^(99)Tc^(m)-MIBI SPECT/CT显像对诊断甲状旁腺功能亢进症的增益价值  

The Additional Advantages of^(99)Tc^(m)-MIBI SPECT/CT Imaging in Hyperparathyroidism

作　　者：韩江琴[1] 戴娜[1] 章斌[1] 董佳佳[1] 刘航[1] HAN Jiangqin;DAI Na;ZHANG Bin;DONG Jiajia;LIU Hang(Department of Nuclear Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院核医学科,江苏苏州215000

出　　处：《标记免疫分析与临床》2024年第7期1236-1241,共6页Labeled Immunoassays and Clinical Medicine

基　　金：江苏省卫健委科研项目(编号:H2023020);姑苏卫生青年拔尖人才项目(编号:GSWS2020013)。

摘　　要：目的拟探讨^(99)Tc^(m)-MIBI(甲氧基异丁基异腈)SPECT/CT(单光子发射计算机断层成像/计算机断层扫描)对甲状旁腺功能亢进症的诊断效能及其相关因素,以及MIBI断层融合显像的增益价值。方法入组标准:(1)回顾性分析2017年5月至2023年6月间临床怀疑甲状旁腺功能亢进症的患者;(2)在本院行甲状旁腺切除术;(3)在术前2周内行^(99)Tc^(m)-MIBI SPECT/CT甲状旁腺显像。由2位核医学科高年资主治医师共同阅片,观察MIBI平面及断层图像,分析记录病变特点及同机CT显示的骨质改变。结果符合筛选条件并最终入组的患者共100例,共切除165个病灶,包括甲旁亢病灶112枚。MIBI平面显像与断层融合显像诊断甲旁亢病灶的灵敏度、特异性、约登指数、阳性预测值和阴性预测值分别为66.07%、87.03%、53.10%、91.36%和55.29%和85.71%、87.03%、72.74%、93.20%和74.60%。MIBI平面显像阳性组患者的血清PTH(甲状旁腺激素)水平、血清ALP(碱性磷酸酶)水平明显高于阴性组。MIBI断层融合显像显示出96个真阳性病灶中,其中76个病灶在CT表现为密度均匀的类圆形或椭圆形结节,17个病灶伴囊性改变,3个病灶伴钙化。另外,MIBI断层融合显像发现了8枚异位甲状旁腺腺瘤。MIBI平面显像阳性组的甲旁亢病灶的长径、PPD(垂直直径的乘积)均大于显像阴性组;MIBI平面显像阳性组较阴性组更易出现颅骨皮质变薄及颅骨增厚。相关性分析结果显示血清ALP水平与颅骨CT值、颅骨皮质变薄、颅骨增厚及有无骨质吸收灶之间均存在相关性。结论MIBI显像对甲旁亢的诊断具有重要作用,SPECT/CT断层融合显像提高了传统平面显像的诊断准确率,同时有助于对甲旁亢病灶提供准确定位。同机CT显示的骨骼特点为甲旁亢的临床诊疗提供了更多的信息。Objective To evaluate the diagnostic efficacy and related factors of Technetium-99 methoxyisobutylisonitrile(^(99)Tc^(m)-MIBI)Single-Photon Emission Computed Tomography/Computed Tomography(SPECT/CT)for hyperparathyroidism,as well as additional advantages of MIBI fusion imaging.Methods Inclusion criteria of the study cohort:①Retrospective analysis of patients with clinically suspected hyperparathyroidism between May,2017 and June,2023;②Patients performed parathyroidectomy in our hospital;③Patients performed^(99)Tc^(m)-MIBI SPECT/CT parathyroid imaging within 2 weeks before surgery.Two senior attending physicians from the Nuclear Medicine Department jointly reviewed the images.Relevant data were recorded.Results A total of 100 patients who met the screening criteria were enrolled in our study.165 lesions,including 112 parathyroid lesions,were resected.The sensitivity,specificity,Jordan index,positive predictive value,and negative predictive value of MIBI planar imaging and fusion imaging in the diagnosis of hyperparathyroidism lesions were 66.07%,87.03%,53.10%,91.36%,and 55.29%and 85.71%,87.03%,72.74%,93.20%,and 74.60%,respectively.Levels of serum thyroid stimulating hormone(PTH)and creatinine(Cr)in patients with positive MIBI planar imaging were significantly higher than those in the negative group.There was no significant difference in clinical characteristics between the positive and negative MIBI tomographic imaging groups.MIBI tomographic fusion imaging showed 96 true positive lesions,of which 76 lesions appeared as uniformly dense circular or elliptical nodules on CT,while 17 lesions with cystic changes,and 3 lesions with calcification.MIBI tomographic fusion imaging revealed 8 ectopic parathyroid adenomas,4 located within the thyroid gland and 4 located in the mediastinum.29 patients had thinning of the skull cortex,while 38 patients had bone thickening,and 9 patients had low-density bone resorption lesions.The MIBI planar imaging positive group was more prone to thinning of the skull cortex and thicke

关 键 词：MIBI显像 SPECT/CT断层融合显像 甲旁亢 增益价值 

分 类 号：R817.4[医药卫生—影像医学与核医学]