| 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 |
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| 引用本文： | 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, 42(3): 201-206. DOI: 10.3760/cma.j.issn.1673-4114.2018.03.002 |
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| 作者姓名： | 曹景佳 李亚明 |
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| 作者单位： | 110001 沈阳, 中国医科大学附属第一医院核医学科 |
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| 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。
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| 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 |
| 收稿时间： | 2017-11-28 |
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 |
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| Jingjia Cao,Yaming Li. 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, 42(3): 201-206. DOI: 10.3760/cma.j.issn.1673-4114.2018.03.002 |
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| Authors: | Jingjia Cao Yaming Li |
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| Affiliation: | Department of Nuclear Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China |
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| Abstract: | ObjectiveTo 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.MethodsPatients 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.ResultsThe 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).ConclusionFor 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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