99mTc-MIBI SPECT/CT显像结合半定量分析在甲状旁腺功能亢进症中的诊断价值及影响因素

目的 评估99mTc-MIBI SPECT/CT、99mTc-MIBI双时相显像（DPS）及颈部超声（US）3种检查方式在甲状旁腺功能亢进症（HPT）患者术前定位中的诊断效能并进一步探讨SPECT/CT半定量分析影响因素。方法 回顾性分析2015年1月~2019年7月行手术治疗的104例HPT患者，术前行99mTc-MIBI显像104例和超声82例。利用半定量分析技术勾画感兴趣区并计算病灶/同侧三角肌摄取比值（T/NT）。采用卡方检验分析99mTc-MIBI SPECT/CT、99mTc-MIBI DPS、US 3种检查方式诊断HPT患者的灵敏度及采用非参数检验进行三种方式检出效能分析。使用Spearman对甲状旁腺瘤（PA）、甲状旁腺增生（PH）的T/NT比值与Cox-2、Bcl-2表达水平进行相关性分析。结果 99mTc-MIBI SPECT/CT、99mTc-MIBI DPS、US检查的诊断灵敏度依次为95.19%（99/104）、91.3%（95/104）、81.71%（67/82）；其中99mTc-MIBI SPECT/CT与US相比具有统计学意义（χ2=9.59，P=0.008）。3种检查方式对PH诊断灵敏度依次为 99mTc-MIBI SPECT/CT>99mTc-MIBI DPS>US（P 均<0.05），而对 PA 诊断灵敏度差异无统计学意义（P 均> 0.05）。含脂肪的增生腺体T/NT比值小于无脂肪的增生腺体（P=0.009）。Bcl-2在PA假阴性组病灶表达低于真阳性组（P= 0.046），而Cox-2在两组病灶中的表达无显著差异（P>0.05）；Bcl-2和Cox-2在PH两组病灶中的表达差异均无统计学意义（P> 0.05）。结论 99mTc-MIBI SPECT/CT对HPT定位诊断具有较高的灵敏度，病灶的T/NT比值与体积呈正相关，PA病灶的Bcl-2表达增高、PH病灶的细胞脂肪含量减少有利于HPT病灶腺体的检出。

Preoperative diagnostic value of 99mTc- MIBI SPECT/CT imaging combined with semi-quantitative analysis in hyperparathyroidism and factors affecting its efficacy

Objective To evaluate the diagnostic efficacy of technetium-99m methoxyisobutylisonitrile single photon emission/computed tomography (99mTc- MIBI SPECT/CT), 99mTc- MIBI double- phase scintigraphy (DPS) DPS and ultrasound (US) in preoperative localization of hyperparathyroidism (HPT) and explore the factors affecting the diagnostic efficacy of 99mTc-MIBI SPECT/CT. Methods We retrospectively analyzed the data of 104 patients with HPT undergoing surgical resection between January, 2015 and July, 2019. Preoperative 99mTc-MIBI imaging was performed in all the patients, and 82 patients also received US examination preoperatively. Semi- quantitative analysis was used to draw the region of interest and calculate the lesion/ipsilateral deltoid muscle (T/NT) uptake ratio. The sensitivity and detection performance of 99mTc-MIBI SPECT/CT, DPS and US in the diagnosis of HPT patients were compared, and the correlations of the T/NT ratios of parathyroid adenoma (PA) and parathyroid hyperplasia (PH) with the expression levels of COX-2 and Bcl-2 were analyzed. Results The diagnostic sensitivity of 99mTc- MIBI SPECT/CT, DPS and US for HPT was 95.19% (99/104), 91.3% (95/104) and 81.71% (67/82), respectively, demonstrating a significantly higher diagnostic sensitivity of 99mTc-MIBI SPECT/CT than US (χ2=9.59, P=0.008). For PH lesions, 99mTc-MIBI SPECT/CT had the highest diagnostic sensitivity, followed by DPS and then by US (P<0.05), but their sensitivity did not differ significantly for PA (P>0.05). The T/NT ratio in fatty hyperplastic glands was significantly lower than that in fat-free hyperplastic glands (P=0.009). In PA, Bcl- 2 expression was significantly lower in false negative lesions than in true positive lesions (P=0.046), but Cox-2 expression did not show such a difference (P>0.05). In PH lesions, the expressions of Bcl-2 and Cox-2 did not differ significantly between false negative than true positive lesions (P>0.05). Conclusions 99mTc-MIBI SPECT/CT has a high sensitivity for HPT localization, and the T/NT ratio is positively correlated with the lesion volume. An increased expression of Bcl-2 in PA lesions and a decreased cell fat content in PH lesions can facilitate the detection of HPT glands by 99mTc-MIBI SPECT/CT.