^(99)Tc^m-MIBI显像定位诊断功能亢进性异位甲状旁腺  

Localization of hyperfunctioning ectopic parathyroid glands using ^(99)Tc^m-MIBI imaging

作　　者：周前[1] 徐竞英[1] 刘世贞[1] 

机构地区：[1]中国医学科学院,中国协和医科大学北京协和医院核医学科,100730

出　　处：《中华核医学杂志》2003年第1期24-26,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的　探讨99Tcm 甲氧基异丁基异腈 (MIBI)显像对于异位甲状旁腺所致原发性甲状旁腺功能亢进 (简称甲旁亢 )的显像特点 ,提高甲状旁腺术前定位的准确性。方法　 61例原发性甲旁亢患者采用99Tcm MIBI显像 (减影法 6例 ,双时相法 5 5例 ) ,其中 5 2例有B超 (US)、15例有CT检查 ,全部病例均经手术和病理检查证实。结果　 61例中发现异位甲状旁腺 16例 ( 2 6.2 % ) ,位置分别为 :颈动脉鞘内 3例 ,下颈部延伸至胸骨后 6例 ,纵隔内 7例。99Tcm MIBI显像全部检出 ( 10 0 % ) ,与手术部位一致。US检查 15例 ,检出 8例 ( 5 3 .3 % ) ,均位于颈部 ,纵隔内 6例及颈动脉鞘内 1例未检出。CT检查 7例 ,纵隔内 6例检出 2例 ( 2 8.6% )。病理检查诊断 :腺瘤 14例 ,增生 2例。病灶最小 1g ,最大 >60g。99Tcm MIBI显像示病灶小者为放射性均匀浓聚 ,大者常有囊性变 ,甚至完全为囊肿样。位于甲状腺影像外者 ,双时相法的初始相即可显示 ,但位于纵隔深部病变的解剖关系不能精确表达。结论99Tcm MIBI显像是最有效的探测异位甲状旁腺的方法 ,缺点是对于纵隔深部病灶的解剖定位不够清楚 。Objective To find out the 99Tc m-MIBI scintigraphic characteristics of ectopic parathyroid glands and to make comparison with other imaging modalities in order to increase the accuracy of preoperative localization or detection of primary hyperparathyroidism. Methods Sixty-one cases of primary hyperparathyroidism underwent 99Tc m-MIBI imaging (6 cases with subtraction and 55 cases with double-phase scintigraphy). Of 61 patients, 52 and 15 also underwent ultrasound (US) and CT studies, respectively.Subsequent surgical and pathological results were obtained for all patients. Results Overall,16 ectopic parathyroids were found(26.2%), 3 were located inside the carotid sheath, 6 at the lower pole of thyroid extending to the superior mediastinum and 7 in the mediastinum. 99Tc m-MIBI scintigraphy detected all 16 cases(100%). US detected 8 cases out of 15 studies, of the undetected cases 6 were in the mediastinum and 1 was inside the carotid sheath. CT found 2 out of 7 studies(28.6%).The pathological diagnosis confirmed 14 adenomas and 2 hyperplasias. The weight of lesions ranged from 1 g to >60 g. The small lesion showed homogeneous concentration of radioactivity and the large ones frequently showed degenerative change in the lesion center, sometimes even assumes a cyst. Conclusions 99Tc m-MIBI scintigraphy is the most effective method to detect the ectopic parathyroid glands in the mediastinum. CT scan is useful to clarify its anatomical relation to surrounding structures after radionuclide localization.

关 键 词：甲状旁腺功能亢进症 甲状旁腺 放射性素显像 MIBI 诊断 

分 类 号：R817.4[医药卫生—影像医学与核医学]