[1]曹景佳,李亚明.SPECT/CT双时相联合减影技术诊断甲状旁腺功能亢进症的增益价值[J].国际放射医学核医学杂志,2018,(3):201-206.[doi:10.3760/cma.j.issn.1673-4114.2018.03.002]
　Cao Jingjia,Li Yaming.Incremental value of SPECT/CT fusion imaging with dual-phase and dual-tracer technique in the diagnostic localization of parathyroid lesions in patients with hyperparathyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2018,(3):201-206.[doi:10.3760/cma.j.issn.1673-4114.2018.03.002]
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SPECT/CT双时相联合减影技术诊断甲状旁腺功能亢进症的增益价值(/HTML)
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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:
201-206
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:
Incremental value of SPECT/CT fusion imaging with dual-phase and dual-tracer technique in the diagnostic localization of parathyroid lesions in patients with hyperparathyroidism
作者:
曹景佳;  李亚明
110001 沈阳, 中国医科大学附属第一医院核医学科
Author(s):
Cao Jingjia;  Li Yaming
Department of Nuclear Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
关键词:
甲状旁腺功能亢进症; 放射性核素显像; 单光子发射计算机体层摄影术; 甲状旁腺腺瘤
Keywords:
Hyperparathyroidism; Radionuclide imaging; Single photon emission computed tomography computed tomography; Parathyroid adenoma
DOI:
10.3760/cma.j.issn.1673-4114.2018.03.002
摘要:
目的 探讨在99Tcm-MIBI双时相平面显像的基础上联合减影平面显像及SPECT/CT融合显像对甲状旁腺功能亢进症（以下简称甲旁亢）患者术前诊断的增益价值。方法 2015年3月至2016年3月序贯纳入本院甲旁亢患者28例。所有患者行放射性核素显像前1～2周检测血清甲状腺旁腺激素（PTH）及血钙值。静脉注射99TcmO4-40~60 MBq后行甲状腺99TcmO4-显像；待采集结束后，再次静脉注射99Tcm-MIBI 600 MBq，行早期99Tcm-MIBI平面显像，后行SPECT/CT融合显像。在行99Tcm-MIBI延迟平面显像后，获得减影平面显像。以病理诊断结果为金标准，计算各显像技术的诊断效能。显像技术检出病灶数据的比较采用配对卡方检验，其他数值型变量采用Wilcoxon秩和检验。结果 原发性和继发性甲旁亢患者术前检测PTH水平分别为（102.4±88.8）、（98.2±53.6） pmol/L，血钙水平分别为（2.9±0.3）、（1.9±0.2） mmol/L。28例甲旁亢患者共发现可疑性结节55处，其中40处甲旁亢病灶，15处非甲旁亢病灶。双时相检出19处病灶和2处阳性浓聚灶，其灵敏度为47.5%（19/40）。在双时相诊断甲旁亢病灶为阴性结果的患者中，减影相检出其他5处病灶，提高了病灶检出的灵敏度（60.0%），差异有统计学意义（χ2=2.716，P=0.125）。SPECT/CT融合显像检出甲旁亢病灶26处，将双时相和减影相联合分析，检出甲旁亢病灶25处、非甲旁亢病灶4处；将双时相联合SPECT/CT融合显像分析，检出甲旁亢病灶26处、非甲旁亢病灶1处。减影相联合SPECT/CT融合显像与全部联合显像诊断效能相同，检出甲旁亢病灶27处、非甲旁亢病灶1处，其灵敏度和特异度较双时相（67.5% vs.47.5%和93.3% vs.86.7%）提高，差异均有统计学意义（χ2=6.635，P=0.02；χ2=4.432，P=0.04）。结论 甲旁亢患者在行常规双时相平面显像的基础上联合减影平面显像及SPECT/CT融合显像，较单纯行双时相平面显像可以提高患者病灶的检出率。
Abstract:
Objective To investigate the increasing value of SPECT/CT fusion imaging with a dual-phase and dual-tracer technique for localizing parathyroid lesions in an unselected patient cohort with hyperparathyroidism. Methods Patients with biochemically confirmed hyperparathyroidism were included in a prospective trial. The baseline values of all laboratory parameters were determined 1-2 weeks before 99Tcm-MIBI parathyroid scintigraphy was performed. Afterward, 40-60 MBq 99TcmO4- was injected with static thyroid image acquisition, followed by 600 MBq 99Tcm-MIBI injection. SPECT/CT was acquired immediately. With 99Tcm-MIBI additional delayed imaging were acquired. Patients were subjected to a subtraction protocol. Surgical and histological findings were used as the standard of comparison, sensitivity and specificity were calculated, and McNemar test and Wilcoton test were conducted to compare them at a significant level of 0.05. Results The preoperative parathyroid hormone(PTH) levels of primary and secondary hyperparathyroidism were (102.4±88.8), (98.2±53.6) pmol/L, and the serum calcium level was (2.9±0.3), (1.9±0.2) mmol/L respectively. After surgical examination was completed, 40 enlarged parathyroid glands were found in 28 patients. Of these patients, 21 had single adenoma, and 7 had a multi-gland disease. The dual-phase technique could be used to accurately detect and diagnose parathyroid disease in 19 of 40 histological samples. The sensitivity and specificity for parathyroid disease localization were 47.5%(19/40). For those who yielded negative results and underwent the subtraction phase, five other lesions were detected, indicating an increased detection sensitivity(60.0%), the difference was significant(χ2=2.761, P=0.125). Furthermore, 26 of 40 histological samples were diagnosed with SPECT/CT fusion imaging, 25 hyperparathyroidism lesions were detected with dual-phase and subtraction-combined analysis, and 26 of 40 histological samples were accurately diagnosed with dual-phase combined with SPECT/CT fusion imaging. Subtraction-combined SPECT/CT fusion imaging and all combined scintigraphy diagnostic values exhibited the same performance. The sensitivity and specificity of the proposed method significantly improved compared with those of the dual-phase technique(67.5% vs. 47.5%, χ2=6.635, P=0.02; 93.3% vs. 86.7%, χ2=4.432, P=0.04). Conclusion For patients with hyperparathyroidism, the detection rate of lesions by conventional dual-phase plane imaging combined with subtraction plane imaging and SPECT/CT fusion imaging was improved compared with that by single-and dual-phase plane imaging.

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备注/Memo

备注/Memo:
收稿日期:2017-11-28。
通讯作者:李亚明,Email:ymli2001@163.com
更新日期/Last Update: 2018-05-25