^99Tc^m-MIBI SPECT/CT对原发性甲状旁腺功能亢进症的诊断价值  

Enhanced diagnostic value of ^99Tc^m-MIBI SPECT/CT in patients with primary hyperparathyroidism

作　　者：顾宇参[1] 邬鹏跃[1] 张宏伟[2] 修雁[1] 李蓓蕾[1] 胡鹏程[1] 张洁[1] 张一秋[1] 顾涛颖[1] 陈曙光[1] 石洪成[1] 

机构地区：[1]复旦大学附属中山医院核医学科、复旦大学核医学研究所、上海市影像医学研究所,上海200032 [2]复旦大学附属中山医院普外科,上海200032

出　　处：《中华核医学与分子影像杂志》2016年第3期242-245,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：上海卫生系统先进适宜技术推广项目（2013SY008）

摘　　要：目的 探讨^99Tc^m-MIBI SPECT/CT显像对原发性甲状旁腺功能亢进症（PHPT）的诊断价值.方法 回顾性分析2008年4月至2012年11月40例[男14例,女26例,年龄（55.4±12.4）岁）]临床疑似PHPT且获得手术病理结果的患者资料.所有患者均行99 Tcm-MIBI双时相平面显像及SPECT/CT显像.以术中所见病理诊断及术后PTH水平为标准,分别计算^99Tc^m-MIBI双时相平面显像及SPECT/CT显像对PHPT的诊断效能.每例患者按4个甲状旁腺计,40例共160个.采用χ^2检验比较2种检查方法诊断的准确性.结果 共计切除40例患者的甲状旁腺病灶43个,病理诊断甲状旁腺腺瘤33例,甲状旁腺增生7例.^99Tc^m-MIBI双时相平面显像和SPECT/CT显像对PHPT的诊断灵敏度、特异性、阴性预测值、阳性预测值和准确性分别为74.4％（32/43）和93.0％ （40/43）,97.4％（114/117）和100％（117/117）,91.2％（114/125）和97.5％（117/120）,91.4％ （32/35）和100％（40/40）,91.2％（146/160）和98.1％（157/160）.2种检查方法准确性间的差异有统计学意义（χ^2=1.125,P＜0.01）.结论 SPECT/CT显像诊断PHPT较^99Tc^m-MIBI双时相平面显像具有更高的准确性.Objective To investigate the additional diagnostic value of ^99Tc^m-MIBI SPECT/CT over dual-phase ^99Tc^m-MIBI scintigraphy in patients with primary hyperparathyroidism （PHPT）.Methods Forty patients （14 males,26 females;mean age （55.4±12.4） years） with suspicious PHPT who underwent dual-phase ^99Tc^m-MIBI scintigraphy and SPECT/CT from April 2008 to November 2012 were retrospectively reviewed.All patients had pathological diagnosis based on surgical resection.There were 160 parathyroid glands in 40 patients.In comparison with the result of pathological diagnosis,the diagnostic efficiency of dual-phase ^99Tc^m-MIBI scintigraphy and SPECT/CT were evaluated.χ^2 test was used to compare the diagnostic accuracy of the 2 methods.Results Forty-three abnormal parathyroid lesions were found in 40 patients.Among the 43 lesions,33 were diagnosed as parathyroid adenoma,and 7 were diagnosed as parathyroid hyperplasia by pathology.Using dual-phase ^99Tc^m-MIBI scintigraphy and SPECT/CT for the diagnosis of PHPT,the sensitivity,specificity,accuracy,negative predictive value,positive predictive value were 74.4%（32/43）vs 93.0%（40/43）,97.4%（114/117） vs 100%（117/117）,91.2%（146/160） vs 98.1%（157/160）,91.2%（114/125） vs 97.5%（117/120）,91.4%（32/35） vs 100%（40/40）,respectively.The diagnostic accuracies of the above two imaging modalities were significantly different （χ^2 =1.125,P〈0.01）.Conclusion Compared with dual-phase ^99Tc^m-MIBI scintigraphy imaging,the diagnostic accuracy of SPECT/CT on PHPT is significantly improved.

关 键 词：甲状旁腺功能亢进症 原发性 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 MIBI 

分 类 号：R582.1[医药卫生—内分泌] R817.4[医药卫生—内科学]