甲状旁腺四维CT在原发性甲状旁腺功能亢进症术前定位中的诊断价值  

Diagnostic value of 4-dimensional computed tomography in preoperative localization in patients with primary hyperparathyroidism

作　　者：宋桉 王鸥 刘春晓 王曼[2] 刘赫[3] 景红丽[4] 胡亚[5] 夏维波 张竹花[2] 金征宇[2] 邢小平 Song An;Wang Ou;Liu Chunxiao;Wang Man;Liu He;Jing Hongli;Hu Ya;Xia Weibo;Zhang Zhuhua;Jin Zhengyu;Xing Xiaoping(Key Laboratory of Endocrinology of National Health Commission of the People's Republic of China,Department of Endocrinology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Ultrasound,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院内分泌科,国家卫生健康委员会内分泌重点实验室,100730 [2]中国医学科学院,北京协和医学院,北京协和医院放射科,100730 [3]中国医学科学院,北京协和医学院,北京协和医院超声科,100730 [4]中国医学科学院,北京协和医学院,北京协和医院核医学科,100730 [5]中国医学科学院,北京协和医学院,北京协和医院基本外科,100730

出　　处：《中华内科杂志》2020年第10期788-795,共8页Chinese Journal of Internal Medicine

基　　金：中国医学科学院医学与健康科技创新工程(2017-I2M-1-001)。

摘　　要：目的:评估甲状旁腺四维CT(4-dimensional computed tomography,4D-CT)单独或联合其他定位手段对原发性甲状旁腺功能亢进症(甲旁亢)患者术前定位诊断的效能,为甲旁亢患者术前定位诊断提供更多的选择。方法:共纳入57例术前完善甲状旁腺4D-CT、甲状旁腺99Tc m-甲氧基异丁基异腈甲状旁腺显像(MIBI)及甲状旁腺超声检查的原发性甲旁亢患者(共包含13例异常位置甲状旁腺病变),回顾性分析其临床及影像学资料。根据患者的术前血钙水平、肿瘤直径以及是否为异常位置甲状旁腺病变分为不同亚组。分别在总体及各亚组中分析4D-CT与其他检查手段单独或联合应用的敏感度、特异度、阳性预测值、阴性预测值,并绘制受试者工作特征(ROC)曲线,进行不同方案间曲线下面积(AUC)的比较。结果:在57例患者中,4D-CT与99Tc m-MIBI诊断效能均高于超声,单独应用时AUC分别为0.943、0.927、0.847(超声与4D-CT、99Tc m-MIBI比较,P=0.01、0.04),任何两种方案联合的诊断效能均高于其中一种方案单独应用,但三者联合与两两联合相比差异均无统计学意义。当根据血钙及肿瘤直径进行亚组分析时,4D-CT诊断效能与99Tc m-MIBI相比差异无统计学意义。当针对异位象限分析时,4D-CT明显优于99Tc m-MIBI及超声,单独应用时AUC分别为:0.989、0.846、0.808(4D-CT与MIBI、超声比较,P=0.035、0.011),且任何两种或3种方案联合的诊断效能与4D-CT单独应用相比差异均无统计学意义。结论:4D-CT在原发性甲旁亢术前定位方面的诊断效能与99Tc m-MIBI相当,并且在识别异常位置甲旁亢方面更具优势。可将4D-CT作为原发性甲旁亢重要的术前定位补充检查方法。Objective To provide more options for preoperative localization diagnosis in patients with primary hyperparathyroidism(PHPT),the diagnostic efficacy of parathyroid 4-dimensional computed tomography(4D-CT)in patients with PHPT was evaluated.Methods This was a single-center retrospective study including 57 patients with surgical proved PHPT.All of the patients underwent 4D-CT,99Tcm-sestamibi parathyroid imaging(MIBI),and ultrasonography(US)preoperatively.The reference standard for correct localization was based on operation reports and pathology confirmation.The patients were grouped according to the preoperative serum calcium levels,tumor diameter,or ectopic lesions(yes/no),respectively.The sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC)of 4D-CT,MIBI and US,alone or in combination,were analyzed in total and each subgroup patients.Results Fifty-seven patients(39 women,18 men;mean age of 56.5 years)were evaluated,including four cases with multi-gland disease and thirteen cases with ectopic parathyroid lesions.In all the patients,similar diagnostic efficacy was found in 4D-CT(AUC:0.943)and MIBI(AUC:0.927),both of which were higher than that of US(AUC:0.847)(P=0.01 for 4D-CT vs.US;P=0.04 for MIBI vs.US).In a subset analysis for ectopic quadrants,the diagnostic efficacy of 4D-CT was significantly higher than that of MIBI(P=0.04)or US(P=0.01),with the sensitivity of 100%,69.2%,and 61.5%,and AUC of 0.989,0.846,and 0.808 for 4D-CT,MIBI and US,respectively.Conclusions 4D-CT has similar diagnostic efficacy for preoperative localization to MIBI in patients with PHPT,and it is superior to MIBI and US in identifying the ectopic parathyroid gland.4D-CT can be recommended as an alternative preoperative localization method,especially when parathyroid lesions could not be precisely located by US and MIBI.

关 键 词：甲状旁腺功能亢进症 原发性 术前定位诊断 甲状旁腺四维CT 

分 类 号：R582.1[医药卫生—内分泌] R816.6[医药卫生—内科学]