高频超声、超声造影与^(99m)Tc-MIBI SPECT/CT在难治性甲状旁腺功能亢进术前定位中的比较  

Localization value of ultrasonography, contrast-enhanced ultrasound and ^(99m)Tc-MIBI SPECT/CT in refractory secondary hyperparathyroidism

作　　者：李秀梅[1] 李军[1] 王宏桥[1] 宁春平[1] 姜彩云[1] 周茂平[1] 牟爽 杨景茹 吴红梅 Li Xiumei;Li Jun;Wang Hongqiao;Ning Chunping;Jiang Caiyun;Zhou Maoping;Mou Shuang;Yang Jingru;Wu Hongmei(Department of Ultrasound,the Affiliated Hospital of Qingdao University,Shandong 266003,China)

机构地区：[1]青岛大学附属医院超声科,266003

出　　处：《中华医学超声杂志（电子版）》2018年第7期522-529,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨高频超声、超声造影、^(99m)锝-甲氧基异丁基异腈(^(99m)Tc-MIBI)单光子发射型计算机断层显像/计算机断层扫描(SPECT/CT)在难治性甲状旁腺功能亢进症术前定位中的诊断效能。方法收集2015年8月至2017年8月青岛大学附属医院收治的难治性甲状旁腺功能亢进症18例,患者术前均接受高频超声、超声造影及^(99m)Tc-MIBI SPECT/CT显像等检查,以术后病理结果为"金标准",比较3种检查方法的诊断效能。结果 18例患者共手术切除73枚结节,经病理证实71枚为甲状旁腺增生结节,高频超声、超声造影及^(99m)Tc-MIBI SPECT/CT显像敏感度分别为98.59%、94.37%、78.87%,准确性分别为97.26%、94.52%、78.08%。高频超声与超声造影在定位甲状旁腺增生结节中的优势差异无统计学意义(P=0.250),两者的诊断效能均优于^(99m)Tc-MIBI SPECT/CT显像(P=0.001、0.012),联合检查可提高定位的特异度(50.00%vs 100.00%),与^(99m)Tc-MIBI SPECT/CT显像联合后可进一步提高定位的准确性(98.63%vs 100.00%)。结论高频超声与超声造影及^(99m)Tc-MIBI SPECT/CT显像联合后可对难治性甲状旁腺功能亢进做出较为全面的术前定位诊断。Objective To explore the diagnostic value of ultrasonography(US),contrastenhanced ultrasonography(CEUS),(99mTc-MIBI)single photon emission computed tomography/computed tomography(SPECT/CT)in refractory secondary hyperparathyroidism.Methods From August 2015 to August 2017,18 cases of refractory hyperparathyroidism admitted to the Affiliated Hospital of Qingdao University were collected.All patients underwent US,CEUS,99mTc-MIBI SPECT/CT imaging before operation.The diagnostic efficiency of the three methods was compared with the pathological results as the gold standard.Results A total of 73 nodules were removed from 18 cases,71 of them were parathyroid nodules confirmed by pathology.The imaging sensitivity of US,CEUS,99mTc-MIBI SPECT/CT was 98.59%,94.37%and 78.87%respectively,and the accuracy was 97.26%,94.52%and 78.08%respectively.There was no significant difference between US and CEUS in locating parathyroid hyperplasia nodules(P=0.250).The diagnostic value of US and CEUS was superior to 99mTc-MIBI SPECT/CT(P=0.001,0.012),and the specificity was increased when combination of US with CEUS(50.00%vs 100.00%).When combined with 99mTc-MIBI SPECT/CT imaging,the accuracy of localization was further improved(98.63%vs 100.00%).Conclusion For refractory secondary hyperparathyroidism,comprehensive preoperative diagnosis can be made after combined application of US,CEUS and 99mTc-MIBI SPECT/CT.

关 键 词：超声检查 99M锝甲氧基异丁基异腈 体层摄影术 螺旋计算机 甲状旁腺功能亢进 

分 类 号：R445.1[医药卫生—影像医学与核医学] R582.1[医药卫生—诊断学]