[1]彭诗瑶,李盼丽,张艾米,等.99Tcm-MIBI SPECT/CT融合断层显像在甲状旁腺功能亢进症中的应用价值[J].国际放射医学核医学杂志,2018,(3):195-200.[doi:10.3760/cma.j.issn.1673-4114.2018.03.001]
　Peng Shiyao,Li Panli,Zhang Aimi,et al.Importance of 99Tcm-MIBI SPECT/CT fusion imaging in primary and secondary hyperparathyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2018,(3):195-200.[doi:10.3760/cma.j.issn.1673-4114.2018.03.001]
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
期数:
2018年第3期
页码:
195-200
栏目:
单光子显像在临床中的应用
出版日期:
2018-05-25

文章信息/Info

Title:
Importance of 99Tcm-MIBI SPECT/CT fusion imaging in primary and secondary hyperparathyroidism
作者:
彭诗瑶1;  李盼丽1;  张艾米1;  刘秋芳1;  徐莲1;  孙晓光1;  黄钢2;  宋少莉1
1. 200127, 上海交通大学医学院附属仁济医院核医学科;
2. 201318, 上海健康医学院医学影像学院
Author(s):
Peng Shiyao1;  Li Panli1;  Zhang Aimi1;  Liu Qiufang1;  Xu Lian1;  Sun Xiaoguang1;  Huang Gang2;  Song Shaoli1
1. Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China;
2. Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
关键词:
99m锝甲氧基异丁基异腈; 单光子发射计算机体层摄影术; 甲状旁腺功能亢进; 原发性; 甲状旁腺功能亢进症; 继发性
Keywords:
Technetium Tc 99m sestamibi; Single-photon; emission-computed; Tomography; Hyperparathyroidism; primary; Hyperparathyroidism; secondary
DOI:
10.3760/cma.j.issn.1673-4114.2018.03.001
摘要:
目的 评价99Tcm-MIBI SPECT/CT双时相融合断层显像在原发性甲状旁腺功能亢进症（PHPT）与继发性甲状旁腺功能亢进症（SHPT）中的应用价值。方法 回顾性分析97例（PHPT 28例，SHPT 69例）HPT患者的99Tcm-MIBI SPECT/CT显像图像特征、症状、血清甲状旁腺激素（PTH）、血钙、磷及碱性磷酸酶（AKP）等结果。分析比较PHPT和SHPT两组患者的显像特点、手术病理、实验室检查以及诊断的灵敏度、特异度与临床指标之间的相关性。结果 （1）99Tcm-MIBI SPECT/CT显像对PHPT的术前诊断灵敏度为96.55%，特异度为98.78%；对SHPT的术前诊断灵敏度为68.77%，特异度为79.17%。（2）PHPT多表现为单发病灶，而SHPT多表现为多个亢进的甲状旁腺病灶，病灶平均直径较小（Z=-2.591，P=0.010），且容易合并钙化（χ2=9.588，P<0.01），差异均有统计学意义。（3）PHPT中无特殊不适主诉的患者比例明显高于SHPT中的比例（χ2=11.713，P<0.001），PHPT出现结石的比例高于SHPT（χ2=6.075，P<0.001），SHPT出现骨痛的比例高于PHPT（χ2=24.382，P<0.01），差异均有统计学意义；SHPT患者血清PTH和AKP水平均明显高于PHPT，差异有统计学意义（Z=-6.663、-4.326，均P<0.001），PHPT具有高钙低磷的特点，SHPT患者血钙正常或轻度升高，血磷明显升高。结论 99Tcm-MIBI SPECT/CT双时相显像在PHPT患者的术前定位中有重要价值，特别是在PHPT中有极高的准确率。与PHPT相比，SHPT血清PTH、AKP水平升高更明显，多表现为多个病灶，病灶小，易合并钙化。
Abstract:
Objective The value of 99Tcm-MIBI SPECT/CT fusion imaging in primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) was evaluated. Methods A total of 97 HPT patients (28 PHPT patients and 69 SHPT) were enrolled in this retrospective study. The 99Tcm-MIBI SPECT/CT imaging features, clinical symptoms, serum PTH, Ca, P, and AKP were analyzed. The following data were compared between PHPT and SHPT patients:imaging features; pathological findings; laboratory examination results; and relevance of diagnostic efficiency and clinical index. Results (1) The sensitivity and specificity of 99Tcm-MIBI SPECT/CT in PHPT were 96.55% and 98.78%, respectively. By contrast, the sensitivity and specificity of 99Tcm-MIBI SPECT/CT SHPT were 68.77% and 79.17%, respectively. (2) PHPT generally exhibited single lesion with average diameter was 17.4 mm. Compared with PHPT, SHPT generally displayed more lesions with smaller diameter of 12.8 mm (Z=-2.591, P=0.010) and more likely to be found with calcification(χ2=9.588, P<0.01). (3) The percentage of patients without special clinical symptoms was higher in PHPT(χ2=11.713, P<0.001). The percentage of patients with calculus in urinary system was also higher in PHPT(χ2=6.075, P<0.001). However, the percentage of patients with ostalgia was higher in SHPT(χ2=24.382, P<0.001). Serum PTH and AKP were significantly higher in SHPT(Z=-6.663, -4.326, both P<0.001). PHPT had high serum calcium level and low phosphorus level, whereas SHPT showed normal or slightly higher calcium level and significantly high phosphorus level. Conclusions 99Tcm-MIBI SPECT/CT fusion imaging had a significant value in preoperation localization of HPT, especially in PHPT. Compared with PHPT, SHPT had a greater increase in serum PTH and AKP and usually exhibited several lesions which are smaller and more likely to accompany calcification.

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备注/Memo

备注/Memo:
收稿日期:2018-02-20。
基金项目:国家自然科学基金（81471708，81771861）；上海市高峰高原计划研究型医师（20172010）
通讯作者:宋少莉,Email:shaoli-song@163.com
更新日期/Last Update: 2018-05-25