甲状旁腺腺瘤相关原发性甲状旁腺功能亢进症定量^(99)Tc^(m)-MIBI SPECT/CT显像参数与功能标志物及疾病严重程度的相关性  

Correlations of quantitative ^(99)Tc^(m)-MIBI SPECT/CT imaging parameters,functional markers and disease severity of parathyroid adenoma-related primary hyperparathyroidism

作　　者：李树恒 栾九松 董曦[1] 苏剑[1] 李晓东[1] LI Shuheng;LUAN Jiusong;DONG Xi;SU Jian;LI Xiaodong(Department of Nuclear Medicine,Affiliated Hospital of Hebei University,Baoding 071000,China;Hebei Key Laboratory of Precise Imaging of Inflammation Related Tumors,Baoding 071000,China;Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院核医学科,河北保定071000 [2]河北省炎症相关肿瘤精准影像学重点实验室,河北保定071000 [3]河北大学附属医院呼吸与危重症医学科,河北保定071000

出　　处：《中国介入影像与治疗学》2024年第12期756-761,共6页Chinese Journal of Interventional Imaging and Therapy

基　　金：保定市科技计划项目(2241ZF330);河北大学附属医院基金(2022QC46)。

摘　　要：目的观察伴甲状旁腺功能亢进症(PHPT)甲状旁腺腺瘤定量^(99)Tc^(m)-甲氧基异丁基异腈(^(99)Tc^(m)-MIBI)SPECT/CT显像参数与其功能标志物及疾病严重程度的相关性。方法回顾性纳入58例单发甲状旁腺腺瘤PHPT患者,记录血甲状旁腺激素(PTH)等临床资料,获取定量^(99)Tc^(m)-MIBI SPECT/CT显像参数,并根据血钙水平评估疾病严重程度(2.55~2.80 mmol/L及>2.80 mmol/L),将患者分为Ⅰ型组(n=25)与Ⅱ型组(n=33)。经重建图像获得病灶定量代谢参数,包括病灶标准摄取值(SUV)最大值(SUV_(max))、平均值(SUV_(mean))及峰值(SUV_(peak)),瘦体标准化SUV(SUL)最大值(SUL_(max))、平均值(SUL_(mean))及峰值(SUL_(peak)),病灶摄取总体积(TLV)、摄取总量(TLU),以及衍生参数病灶与同侧三角肌摄取比值(LBR)和病灶密度(LD)并进行组间比较;以受试者工作特征(ROC)曲线下面积(AUC)评估各指标及多指标联合logistic回归模型鉴别PHPT严重程度的效能。结果Ⅰ型组血PTH及血钙水平均低于Ⅱ型组(P均<0.05)。^(99)Tc^(m)-MIBI SPECT/CT断层显像与平面显像对伴PHPT甲状旁腺腺瘤的检出率差异无统计学意义(96.56%vs.91.38%,P=0.063)。TLV、TLU均与血PTH(r_(s)=0.416、0.422)及血钙水平(r_(s)=0.391、0.349)呈弱相关(P均<0.05)。Ⅰ型组TLV、TLU明显低于Ⅱ型组(P均<0.05)。以PTH、TLV及TLU鉴别Ⅰ、Ⅱ型伴PHPT甲状旁腺腺瘤的AUC分别为0.770、0.741及0.716,三者联合的AUC为0.790,均未见统计学差异(Z=0.361~1.454,P均>0.05)。结论根据甲状旁腺^(99)Tc^(m)-MIBI SPECT/CT定量代谢参数TLV、TLU可用于评估伴PHPT甲状旁腺腺瘤患者甲状旁腺功能状态及疾病严重程度。Objective To observe the correlations of quantitative ^(99)Tc^(m)-methoxyisobutylisonitrile(^(99)Tc^(m)-MIBI)SPECT/CT imaging parameters,functional markers and disease severity of primary hyperparathyroidism(PHPT)related to parathyroid adenoma.Methods Fifty-eight patients with PHPT due to single parathyroid adenoma were retrospectively collected,clinical data including serum parathyroid hormone(PTH)levels were recorded,and quantitative ^(99)Tc^(m)-MIBI SPECT/CT imaging parameters were obtained.According to serum calcium level reflecting disease severity(2.55—2.80 mmol/L or>2.80 mmol/L),the patients were categorized into typeⅠgroup(n=25)and typeⅡgroup(n=33).Quantitative metabolic parameters of lesions,i.e.standard uptake value(SUV)values(the maximum SUV[SUVmax],the mean SUV[SUV_(mean)],the peak SUV[SUV_(peak)]),SUV values normalized by lean body mass(SUL,including the maximum SUL[SUL_(max)],the mean SUL[SUL_(mean)]and the peak SUL[SUL_(peak)]),total lesion volume(TLV)and total lesion uptake(TLU),as well as derived parameters such as lesion to background ratio(LBR)contrast to contralateral deltoid muscle and lesion density(LD)were obtained from reconstructed images and compared between groups.The area under curves(AUC)of the receiver operating characteristic(ROC)curves were used to evaluate the performance of each index and their combined logistic regression model for distinguishing the severity of PHPT.Results The serum PTH and serum calcium levels in typeⅠgroup were both significantly lower than those in typeⅡgroup(both P<0.05).No statistically significant difference of detection rate of parathyroid adenoma with PHPT was found between ^(99)Tc^(m)-MIBI SPECT/CT and planar imaging(96.56%vs.91.38%,P=0.063).TLV and TLU were weakly correlated with serum PTH(r_(s)=0.416,0.422)and serum calcium levels(r_(s)=0.391,0.349)(all P<0.05).TLV and TLU values in typeⅠgroup were significantly lower than those in typeⅡgroup(both P<0.05).The AUC of PTH,TLV and TLU for differentiating typeⅠand typeⅡPHPT related to

关 键 词：甲状旁腺功能亢进 原发性 甲状旁腺肿瘤 体层摄影术 发射型计算机 单光子 99M锝甲氧基异丁基异腈 

分 类 号：R582[医药卫生—内分泌] R445.5[医药卫生—内科学]