摘要
目的:探讨MRI在维持性血液透析患者甲状旁腺增生术前定位的诊断价值。方法:选择2019年1月-2020年6月符合纳入标准的43例维持性血液透析(MHD)合并继发性甲状旁腺功能亢进(SHPT)患者,所有患者均行MRI、超声、CT检查,并由2名及以上影像学医师对检查结果分析,所有患者均行甲状旁腺切除术及病理检查。以病理检查结果为"金标准",记录MRI、超声、CT检查对甲状旁腺病灶的检出数、漏诊数,计算符合率。结果:在入组的43例患者中,术后病理检查结果所报甲状旁腺共89枚,包括常位甲状旁腺78枚、异位甲状旁腺11枚,其中异位甲状旁腺均位于前上纵隔。MRI、超声、CT以及三者联合检测常位甲状旁腺的符合率分别为88.5%、82.1%、80.8%、91.0%,差异无统计学意义(P>0.05)。MRI诊断SHPT患者异位甲状旁腺的符合率(54.5%)高于超声检查符合率(0)及CT检查符合率(9.1%),差异有统计学意义(P<0.05)。在本研究MRI检出的75枚甲状旁腺病灶中,多呈现类圆形、类椭圆形等规则形态,双侧甲状腺后方34枚、上方11枚、下方21枚,气管-食管旁沟3枚,前上纵隔6枚。T1WI图像上,有36个病灶呈等信号,25个病灶呈稍低信号,13个显示不清晰;T2WI图像上,有33个病灶呈均匀高信号,41个病灶呈不均匀高信号。结论:MRI是维持性血液透析患者甲状旁腺增生术前定位的有效检查方法,具有良好的组织分辨率,对甲状旁腺病灶的诊断符合率优于超声和CT检查。
Objective:To explore the diagnostic value of MRI in preoperative localization of parathyroid hyperplasia in maintenance hemodialysis patients.Methods:Forty-three patients with maintenance hemodialysis(MHD)complicated with secondary hyperparathyroidism(SHPT)from January 2019 to June 2020 were enrolled.All patients performed MRI,ultrasound,and CT,which were analyzed by two or more radiologists.According to the pathological examination results as gold standard,the detected and missed foci of parathyroid lesions by MRI,ultrasound,and CT were recorded,and the accuracy was calculated.Results:Eighty-nine parathyroids of 43 patients were reported by pathological examination,including 78 normal parathyroids and 11 ectopic parathyroids located in the anterior superior mediastinum.The accuracy of MRI,ultrasound,CT and combined detection of normal parathyroid gland were 88.5%,82.1%,80.8%and 91.0%,respectively,and the difference was not statistically significant(P>0.05).The accuracy of MRI in the diagnosis of ectopic parathyroid glands in SHPT patients(54.5%)was higher than that of ultrasound(0)and CT(9.1%)(P<0.05).In the 75 parathyroid lesions detected by MRI,most of them were round or oval in shape,34 in the posterior part of the thyroid gland,11 in the upper part,21 in the lower part,3 in the trachea paraesophageal groove and 6 in the anterior and superior mediastinum.Thirty-six lesions were isointense and 25 lesions were slightly hypointense on T1WI,but 13 lesions didn’t show clearly.Thirty-three lesions were homogeneous hyperintensity and 41 lesions were heterogeneous hyperintensity on T2WI.Conclusion:MRI with good tissue resolution is an effective method for preoperative localization of parathyroid hyperplasia in maintenance hemodialysis patients.Its diagnostic sensitivity for parathyroid lesions is higher than that of ultrasound and CT.
作者
易建玮
易加朝
吴荣兴
廖仁引
周卫国
赵旁益
YI Jian-wei;YI Jia-chao;WU Rong-xing(Department of Radiology,Liuzhou Tanzhong People's Hospital,Guangxi 545027,China)
出处
《放射学实践》
CSCD
北大核心
2021年第7期852-856,共5页
Radiologic Practice
基金
广西壮族自治区卫生健康委员会自筹经费科研项目(Z20190292)。
关键词
磁共振成像
维持性血液透析
继发性甲状旁腺功能亢进
甲状旁腺增生
诊断
Magnetic resonance imaging
Maintenance hemodialysis
Secondary hyperparathyroidism
Parathyroid hyperplasia
Diagnosis
