摘要
目的探讨99m锝-甲氧基异丁基异腈(99Tcm-sestamibi,99Tcm-MIBI)双时相法平面显像及SPECT/CT断层显像对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT甲旁亢)临床应用价值,初步探讨SPECT/CT断层显像是否可以提高SHPT术前定位诊断的准确性。方法采用99mTc-MIBI双时相法显像。31例患者中22例行平面显像,9例行平面及SPECT/CT断层显像,全部病例均经手术和病理检查证实。将每一患者延迟显像中甲状旁腺摄取的最高放射性比值(T/NT)与其近期全段甲状旁腺激素(intact parathy-roid hormone,iPTH)水平及手术和病理结果进行对照。结果患者延迟显像中甲状旁腺摄取的最高T/NT值与其显像前iPTH值呈正相关(r=0.426,P<0.05),与其手术切除的相应甲状旁腺体积呈显著正相关(r=0.352,P<0.01)。所有手术切除的甲状旁腺病理结果均为增生。平面显像在经手术和病理检查证实的106枚功能亢进的甲状旁腺中检出了73枚,准确性为68.9%。SPECT/CT断层显像在经手术和病理检查证实的30枚功能亢进的甲状旁腺中检出了23枚,准确性为76.7%,这些患者的平面显像检出了19枚甲状旁腺,准确性为63.3%。SPECT/CT显像对于继发甲旁亢的增生甲状旁腺检出的准确性较高。结论 99Tcm-MIBI双时相显像能够估测甲状旁腺功能及其增生的程度,也是定位诊断SHPT的有效方法。SPECT/CT断层显像较单纯平面显像能发现更多功能增强的甲状旁腺,结合CT断层对于病灶的解剖定位更加准确,尤其是术后继发甲旁亢持续存在或复发需再次手术者,为手术治疗继发甲旁亢提供更多证据。
Objective To discuss the clinical value of dual-phase 99Tcm-sestamibi（99Tcm-MIBI） scintigraphy and SPECT/CT in secondary hyperparathyroidism,and to investigate the possibility of SPECT/CT for the accurate localization diagnosis of secondary hyperparathyroidism preoperatively.Methods Thirty-one patients underwent parathyroid imaging with double-phase 99Tcm-MIBI before surgery for hyperparathyroidism.Planar imaging was conducted in 22 patients,and planar and SPECT/CT imaging in 9 patients.The diagnosis of hyperparathyroidism was confirmed by surgical and pathological findings.Target/non-target（T/NT） ratio in delay image was compared with the volume of excised parathyroid,the intact parathyroid hormone（iPTH）,and the pathology of the surgical sample.Results T/NT ratio was correlated with serum iPTH（r=0.426,P0.05） and parathyroid volume（r=0.352,P0.01）.Hyperplasia of parathyroid gland was found in all excised samples.Planar images showed hyperparathyroidism in 73 of the 106 excised parathyroid glands,and the accuracy rate is 68.9%.In the 30 excised parathyroid glands,SPECT/CT images detected 23 hyperparathyroidism（accuracy rate 76.7%）,and planar imaging found 19 hyperparathyroidism（accuracy rate 63.3%）.Conclusions Dual-phase 99Tcm-MIBI scintigraphy can be used to assess function and hyperplasia of parathyroid,being the most effective method for localization diagnosis of secondary hyperparathyroidism.SPECT/CT imaging is more efficient than planar imaging for the detection of parathyroid glands with hyperparathyroidism.SPECT/CT parathyroid imaging combined with CT scan will provide more information about localization of the lesions,especially for those with persistent or recurrent hyperthyroidism after parathyroidectomy.
出处
《中国血液净化》
2011年第5期242-245,共4页
Chinese Journal of Blood Purification
基金
首都医学发展科研基金资助项目(2009-3023)
