^(99m)锝-甲氧基异丁基异腈SPECT/CT显像对慢性肾病继发甲状旁腺功能亢进甲状旁腺病灶的诊断效能被引量：9

Diagnostic efficacy of ^(99)Tc^(m)-sestamibi SPECT/CT for parathyroid lesions in patients with secondary hyperparathyroidism caused by chronic kidney disease

下载PDF

导出

摘要目的探讨SPECT/CT术前准确定位慢性肾病(CKD)继发性甲状旁腺功能亢进(sHPT)患者甲状旁腺病灶的价值。方法 52例甲状旁腺切除术sHPT患者均于术前2周内接受^(99)m锝-甲氧基异丁基异腈双时相平面显像和延迟相SPECT/CT检查。以病理结果为金标准,计算并比较^(99) Tc^m-MIBI平面显像、SPECT、CT和SPECT/CT术前检出甲状旁腺病灶的灵敏度、特异度和准确率。方法经手术病理证实,52例共检出172个甲状旁腺病灶,其中甲状旁腺瘤(PM)13个、腺瘤样增生(AH)26个、甲状旁腺增生(PH)133个。^(99) Tc^m-MIBI平面显像、SPECT、CT、SPECT/CT诊断甲状旁腺病灶的灵敏度分别为55.81%(96/172)、70.35%(121/172)、79.65%(137/172)和81.40%(140/172),特异度分别为92.05%(81/88)、90.91%(80/88)、76.14%(67/88)和93.18%(82/88),准确率分别为68.08%(177/260)、77.31%(201/260)、78.46%(204/260)和85.38%(222/260)。SPECT/CT的灵敏度明显高于及^(99) Tc^m-MIBI平面显像,特异度明显高于,准确率高于13.136,P<0.001)、和^(99) Tc^m-MIBI平面显像。结论 SPECT/CT术前定位诊断sHPT患者甲状旁腺病灶的价值明显优于单一^(99) Tc^m-MIBI平面显像、SPECT或CT。 Objective To investigate the efficacy of SPECT/CT in detecting parathyroid lesions in chronic kidney disease （CKD） with secondary hyperparathyroidism （sHPT） patients. Methods Within 2 weeks before parathyroidectomy （PTX）, 52 patients of CKD with sHPT underwent 99Tem-sestamibi （^99Tc^m-MIBI） dual-phase planar and delayed SPECT/ CT seintigraphy. Taking surgical pathology as the golden standards, the sensitivity, specificity and accuracy of dual-phase planar, SPECT, CT and SPECT/CT were calculated and compared. Results Totally 172 lesions were detected in surgical operation, including 13 parathyroidomas （PM）, 26 adenomatoid hyperplasias （AH） and 133 diffuse parathyroid hyperplasias （PH）. The sensitivity of ^99Tc^m-MIBI dual-phase planar, SPECT, CT and SPECT/CT was 55.81% （96/ 172）, 70.35% （121/172）, 79.65% （137/172） and 81. 400/00 （140/172）, respectively, while the specificity was 92.05% （81/88）, 90.91% （80/88）, 76. 14% （67/88）, 93.18% （82/88）, the accuracy was 68.08% （177/260）, 77.31% （201/ 260）, 78.46% （204/260） and 85.38% （222/260）, respectively. The sensitivity of SPECT/CT was superior to that of SPECT （χ^2=17. 053, P〈0. 001） and ^99Tc^m-MIBI dual-phase planar （χ^2=44. 000, P〈0. 001）. SPECT/CT was superior to CT （χ^2 =10. 316, P =0.001） for specificity, and superior to CT （χ^2=13. 136, P〈0. 001）, SPECT （χ^2=14. 815, P〈0. 001） or ^99Tc^m-MIBI dual-phase planar （χ^2=39. 706, P〈0. 001） for accuracy. Conclusion SPECT/CT fusion imaging is better in localization of parathyroid lesions of CKD with sHPT patients than ^99Tc^m-MIBI dual-phase planar, SPECT or CT imaging alone.

作者刘德军冯彦林余丰文杨明冼伟均王颖鲁胜男 LIU Dejun;FENG Yanlin;YU Fengwen;YANG Ming;XIAN Weijun;WANG Ying;LU Shengnan(Department of Nuclear Medicine, the First People＇s Hospital of Foshan, Foshan 528000, Chin)

机构地区佛山市第一人民医院核医学科

出处《中国医学影像技术》 CSCD 北大核心 2018年第4期509-513,共5页 Chinese Journal of Medical Imaging Technology

关键词肾功能衰竭慢性甲状旁腺功能亢进症 ^99M锝-甲氧基异丁基异腈体层摄影术发射型计算机单光子 Kidney failure, chronic Hyperparathyroidism ^99Tc^m-sestamibi Tomography, emission-computed, single-photon

分类号 R582.1 [医药卫生—内分泌] R817.4 [医药卫生—影像医学与核医学]

引文网络
相关文献

参考文献2

1张祥铭,张敏,胡佳佳,席云,孙晨玮,李彪.^(99)Tc^m-甲氧基异丁基异腈双时相平面显像和SPECT/CT断层显像诊断原发性甲状旁腺功能亢进症[J].中国医学影像技术,2014,30(6):850-853. 被引量：7
2姚晓爱,姜涛,童冠圣,金延方,王慧宇,付玥玥.不同影像学检查方法对原发性甲状旁腺功能亢进症患者甲状旁腺病灶的定位诊断价值[J].中国医学影像技术,2016,32(7):1043-1046. 被引量：17

二级参考文献26

1盛矢薇,朱瑞森,樊友本,高云朝,陆汉魁.^(99m)Tc-MIBI SPECT/CT对原发性甲状旁腺功能亢进症的诊断价值[J].上海交通大学学报（医学版）,2011,31(10):1423-1427. 被引量：17
2方文强,贺晓燕,陈曦,唐永华,刘建民,宁光,陈克敏.原发性甲状旁腺功能亢进症的影像学诊断[J].诊断学理论与实践,2006,5(6):487-491. 被引量：10
3Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single-and dual- phase (99m) Tc-sestamibi parathyroid scintigraphy. J Nucl Med, 2007,48(7) : 1084-1089.
4Gayed IW, Kim EE, Broussard WF, et al. The value of 99Tcm Sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med, 2005, 46 (2) :248-252.
5Clark PB, Case D, Watson NE, et al. Experienced scintigraphers contrihute to success of minimally invasive parathyroidectomy by skilled endocrine surgeons. Am Surg, 2003,69(6):478-483.
6Gómez-Ramirez J, Sancho-Insenser JJ, Pereira JA, et ah Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in pa- tients with primary hyperparathyroidism. Langenbeeks Arch Surg, 2010,395(7) :929 933.
7Boi F, Lombardo C, Cocco MC, et al. Thyroid diseases cause mismatch between MIB1 scan and neck ultrasound in the diagno- sis of hyperfunctioning parathyroids: Usefulness of FNA-PTH assay. EurJ Endoerinol, 2013,168(1) :49 -58.
8Heizmann O, Viehl CT, Schmid R, et al. Impact of concomitant thyroid pathology on preoperative workup for primary hyperpar athyroidism. EurJ Med Res, 2009, 14(1) :37-41.
9Fraser WD. Hyperparathyroidism. Lancet, 2009,374(9684)145-158.
10AACE/AAES Task Force on Primary Hyperparathyroidism. The American of Clinical Endocrinologists and the American Associa- tion of Endorine Surgeons position ataement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract, 2005,11(1) :49-54.