99mTc-MIBI 显像及定量分析定位诊断甲状旁腺腺瘤的临床应用

目的根据高功能甲状旁腺对MIBI摄取增高的原理,应用SPECT和平面显像定量分析评价术前定位原发性甲旁亢的诊断价值。方法对21例原发性甲旁亢患者采用99mTc-MIBI平面双时相显像及定量分析作术前定位;其中4例加作SPECT断层显像。检测所有病人血清PTH水平及血清钙水平。定量分析采用靶甲状旁腺腺瘤与最大甲状腺放射性(ROI)平均计数比率和靶甲状旁腺腺瘤(T)与对侧相应甲状腺(NT)比值计算。结果双时相平面显像的敏感性为81%(17/21);其中4例平面显像假阴性者2例经SPECT断层获得阳性定位(1例异位腺瘤、1例腺瘤虽然位置正常但同时存在多发结节性甲状腺肿);另2例假阴性者为位置正常但摄取99mTc-M IB I低的腺瘤。甲状旁腺腺瘤对最大甲状腺放射性计数的平均摄取比值和T/NT比值分别为0.95±0.41和2.51±1.76。结论99mTc-MIBI显像是最有效的探测甲状旁腺腺瘤的方法;对探测异位性甲状旁腺腺瘤或同时存在多发结节性甲状腺肿时SPECT断层的敏感性比平面显像更高。     

核医学诊断原发性甲状旁腺功能亢进症的价值

目的 探讨核医学诊断原发性甲状旁腺功能亢进症的临床价值.方法 回顾性分析10例以全身骨扫描而得到启发考虑原发性甲状旁腺功能亢进症并进一步行99mTc-MIBI双时相核素及99mTcO4-甲状腺显像的患者资料.结果 10例患者骨显像呈代谢性骨病表现,T99mc-MIBI双时相核素及99mTc04-甲状腺显像部分发现异常影像,最后经手术病理证实.结论 对于无肿瘤病史的首发骨痛患者,核医学影像对诊断原发性甲状旁腺功能亢进症及其病灶定位有重要的临床价值.     

99Tcm-MIBI 核素显像对甲状旁腺瘤术前定位诊断意义

目的：比较^99Tc^m－甲氧基异丁基异腈（MIBI）核素显像、B超、CT对于高功能甲状旁腺病灶定位诊断的价值。方法：经临床诊断为原发性甲状旁腺机能亢进（简称原发甲旁亢）的7例患者均做了^99Tc^m－MIBI核素显像主B超、CT检查。结果：7例患者共摘除7枚腺瘤和1枚增生腺体，均经病理诊断证实。^99Tc^m－MIBI核素显像、B超、CT的灵敏度分别为88％、75％和63％，特异性为100％、100％和95％，准确性为96％、93％和89％。^99Tc^m－MIBI核素显像与CT无明显差异，^99Tc^m－MIBI核素显像在灵敏度和准确性方面优于B超，但特异性三者近似。结论：^99Tc^m－MIBI双时相法对于甲状旁腺瘤的定位诊断很有帮助，原发甲旁亢患者首次探查术前进行无创影像定位检查是必要的。     

SPECT/CT融合显像在甲状旁腺功能亢进症术前诊断中的应用价值

目的:探讨SPECT/CT融合显像在原发性甲状旁腺功能亢进症(PHPT)术前诊断中的应用价值。方法:回顾性分析2017年2月~2019年1月就诊于本院的52例PHPT患者临床资料,术前30d均接受99TCm-MIBI SPECT/CT融合显像检查。以病理诊断为金标准,分析99TCm-MIBI SPECT/CT融合显像检查PHPT的检出率和不同病灶的检出率。结果:52例患者经病理诊断共73处病灶,其中异位甲状旁腺腺瘤3例(3处病灶),甲状旁腺腺瘤42例(55处病灶),甲状旁腺增生3例(12处病灶),甲状旁腺癌术后淋巴结转移3例(3处病灶);经99TCm-MIBI SPECT/CT融合显像检查确诊患者52例,检出病灶63个,检出率为86.30%(63/73),其中异位甲状旁腺腺瘤3处(100.00%),甲状旁腺腺瘤52处(94.55%),甲状旁腺增生5处(41.67%),甲状旁腺癌术后淋巴结转移3处(100.00%)。结论:99TCm-MIBI SPECT/CT融合显像是检测PHPT的有效方式,可精确定位病灶,为手术提供重要参考依据。     

无症状型甲状旁腺肿物高频超声诊断价值

目的探讨高频超声对无症状甲状旁腺肿物的诊断价值.方法回顾分析1645例甲状腺查体中发现7例患有甲状旁腺肿物,发现可疑病灶后,进行全面甲状旁腺扫查,结果与血清检查及病理诊断等临床资料综合分析.结果7例甲状旁腺肿物中4例为甲旁腺腺瘤,其中1例合并结甲,1例并部分腺瘤囊性变;1例因可疑甲状旁腺增生进一步检查合并肾功能不全;另2例经穿刺抽液证实为无功能性甲状旁腺囊肿.结论高频超声检查可以较早发现甲状旁腺疾病,可避免进一步影响患者生活质量,是首选的一种可靠检查方法.     

原发性甲状旁腺功能亢进症的诊断与外科治疗

目的 探讨原发性甲状旁腺功能亢进症(PHPT)的诊断和外科治疗经验.方法 回顾性分析2000～2006年行外科手术治疗的26例PHPT患者的临床资料.甲状旁腺腺瘤22例,甲状旁腺增生3例,甲状旁腺癌1例.所有患者均有血钙和血清甲状旁腺素(PTH)升高,全组平均血钙为(3.4±0.8)mmol/L,术前测血清PTH平均为(921.7±819.2)pg/ml.手术治疗以病变甲状旁腺切除术为主,占96.15%(25/26).结果 全组患者均为一次手术切除病灶,手术治疗过程中无一例术中死亡,无一例出现喉返神经损伤.术后第1、3、7天测血清PTH均在正常范围,无一例出现甲状旁腺功能减退,但全组患者术后均出现不同程度的低钙血症,血钙为1.8～2.2 mmol/L.术后随访17例,随访时间6个月至3年.14例患者血钙于6个月内恢复正常,并不需要额外补充钙剂;另2例骨折患者和1例骨痛患者于血钙正常后自行持续口服钙剂.随访中无一例出现PHPT复发或甲状旁腺功能减退.结论 PHPT根据临床症状和辅助检查可以确诊,甲状旁腺切除术是治疗PHPT的有效方法,术前的准确定位和术中监测血清PTH是手术成功的关键.     

外科手术治疗原发性甲状旁腺功能亢进39例

目的 总结原发性甲状旁腺功能亢进(PHPT)的诊断与外科治疗经验.方法 回顾性分析2000年1月至2008年12月39例PHPT的诊断和外科手术治疗经验.结果 定位明确的32例甲状旁腺单发腺瘤及3例多发腺瘤行单侧探查,另外1例多发腺瘤和2例甲状旁腺增生行双侧探查,1例甲状旁腺癌行根治性切除和颈部淋巴结清扫术,手术后均发生不同程度的低钙血症,应用钙剂后症状缓解.结论 超声和~(99m)Tc放射性核素扫描可作为诊断甲状旁腺疾病的首选定位诊断方法,定性诊断主要依据血钙和血甲状旁腺激素的检测.单侧探查定位明确的甲状旁腺腺瘤是安全可靠的;对于甲状旁腺增生和术前定位不明确的多发腺瘤,必须进行双侧探查;甲状旁腺癌进行根治性切除和颈部淋巴结清扫.     

原发性甲状旁腺机能亢进症11例分析

原发性甲状旁腺机能亢进症(简称原发性甲旁亢)系指甲状旁腺发生腺瘤、增生或癌,甲状旁腺素分泌过剩所致钙、磷及骨的代谢异常。随着生化筛选法在临床广泛应用,确诊率逐年增加,本文就我院收治的11例,对原发性甲旁亢的某些诊治问题讨论如下: 临床资料:一、1959到1984年共11例。男2例,女9例。病程为0.5～9午。二、临床症状:11例中有双膝痛者10例,腰背痛6例,髋部痛5例。所有病人首发症状均起于下肢。有肌无力表现者9例,行走困难者9例,5例下蹲困难。8例曾发生病理骨折,有食欲不     

原发性甲状旁腺机能亢进症易被误诊

甲状旁腺数目一般人有四个,约黄豆大小,扁平,黄褐色,质软,附着在甲状腺左右两叶的背面,就是肿大也很难摸到它。甲状旁腺分泌一种甲状旁腺激素,其作用一方面通过骨组织,另方面通过肾脏,调节人机体内钙和磷的代谢,使其经常维持血中钙含量在正常水平。如果正常的甲状旁腺长了腺瘤或增生肥大或发生腺癌(少见),则它所分泌的甲状旁腺激素就大为增多,功能加强,一般叫做“原发性甲状旁腺机能亢进”,简称甲旁亢。因甲状旁腺激素增多,钙就从骨中动员出来跑到血循环中,血清中     

原发性甲状旁腺功能亢进症6例误诊分析

原发性甲状旁腺功能亢进(以下简称原发性甲旁亢)是一种较少见的内分泌疾病,常导致骨骼、肾脏、消化系统、神经系统病变和钙磷代谢紊乱.因其缺乏特异性临床表现,故在临床诊治过程中多数曾有误诊[1],而且确诊者多为出现严重并发症的晚期病例,治疗效果不佳.现就我科收治的6例原发性甲旁亢误诊报道如下.……     

Radionuclide imaging of parathyroid adenoma using the 201TI-99mTc substraction scintigraphy method

Primary hyperparathyroidism is the most frequent parathyroid disease. Parathyroid adenomas account for the majority of primary hyperparathyroidism (81%) while carcinoma and diffuse hyperplasia occur less frequently (4% and 15%). Ten per cent of adenomas are located substernally. The difficulties of preoperative localization of parathyroid adenomas may lead to incomplete surgical removal. Therefore an accurate technique for preoperative localization of the parathyroid gland is of utmost importance. Various imaging methods are available (ultrasonography, computer tomography, angiography, etc.), each with their own limitations. Thus, a nuclear technique performed via 201Tl-99mTc dual isotope subtraction scintigraphy may well contribute to the safety of diagnostics. The authors present a case of parathyroid adenoma diagnosed by this method and confirmed histologically. The role of non-invasive techniques in preoperative localization of parathyroid adenomas protecting the patient from invasive procedures and repeated surgical explorations is highly emphasized.     

Intra-operative parathyroid hormone assay for simplified localization of parathyroid adenomas.

Lack of success in parathyroid surgery is usually due to failure to identify the abnormal parathyroid gland correctly at operation. The surgeon may be helped by rapid parathyroid hormone (PTH) assay in peripheral blood after removal of a suspected adenoma, and by frozen section histology, but these are not true localization techniques. We have adapted a non-isotopic immunoassay for rapid measurement of PTH in samples from the upper, middle and lower thyroid veins taken at operation, before exploration begins. Fifteen patients with primary hyperparathyroidism were operated on. In 10 the parathyroid adenoma was located easily, and was associated with high local venous PTH levels. In four patients the abnormal parathyroid was not immediately apparent but the assay indicated its location, which was confirmed after further exploration. In one patient there was no difference in PTH levels in the six venous samples. An ectopic adenomatous gland was successfully identified behind the thymus. The operation was successful in all patients as shown by a fall in the plasma calcium to the normal range. We conclude that intra-operative selective venous sampling and rapid PTH assay facilitates operative localization of parathyroid adenomas.     

Clinical profile of 128 subjects operated for primary hyperparathyroidism

From 1960 to 1990, one hundred twenty eight (128) subjects with primary hyperparathyroidism were operated in the University Hospital. The medical records were reviewed. Serum and urine chemistries were done by conventional methods, serum PTH was done by RIA's (N-, C-, and midregion) and intact by IRMA and 1,25 dihydroxycholecalciferol by a non equilibrium receptor assay from calf thymus and preceded by double Sep-Pak chromatography. The distal third of the radius (nondominant arm) was used to evaluate radial bone density (RBD), using single photon absorptiometry (Norland) and the lumbar bone density (LBD) was measured by dual energy X Ray absorptiometry (DEXA). The RBD was done in 41 females and 15 males and the LBD in 12 females and 4 males. The series comprised 95 females, age range from 15 to 79 years, and 33 males, age range from 14 to 69 years. Prominent clinical features included nephrolithiasis in 72 subjects (56%), osteitis fibrosa cystica in 2, isolated familial hyperparathyroidism in 4 subjects in one family, 7 subjects with MEN-1 in 3 families, and 4 subjects with MEN-2 in one family. Only 7 subjects were asymptomatic. Serum calcium was elevated in all, serum alkaline phosphatase was elevated in 24% and urinary hydroxiproline was increased in 48%. Serum phosphorus was low in 92%. PTH assay was either elevated or inappropriately normal for the serum calcium in all patients tested. Serum 1,25 D was elevated in 57%. The PTH level was positively correlated with the serum calcium (r = 0.70), but had no significant correlation with the serum phosphorus and the 1,25 D. The RBD expressed as the standard deviation from that of the mean for age and sex matched controls was > or = 2 SD below the mean in 39% of females and in 40% of males. In contrast to the RBD none of the subjects tested had a LBD > or = 2 SD below the age and sex adjusted mean. 103 subjects had adenomas, 20 primary hyperplasia, 2 carcinomas and in 3 surgical exploration was unsuccessful. As to the outcome of Surgery, 117 (93%) were cured. Thus, in this series, successful surgery for primary hyperparathyroidism is the rule. Primary hyperparathroidism is rarely asymptomatic and appendicular bone disease and nephrolithiasis are commonly seen.     

Recent advances in preoperative and intraoperative nuclear medicine procedures in patients with primary hyperparathyroidism

Although bilateral neck exploration is traditionally considered as the treatment of choice in patients with primary hyperparathyroidism (HPT), several surgical techniques of limited neck exploration have been proposed over the last 10 years in primary HPT patients with a high probability to be affected by a solitary parathyroid adenoma. The availability in recent years of highly sensitive and accurate preoperative imaging modalities, particularly the parathyroid scintigraphy with 99mTc-MIBI and high resolution neck ultrasonography, allowed to increase the rate of primary HPT patients as candidates to a selective parathyroidectomy. One of the most innovative techniques for limited surgery is the minimally invasive radio-guided parathyroidectomy that is based on the intraoperative detection of the parathyroid adenoma under the guidance of a gamma probe allowing the removal of the parathyroid adenoma through a small 2-cm skin incision. However, if a minimally invasive parathyroidectomy is taken into consideration, accurate preoperative imaging is mandatory not only to distinguish patients with a solitary parathyroid adenoma from those with multi-glandular disease but also to diagnose patients with concomitant thyroid nodule(s) that can cause false-positive results at radio-guided surgery. In the present study the most recent advances reached with preoperative localizing imaging of parathyroid adenomas are reviewed and the techniques proposed to perform a minimally invasive radio-guided surgery are discussed with particular regard to the therapeutic efficacy and cost-effectiveness analysis.     

New intraoperative diagnostic methods in parathyroid surgery: intraoperative measurement of parathyroid hormone

In thirty-seven patients undergoing parathyroidectomy from November 1999 to July 2000 with diagnosis of primary hyperparathyroidism the intraoperative intact parathyroid hormone level were studied. Preoperative samples of blood were taken from a peripheral vein before the beginning the operation. The second sample was taken 5 minutes after removal of parathyroid adenoma. The plasma intact parathyroid hormone concentration was measured by quick IRMA method. The preoperative high PTH levels reduced after excision of adenoma to the mean 18%. 33 patients had normal PTH levels after 5 minutes of removing. The total measuring time of quick PTH assay was about 30 minutes. The QPTH assay was a quantitative adjunct for the surgeon to ensure a successful parathyroidectomy. When the intraoperative QPTH level is not reduced to 50%, then the exploration should be continued and the probability of reoperation is decreased. They propose the application of the routine intraoperative measurement of QPTH level in all parathyroidectomy.     

^18F-FDG显像诊断骨转移瘤价值与骨显像的比较

目的:本文旨在评价18F-FDG符合线路显像与99mTc-MDP全身骨显像对骨转移瘤的诊断价值,探讨两种显像结果的差异及可能的原因。方法:对41例因怀疑恶性肿瘤或有骨转移病人在4周内同期行18F-FDG显像和99mTc-MDP全身骨显像,并对两种检查结果进行比较。结果:39例恶性肿瘤,确诊骨转移瘤19例,11例良性骨病变,9例正常,2例良性肿瘤。18F-FDG符合线路显像对骨转移瘤诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为94.7%、85.0%、87.1%、93.7%和89.7%,而99mTc-MDP全身骨显像分别为84.2%、55.0%、65.3%、76.5%和69.2%,两组仅准确率(P<0.05)的差异存在统计学上的意义。结论:两种显像在判断恶性肿瘤骨转移方面的效果基本相同,都是比较理想的检查方法。但18F-FDG显像对骨转移瘤诊断的准确率高于骨显像。     

New intraoperative diagnostic methods parathyroid surgery. Adenoma localization by gamma probe

INTRODUCTION: The key to heal primary hyperparathyroidism is to find the hyper functioning parathyroid gland(s). Promoting this the perioperative isotope guided localization technique is worldwide used in the last years. Aim: Authors use this method since February, 2000. They present their experiences. METHODS: At 122 patients undergoing parathyroidectomy in last 5 years with diagnosis of primary hyperparathyroidism perioperative sestamibi scanning by gamma probe was taken to localize the adenoma. Tc-99m-sestamibi was administered 90-150 minutes before starting anesthesia. The distribution of activity was measured before operation percutaneously on the neck and during operation directly at explored parathyroid regions. Finally the removed specimens were ex vivo scanned. RESULTS: Because of the thyroid lobes also accumulate sestamibi the localizability of adenomas depended on direction of scanning. Important factor is the correct timing of isotope administration in order to achieve domination of parathyroid activity in time of measurement. Localization of adenomas by percutaneous measurement was correct in 36.1% of cases and by perioperative direct scanning in 66.4%. Furthermore, ex vivo scan of removed adenomas showed impressively high activity in all cases. CONCLUSIONS: In their experience sestamibi scanning lightens the operation only in a part of cases but probably it will be the most important method of localization if isotope selectively accumulating in parathyroid gland could be found. For the moment the greatest profit of this method is that the ex vivo measurement indicates the success of operation with great probability.     

肾石型原发性甲状旁腺功能亢进症9例报告——附文献复习

目的 探讨肾石型原发性甲状旁腺功能亢进症(PHPT)的诊断及治疗.方法 对2000-2005年收治的881例肾结石患者中用简易代谢评估法初诊确诊并经手术和病理证实为PHPT9例患者的临床资料进行回顾和总结,并复习有关文献.结果 9例PHPT患者术前血钙平均(2.96±0.48)mmol/L,术后平均(1.94±0.42)mmol/L;术前血清甲状旁腺激素(PTH)平均(1133.53±788.21)pmol/L,术后24 h平均(74.52±49.17)pmol/L,手术前后血钙、PTH水平比较差异均有统计学意义(P值均＜0.01).随访14个月至6年,术后3个月内PTH均下降至正常范围,此后8例患者PTH、血钙、血磷维持于正常范围内,所有经治疗的输尿管结石3个月后均排尽,而肾结石无明显变化.结论 肾结石患者中血钙升高是诊断肾石型PHPT的有利线索.血钙不高者PTH升高2倍以上也需考虑为PHPT.建议尿路结石患者初诊时应进行包括血清钙、磷代谢及PTH等在内的简易代谢评估.