超声在甲状旁腺功能亢进症诊断及术前定位中应用  

Ultrasonography in diagnosis and preoperative localization of hyperparathyroidism

作　　者：龚志琰 GONG Zhi-yan(Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, Chin)

机构地区：[1]重庆医科大学附属第一医院超声科,重庆400042

出　　处：《临床军医杂志》2016年第10期1070-1073,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨超声对甲状旁腺功能亢进症的诊断价值。方法对2012年5月至2015年12月重庆医科大学附属第一医院收治的经病理学检查确诊为甲状旁腺功能亢进(HPT)的50例患者的临床资料进行回顾性分析,统计病灶所在部位,所有患者术前血钙、血磷、血清甲状旁腺素(PTH)值,甲状旁腺超声及99m Tc-MIBI显像结果,手术病理结果。并以病理学作为金标准,进一步分析两种影像学检查方法的敏感性及阳性预测值,探讨单发病灶者和多发病灶者的血清学指标有无统计学差异。结果 HPT病灶多位于甲状腺下极,多呈大小不一的低回声病变,内可探及明显血流信号。超声和核素显像对HPT定性诊断的敏感性分别为88.0%、94.0%,差异无统计学意义(P>0.05)。术前定位诊断中,超声和核素显像诊断的敏感性分别为87.8%、76.8%,差异无统计学意义(P>0.05)。阳性预测值分别为97.3%、98.4%,差异无统计学意义(P>0.05)。联合诊断的敏感性为93.9%,与超声比较,差异无统计学意义(P>0.05);与核素比较,差异有统计学意义(P<0.05)。单发患者与多发患者的血钙、血磷、血清PTH值比较,差异均有统计学意义(P<0.05)。结论超声可作为PTH诊断和术前定位的首选方法,敏感度和99mTc-MIBI显像相当,同时行超声和99mTc-MIBI显像可提高检出率。Objective To explore the ability of uhrasonography in diagnosis and preoperative localization of hyperparathyroidism. Methods A retrospective study was performed on 50 patients with pathologically confirmed hyperparathyroidism（HPT） that were received in The First Affiliated Hospital of Chongqing Medical University from May 2012 to December 2015. The sites of lesions,serum calcium, phosphor and parathyroid hormone （ PTH）, results of parathyroid uhrasonography, 99mTc-MIBI scintigraphy and pathological examinations were analyzed. The analysis were focused on the sensitivity and positive predictive value of the two methods as taking pathological results as golden standard and the final statistic differences of the serum biological marker between the patients with multiple lesions and the ones with solo lesion were evaluated. Results HPT lesions were commonly located in the lower part of thyroid gland,with lower echogenicity compared to the surrounding thyroid tissue and the blood flow signals could be usually detected. For the etiological diagnosis of HPT, the sensitivity of ultrasonography and 99mTc-MIBI scintigraphy were 88.0%, 94. 0% respectively （ P 〉0. 05）. For the diagnosis of HPT lesion, the sensitivity of uhrasonography and 99mTc-MIBI scintigraphy were 87. 8% ,76. 8%, respec- tively（P 〉 0. 05）. The positive predictive value were 97. 3%, 98. 4%, respectively （P 〉 0. 05 ）. As the two examinations were combined,the sensitivity was 93.9%, compared with ultrasonography, which had no statistical significance （P 〉 0. 05 ）, compared with 99mTc-MIBI scintigraphy, which was significantly higher（ P 〈 0.05 ）. The serum calcium, phosphor and PTH between the patients with multiple lesions and the ones with solo lesion were statistically significant, （P 〈 0. 05）. Conclusion Uhrasonography is the preferred examination method for HPT patients, which has comparative sensitivity to 99mTc-MIBI scintigraphy, when these two are combined, the sensitivity can be significantly higher.

关 键 词：甲状旁腺功能亢进 超声检查 99mTc-MIBI核素显像 

分 类 号：R445[医药卫生—影像医学与核医学] R582[医药卫生—诊断学]