术中甲状旁腺素快检联合^(99)Tc^(m)-MIBI SPECT双时相显像对疑似甲状旁腺肿物的诊断价值  

Diagnostic value of rapid parathyroid hormone combined with ^(99)Tc^(m)-MIBI SPECT dual-phase imaging in suspected parathyroid tumor

作　　者：张富强 刘善廷 王超 李德宇 周斯 杨光 李汝平 杨辉 Zhang Fuqiang;Liu Shanting;Wang Chao;Li Deyu;Zhou Si;Yang Guang;Li Ruping;Yang Hui(Department of Nuclear Medicine,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Thyroid Surgery,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学附属肿瘤医院核医学科,450003 [2]郑州大学附属肿瘤医院甲状腺外科,450003

出　　处：《中华内分泌外科杂志》2021年第4期353-357,共5页Chinese Journal of Endocrine Surgery

基　　金：河南省科技攻关项目(LHGJ20190663)。

摘　　要：目的探讨^(99)Tc^(m)-MIBI SPECT双时相显像联合术中甲状旁腺激素(parathyroid hormone,PTH)快检对甲状腺癌合并疑似甲状旁腺肿物的诊断效能。方法回顾性分析郑州大学附属肿瘤医院甲状腺外科76例彩超或CT检查发现甲状腺癌合并颈部疑似甲状旁腺肿物的患者资料,其中男28例,女48例,所有患者均于术前1周行^(99)Tc^(m)-MIBI SPECT双时相平面加局部断层显像,术前抽血检测PTH,术中钳夹肿物血管后快检PTH,以术后病理结果为标准,评价各种诊断方法的灵敏度、特异度、准确度及一致性分析。以钳夹肿物血管后测定甲状旁腺浓度较术前减少比例a值绘制ROC曲线。结果^(99)Tc^(m)-MIBI SPECT双时相显像联合术中PTH快检诊断疑似甲状旁腺肿物的灵敏度、准确率为(96.5%、93.4%),优于^(99)Tc^(m)-MIBI SPECT双时相显像法(77.6%、78.9%)和术中快检方法(86.2%、82.8%),且与病理检验结果有较高的一致性,Kappa值为0.81。两种方法联合对疑似甲状旁腺肿物检出率显著高于^(99)Tc^(m)-MIBI SPECT双时相显像法、术中快检法,而^(99)Tc^(m)-MIBI SPECT双时相显像法和术中快检方法差异无统计学意义。钳夹肿物血管后减少比例a值ROC曲线下面积为0.774,标准误差为0.073,差异有统计学意义(P<0.001,95%CI 0.631~0.918);根据ROC所得结果,以约登指数(灵敏度+特异性-1)为纵坐标、a值为横坐标作图,得到约登指数最大为0.584,该点对应的a值为0.52。0.52为DCP值,对应的灵敏度、特异度、准确度为86.2%、72.2%、82.9%。结论^(99)Tc^(m)-MIBI SPECT双时相显像联合术中PTH快检对甲状腺癌合并疑似甲状旁腺肿物具有较好的诊断价值,与病理诊断有完全的一致性。Objective To investigate the diagnostic efficacy of ^(99)Tc^(m)-MIBI SPECT dual-phase imaging combined with rapid parathyroid hormone detection in thyroid cancer with suspected parathyroid mass.Methods Data of 76 cases of thyroid cancer with suspected cervical parathyroid gland tumors receiving colorectal ultrasonography or CT examination in Thyroid Surgery Department of the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed.Blood samples were taken before surgery to detect parathyroid hormone.Parathyroid hormone was quickly detected after clamping the tumor blood vessels during surgery.Based on the postoperative pathological results,the sensitivity,specificity,accuracy and consistency of various diagnostic methods were evaluated.The ROC curve was drawn by measuring the value of the parathyroid gland concentration after reduction of the tumor blood vessels by clamping the tumor.Results The sensitivity and accuracy of the ^(99)Tc^(m)-MIBI SPECT dual-phase imaging combined with the rapid detection of parathyroid hormone in diagnosis of suspected parathyroid tumors were(96.5%,93.4%)better than the ^(99)Tc^(m)-MIBI SPECT dual-phase imaging methods(77.6%,78.9%)and intraoperative rapid detection methods(86.2%,82.8%),and had a high consistency with the results of pathological examination,Kappa value of 0.81.The combined detection rate of suspected parathyroid tumors was significantly higher than that of ^(99)Tc^(m)-MIBI SPECT dual-phase imaging and rapid intraoperative detection,but there was no significant difference between ^(99)Tc^(m)-MIBI SPECT dual-phase imaging and intraoperative rapid detection.The area under the ROC curve of the reduction ratio a value after clamping the blood vessels of the tumor was 0.774,and the standard error was 0.073.The difference was statistically significant(P<0.001,95%CI:0.631-0.918).According to the results obtained by the ROC,the index(sensitivity+specificity-1)was plotted on the ordinate and a was the abscissa.The maximum value of the Jordan index was 0

关 键 词：甲状旁腺肿瘤 甲状腺癌 ^(99)Tc^(m)-甲氧基异丁基异腈 单光子发射型计算机断层 甲状旁腺素 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]