高频超声联合放射性核素对原发性甲状旁腺功能亢进的术前诊断价值  

Value of high frequency ultrasound combined with radionuclide in preoperative diagnosis of primary hyperparathyroidism

作　　者：谢东晴 沈智辉 宋青[1] 张颖[1] 罗渝昆[1] XIE Dongqing;SHEN Zhihui;SONG Qing;ZHANG Ying;LUO Yukun(Department of Ultrasound,Chinese PLA General Hospital,Beijing 100853,China;Department of Nuclear Medicine the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声诊断科,北京100853 [2]解放军总医院第一医学中心核医学科,北京100853

出　　处：《解放军医学院学报》2022年第6期654-658,664,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景手术切除是原发性甲状旁腺功能亢进主要的治疗方法,超声和放射性核素是术前最常用的定位诊断影像学方法,但最佳检查方案尚未明确。目的探讨在高频超声的基础上联合放射性核素对原发性甲状旁腺功能亢进症术前的诊断价值。方法回顾性分析2017年1月-2019年12月在解放军总医院第一医学中心外科手术切除后经病理证实的103例原发性甲状旁腺功能亢进症患者的临床资料,术前均行高频超声和放射性核素检查,记录手术前后生化指标,包括血钙、血磷和甲状旁腺激素。以病理结果为金标准,分析超声和放射性核素单独及两种影像联合检查方法的诊断效能。结果手术共切除115枚结节,其中甲状旁腺结节108枚。超声、放射性核素以及二者联合诊断原发性甲状旁腺功能亢进症的敏感度分别为88.0%、93.5%和98.1%、特异性分别为42.9%、57.1%和85.7%,准确率分别为85.2%、91.3%和97.4%,AUC分别为0.654、0.753和0.919。超声单独使用与金标准的关联性差异有统计学意义(P=0.022),优势性差异检验有统计学意义(P=0.049);核素、超声核素联合使用与金标准的关联性差异有统计学意义(P均<0.01),优势性差异检验无统计学意义(P均>0.05)。结论在高频超声基础上联合放射性核素可提高对甲状旁腺病灶的术前诊断准确率。Background Ultrasound and radionuclide are the most commonly used preoperative imaging methods for localization of primary hyperparathyroidism,but the optimal choice has not been determined.Objective To investigate the diagnostic value of primary hyperparathyroidism(PHPT)by high frequency ultrasound combined with radionuclide.Methods A retrospective analysis was performed in 103 patients with primary hyperparathyroidism confirmed by surgical resection and pathology in Chinese PLA General Hospital from January 2017 to December 2019.High frequency ultrasound and radionuclide examination were performed before operation.Biochemical indexes before and after operation were recorded.Based on the pathological results as the gold standard,the diagnostic performance of the two imaging methods alone and the combination was calculated.Results A total of 115nodules were resected,including 108 parathyroid nodules.The sensitivity of ultrasonography,radionuclide and their combination for diagnosis of PHPT was 88.0%,93.5%and 98.1%,the specificity was 42.9%,57.1%and 85.7%,the accuracy was 85.2%,91.3%and97.4%,and the AUC was 0.654,0.753 and 0.919,respectively.Chi-square test for association and McNemar test between ultrasound alone and gold standard demonstrated statistically significant differences(P<0.05,respectively).There were statistically significant differences in the Chi-square test for association between nuclide with gold standard,and the combination with gold standard(P<0.01,respectively),and no statistically significant difference was found in McNemar test(P>0.05).Conclusion Ultrasound combined with radionuclide can improve the preoperative localization diagnosis accuracy for parathyroid lesions.

关 键 词：甲状旁腺结节 原发性甲状旁腺功能亢进 高频超声 放射性核素 术前定位诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]