidism was diagnosed based on the associated symptoms and signs in 93 patients, while it was indicated in 11 asymptomatic patients due to the presence of hypercalcemia in health examination. Parathroid hormone levels ranged from 98 to 2 800 ng/L, and serum calcium levels were between 2.56 - 4.23 mmol/L. Results The sensitivity of MIBI for total diseased parntyroids was 84.0% （100/119）, and that for parathyroid adenoma, parnthyroid carcinoma, atypical adenoma and primary parathyroid hyperplasia was 87. 1% （88/101）, 3/3,2/2 and 7/13, respectively. Conclusions MIBI is efficient in the diagnosis of parathyroid diseases with primary hyperparathyroidism. The size and cystic degeneration of parathroid disease are two common factors decreasing MIBI reliability, and thyroid nodule is additional source leading to false-positive results.

关 键 词：甲状旁腺功能亢进 ^99m锝甲氧基异丁基异腈 甲状旁腺切除术 

分 类 号：R817.4[医药卫生—影像医学与核医学] R581.1[医药卫生—放射医学]