^(99m)Tc-MIBI SPECT/CT在甲状旁腺病灶与结节性甲状腺肿鉴别诊断中的价值  

Value of ^(99m)Tc-MIBI SPECT/CT in distinguishing between parathyroid lesions and nodular goiter

作　　者：刘进言 李新辉[1] 邓豪余[1] LIU Jinyan;LI Xinhui;DENG Haoyu(Department of Nuclear Medicine(PET Center),Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院核医学科(PET中心),长沙410008

出　　处：《中南大学学报（医学版）》2021年第9期1018-1023,共6页Journal of Central South University ：Medical Science

摘　　要：目的:功能亢进的甲状旁腺病灶需手术切除,^(99m)锝-甲氧基异丁基异腈(^(99m)Tc-methoxyisobutylisonitrile,^(99m)Tc-MIBI)单光子发射计算机体层摄影/计算机体层摄影(single-photon emission computed tomography/computed tomography,SPECT/CT)在甲状旁腺病灶定位诊断中起重要作用,而部分结节性甲状腺肿摄取^(99m)Tc-MIBI较高,与功能亢进的甲状旁腺病灶难以鉴别。本研究旨在探讨^(99m)Tc-MIBI SPECT/CT在甲状旁腺病灶与结节性甲状腺肿鉴别诊断中的价值。方法:回顾性分析通过^(99m)Tc-MIBI SPECT/CT拟诊为甲状旁腺病灶的68例患者,共计81个病灶。根据手术切除后病理检查结果将病灶分为甲状旁腺病灶组(69个)和结节性甲状腺肿组(12个)。测量所有病灶的放射性计数最大值(target maximum radioactivity count,Tmax),以主动脉弓平均放射性计数作为本底放射性计数平均值(background mean radioactivity count,Bmean),并计算二者的比值(Tmax/Bmean),比较2组间Tmax/Bmean的差异;测量病灶CT密度最小值、平均值和最大值,比较2组间各CT密度值的差异;绘制甲状旁腺病灶患者与结节性甲状腺肿患者受试者操作特征(receiver operating characteristic,ROC)曲线,评估各CT密度值的诊断效能。结果:甲状旁腺病灶与结节性甲状腺肿病灶^(99m)Tc-MIBI放射性摄取明显浓聚;2种病灶的CT密度值均低于正常甲状腺组织,2种病灶与甲状腺的分界均可表现为清晰或模糊2种情况。2组Tmax/Bmean值比较差异无统计学意义(P=0.221)。2组CT密度最小值、平均值及最大值比较,差异均有统计学意义(均P<0.05)。CT密度最大值的诊断效能最优,曲线下面积(area under the curve,AUC)为0.894(P<0.001),其阈值为91 HU,敏感度为83.3%,特异度为94.2%。结论:病灶^(99m)Tc-MIBI放射性摄取程度对甲状旁腺病灶与结节性甲状腺肿的鉴别价值有限,病灶CT密度最大值具有较高诊断效能。Objective:Hyperfunctioning parathyroid lesions require surgical resection.^(99m)Tcmethoxyisobutylisonitrile(^(99m)Tc-MIBI)single-photon emission computed tomography/computed tomography(SPECT/CT)plays an important role in the diagnosis of parathyroid lesions.Some nodular goiters have a higher uptake of ^(99m)Tc-MIBI,which is difficult to distinguish from hyperfunctioning parathyroid lesions.This study aims to explore the value of ^(99m)Tc-MIBI SPECT/CT in the differential diagnosis of parathyroid lesions and nodular goiter.Methods:This study was a retrospective analysis.A total of 68 patients who were diagnosed as parathyroid lesions by ^(99m)Tc-MIBI SPECT/CT were enrolled,with a total of 81 lesions.According to the results of pathological examination after surgical resection,the lesions were divided into a parathyroid lesion group(n=69)and a nodular goiter group(n=12).The target maximum radioactivity count(Tmax)of all lesions was measured.The mean radioactivity count of the aortic arch was used as the background mean radioactivity count(Bmean),and the ratio of the Tmax to Bmean was calculated.The difference in Tmax/Bmean between the 2 groups was compared.The minimum,mean,and maximum of CT density in the lesion were measured.The difference of CT density between the 2 groups was compared.The receiver operating characteristic(ROC)curve of patients with parathyroid lesions and patients with nodular goiter was drawn,and the diagnostic efficacy of each CT density value was evaluated.Results:The ^(99m)Tc-MIBI radioactive uptake in parathyroid lesions and nodular goiter lesions was significantly concentrated.The CT density values of the 2 lesions were lower than normal thyroid tissue,and the boundary between the 2 lesions and the thyroid was clear or blurred.There was no significant difference in Tmax/Bmean between the 2 groups(P=0.221).The differences in the minimum,mean and maximum of CT density between the 2 groups were statistically significant(all P<0.05).The diagnostic efficiency of maximum of CT density was the be

关 键 词：甲状旁腺病灶 结节性甲状腺肿 单光子发射型计算机断层显像/计算机断层扫描 CT密度最大值 

分 类 号：R653[医药卫生—外科学]