99mTc—MIBISPECT—CT技术在甲状旁腺切除术前定位诊断中的增益价值  

Additional role of 99mTc-MIBI SPECT- CT imaging in preoperative localization of parathyroidectomy--clinical analysis of 359 patients with secondary hyperparathyroidism

作　　者：曾鸣[1] 柳卫[2] 王宁宁[1] 邢昌赢[1] 毛慧娟[1] 俞香宝[1] 查小明[3] 孙彬[1] 杨光[1] 张波[1] 欧阳春[1] 吕小林[1] 王玲[1] 马晴[1] 潘艳艳[1] 

机构地区：[1]南京医科大学第一附属医院肾内科,210029 [2]南京医科大学第一附属医院核医学科,210029 [3]南京医科大学第一附属医院普外科,210029

出　　处：《中华肾脏病杂志》2017年第2期86-91,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金面上项目（81570666、81270408）;江苏省临床医学科技专项（BL2014080）

摘　　要：目的评估99m锝-甲氧基异丁基异腈（99mTc—MIBI）单光子发射计算机断层及CT断层融合显像（SPECT—CT）技术在继发性甲状旁腺功能亢进症（SHPT）患者甲状旁腺切除术（PTX）前甲状旁腺影像定位诊断中的增益价值。方法回顾性分析2011年4月至2016年1月期间在南京医科大学第一附属医院肾内科接受PTX治疗的359例慢性肾脏病伴发SHPT患者的临床资料，根据术前99mTC-MIBI显像方法的不同将所有患者分为两组：A组患者仅接受过99mTc-MIBI双时相法平面显像；B组患者在99mTc-MIBI双时相法平面显像的基础上加做早期相SPECT-CT显像。以术后病理检查证实的甲状旁腺数目为对照，比较两组在甲状旁腺影像定位诊断中灵敏度、特异度、影像和病理诊断一致率及手术成功率的差异。结果359例入选患者平均年龄（45．90±11．20）岁；中位透析龄84（60．0，120．O）个月；接受规律血液透析者339例，腹膜透析者20例。A组患者169例，术前甲状旁腺检测总灵敏度65．54％，总特异度56．52％，总诊断一致率65．24％；B组患者190例，总灵敏度73．84％，总特异度84．62％，总一致率74．21％。B组较A组总灵敏度和一致率增高（均P〈0．01），但两组总特异度的差异无统计学意义（P=0．055）。两组双上甲状旁腺检测灵敏度及诊断一致率均低于双下甲状旁腺（均Pc0．01），但B组较A组双上极甲状旁腺检测灵敏度和诊断一致率提高（均P〈0．05）。甲状旁腺检测的特异度上各亚组间的差异无统计学意义。A组及B组手术成功率的差异亦无统计学意义（87．57％比92．63％，P〉0．05）。结论99mTc—MIBISPECT—CT技术能有效融合解剖图像，提高SHPT患者甲状旁腺检测的灵敏度及手术前后诊断的一致率，可对病灶进行准确解剖定位，有利于提高PTX效率。Objective To evaluate the additional role of 99mTc-MIBI SPECT-CT imaging before parathyroidectomy （PTX） for secondary hyperparathyroidism （SHPT） patients. Methods A total of 359 SHPT patients from the First Affiliated Hospital of Nanjing Medical University were enrolled in the study from April 2011 to January 2016. Patients were divided into two groups according to the difference of 99mTc-MIBI imaging techniques preoperatively. Patients in group A had dual-phase 99ZTc- sestamibi parathyroid scintigraphy performed only. Patients in group B had SPECT- CT parathyroid scintigraphy added in the early phase. With the parathyroid glands confirmed by pathology after operation being the reference, sensitivity, specificity, consistency and surgical success rates of the patients in two groups were compared. Results 359 patients （166 men and 193 women） were enrolled, among which 339 on hemodialysis and 20 on peritoneal dialysis. The average age of those patients was （45.90±11.20） years and median dialysis age was 84 （60.0, 120.0） months. Total detection sensitivity, specificity, consistency in group A （169 patients） were 65.54%, 56.52%, 65.24% and in group B （190 patients） were 73.84%, 84.62%, 74.21% respectively. Total sensitivity and consistency were higher in group B than those in group A （P 〈 0.01）, while no difference in total specificity was observed between two groups （P=0.055）. In group A, detection sensitivity of parathyroid glands were 47.56%, 77.44%, 57.14% and 79.88% in right upper gland （RU）, right lower gland （RL）, left upper gland （LU） and left lower gland （LL） respectively. Consistency in group A were 48.52%, 77.51%, 56.21% and 78.70% respectively. In group B, sensitivity were 58.33%, 83.78%, 69.78% and 82.89% in RU, RL, LU and LL respectively. Consistency in group B were 59.47%, 84.21%, 70.53% and 82.63% respectively. Sensitivity and consistency of upper glands were lower than lower glands in both groups （P 〈 0.01）. When SPECT- CT was added, sensit

关 键 词：甲状旁腺功能亢进症 继发性 甲状旁腺切除术 体层摄影术 发射型计算机 单光子 99mTc—MIBI双时相法平面显像 

分 类 号：R653[医药卫生—外科学]