^99Tc^m-MIBI SPECT/CT融合断层显像在甲状旁腺功能亢进症中的应用价值  

Importance of ^99Tc^m-MIBI SPECT/CT fusion imaging in primary and secondary hyperparathyroidism

作　　者：彭诗瑶 李盼丽 张艾米 刘秋芳[1] 徐莲[1] 孙晓光[1] 黄钢 宋少莉[1] Peng Shiyao;Li Panli;Zhang A imi;Liu Qiufang;Xu Lian;Sun Xiaoguang;Huang Gang;Song Shaoli(Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shang- hai 200127, China;Shanghai University of Medicine＆Health Sciences, Shanghai 201318, China)

机构地区：[1]上海交通大学医学院附属仁济医院核医学科,200127 [2]上海健康医学院医学影像学院,201318

出　　处：《国际放射医学核医学杂志》2018年第3期195-200,共6页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：国家自然科学基金（81471708,81771861）;上海市高峰高原计划研究型医师（20172010）

摘　　要：目的 评价^99Tc^m-MIBI SPECT/CT双时相融合断层显像在原发性甲状旁腺功能亢进症（PHPT）与继发性甲状旁腺功能亢进症（SHPT）中的应用价值。方法 回顾性分析97例（PHPT 28例，SHPT 69例）HPT患者的^99Tc^m-MIBI SPECT/CT显像图像特征、症状、血清甲状旁腺激素（PTH）、血钙、磷及碱性磷酸酶（AKP）等结果。分析比较PHPT和SHPT两组患者的显像特点、手术病理、实验室检查以及诊断的灵敏度、特异度与临床指标之间的相关性。结果 （1）99Tcm-MIBI SPECT/CT显像对PHPT的术前诊断灵敏度为96.55%，特异度为98.78%；对SHPT的术前诊断灵敏度为68.77%，特异度为79.17%。（2）PHPT多表现为单发病灶，而SHPT多表现为多个亢进的甲状旁腺病灶，病灶平均直径较小（Z=-2.591，P=0.010），且容易合并钙化（χ2=9.588，P〈0.01），差异均有统计学意义。（3）PHPT中无特殊不适主诉的患者比例明显高于SHPT中的比例（χ2=11.713，P〈0.001），PHPT出现结石的比例高于SHPT（χ2=6.075，P〈0.001），SHPT出现骨痛的比例高于PHPT（χ2=24.382，P〈0.01），差异均有统计学意义；SHPT患者血清PTH和AKP水平均明显高于PHPT，差异有统计学意义（Z=-6.663、-4.326，均P〈0.001），PHPT具有高钙低磷的特点，SHPT患者血钙正常或轻度升高，血磷明显升高。结论 99Tcm-MIBI SPECT/CT双时相显像在PHPT患者的术前定位中有重要价值，特别是在PHPT中有极高的准确率。与PHPT相比，SHPT血清PTH、AKP水平升高更明显，多表现为多个病灶，病灶小，易合并钙化。Objective The value of ^99Tc^m-MIBI SPECT/CT fusion imaging in primary hyperparathyroidism （PHPT） and secondary hyperparathyroidism （SHPT） was evaluated. Methods A total of 97 HPT patients （28 PHPT patients and 69 SHPT） were enrolled in this retrospective study. The 99Tcm-MIBI SPECT/CT imaging features, clinical symptoms, serum PTH, Ca, P, and AKP were analyzed. The following data were compared between PHPT and SHPT patients：imaging features; pathological findings; laboratory examination results; and relevance of diagnostic efficiency and clinical index. Results （1） The sensitivity and specificity of 99Tcm-MIBI SPECT/CT in PHPT were 96.55% and 98.78%, respectively. By contrast, the sensitivity and specificity of 99Tcm-MIBI SPECT/CT SHPT were 68.77% and 79.17%, respectively. （2） PHPT generally exhibited single lesion with average diameter was 17.4 mm. Compared with PHPT, SHPT generally displayed more lesions with smaller diameter of 12.8 mm （Z=-2.591, P=0.010） and more likely to be found with calcification（χ2=9.588, P〈0.01）. （3） The percentage of patients without special clinical symptoms was higher in PHPT（χ2=11.713, P〈0.001）. The percentage of patients with calculus in urinary system was also higher in PHPT（χ2=6.075, P〈0.001）. However, the percentage of patients with ostalgia was higher in SHPT（χ2=24.382, P〈0.001）. Serum PTH and AKP were significantly higher in SHPT（Z=-6.663, -4.326, both P〈0.001）. PHPT had high serum calcium level and low phosphorus level, whereas SHPT showed normal or slightly higher calcium level and significantly high phosphorus level. Conclusions 99Tcm-MIBI SPECT/CT fusion imaging had a significant value in preoperation localization of HPT, especially in PHPT. Compared with PHPT, SHPT had a greater increase in serum PTH and AKP and usually exhibited several lesions which are smaller and more likely to accompany calcification.

关 键 词：99M锝甲氧基异丁基异腈 单光子发射计算机体层摄影术 甲状旁腺功能亢进 原发性 甲状旁腺功能亢进症 继发性 

分 类 号：R582.1[医药卫生—内分泌]