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刘德军,冯彦林,余丰文,杨明,冼伟均,王颖,鲁胜男.^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[J].中国医学影像技术,2018,34(4):509~513

^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

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

投稿时间：2017-05-09 修订日期：2018-03-13

DOI：10.13929/j.1003-3289.201705049

中文关键词: 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

英文关键词:Kidney failure,chronic Hyperparathyroidism ⁹⁹Tc^m-sestamibi Tomography,emission-computed,single-photon

基金项目:

作者	单位	E-mail
刘德军	佛山市第一人民医院核医学科, 广东佛山 528000
冯彦林	佛山市第一人民医院核医学科, 广东佛山 528000	fylin@fsyyy.com
余丰文	佛山市第一人民医院核医学科, 广东佛山 528000
杨明	佛山市第一人民医院核医学科, 广东佛山 528000
冼伟均	佛山市第一人民医院核医学科, 广东佛山 528000
王颖	佛山市第一人民医院核医学科, 广东佛山 528000
鲁胜男	佛山市第一人民医院核医学科, 广东佛山 528000

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中文摘要:

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^99m锝-甲氧基异丁基异腈（⁹⁹Tc^m-MIBI）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⁹⁹Tc^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。结果经手术病理证实，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。⁹⁹Tc^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SPECT（χ²=17.053，P<0.001）及⁹⁹Tc^m-MIBI平面显像（χ²=44.000，P<0.001），特异度明显高于CT（χ²=10.316，P=0.001），准确率高于CT（χ²=13.136，P<0.001）、SPECT（χ²=14.815，P<0.001）和⁹⁹Tc^m-MIBI平面显像（χ²=39.706，P<0.001）。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一⁹⁹Tc^m-MIBI平面显像、SPECT或CT。

英文摘要:

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 ⁹⁹Tc^m-sestamibi (⁹⁹Tc^m-MIBI) dual-phase planar and delayed SPECT/CT scintigraphy. 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 81.40% (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 (χ²=17.053, P<0.001) and ⁹⁹Tc^m-MIBI dual-phase planar (χ²=44.000, P<0.001). SPECT/CT was superior to CT (χ²=10.316, P=0.001) for specificity, and superior to CT (χ²=13.136, P<0.001), SPECT (χ²=14.815, P<0.001) or ⁹⁹Tc^m-MIBI dual-phase planar (χ²=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.

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