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甲状旁腺功能亢进症(HPT)的主要治疗方法为手术治疗,准确的术前影像学定位对手术至关重要。目前HPT手术的术前定位方法有很多种,包括超声、甲状旁腺核素平面显像、CT和MRI。超声、CT、MRI可显示颈部病灶的位置及解剖关系,甲状旁腺核素平面显像可以相对特异地定位病变的甲状旁腺,但均存在一定的局限性。甲状旁腺体积小,数量与位置多变异,SPECT/CT、PET/CT、超声造影、四维CT和四维MRI的应用,可进一步提高HPT术前定位的灵敏度、准确率和手术成功率。笔者旨在介绍并分析各种甲状旁腺影像学检查的优劣势。 相似文献
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目的探讨^99Tc^m-MIBI双时相显像在定位诊断继发性甲状旁腺功能亢进症(SHPT)中的临床价值。方法回顾性分析2010年至2013年间20例(男8例,女12例,平均年龄49.6岁)行甲状旁腺切除术的肾性SHPT患者影像学资料,以术后病理结果为“金标准”,计算^99Tc^m-MIBI双时相SPECT/CT显像结果与彩色多普勒超声(CDUS)对SHPT的诊断效能,同时对延迟显像中甲状旁腺摄取的最高放射性比值(T/NT)与患者近期全段PTH(iPTH)水平及术中切除的相应甲状旁腺体积的关系作分析。采用x^2检验、Pearson相关或Spearson相关分析数据。结果^99Tc^m-MIBI双时相显像和CDUS诊断SHPT的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为66.67%(44/66)、100%(14/14)、100%(44/44)、38.89%(14/36)、72.50%(58/80)和78.19%(43/55)、52.38%(11/21)、81.13%(43/53)、47.83%(11/23)、71.05%(54/76)。二者诊断SHPT的特异性和阳性预测值差异有统计学意义(x^2=9.33和9.26,均P〈0.05),其余3个指标差异均无统计学意义(x^2=1.97、0.04和0.46,均P〉0.05)。最高T/NT与患者iPTH水平及手术切除的相应甲状旁腺体积均呈正相关(r=0.638,rs=0.571,均P〈0.05)。结论^99Tc^m-MIBISPECT/CT显像诊断SHPT的特异性高于CDUS0^99Tc^m-MIBI双时相显像可准确定位功能亢进的甲状旁腺,为手术治疗提供依据。 相似文献
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目的评价99mTc-MIBI双时相显像对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPD)的应用价值。方法 58例临床确诊或疑诊的SHPD患者,行99mTc-MIBI 20 min和2 h双时相显像,同期行甲状旁腺B超检查。最后诊断方法为术后病理或血清IPTH水平与临床随访综合分析。确诊为SHPD 52例,排除诊断6例。其中25例手术后病理诊断为:甲状旁腺增生10例,甲状旁腺增生伴腺瘤9例,甲状旁腺腺瘤6例。结果 58例患者99mTc-MIBI双时相显像阳性50例,阴性8例。其中真阳性49例,假阳性1例,真阴性5例,假阴性3例。99mTc-MIBI双时相显像诊断SHPD的敏感性、特异性和准确率分别为94.2%、83.3%和93.1%。对于49例真阳性,99mTc-MIBI双时相显像共发现SHPD病灶114个,其中1个病灶为14例,2个病灶为21例,3个以上病灶14例。同组资料B超诊断SHPD的敏感性、特异性和准确率分别为88.5%、50%和84.4%。结论99mTc-MIBI双时相显像对SHPD的定性、定位诊断均有很高的价值,应作为术前的常规检查。 相似文献
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目的探讨99Tcm-MIBI SPECT/CT双时相显像在诊断原发性甲状旁腺功能亢进症(pHPT)中的价值。资料与方法 52例血清甲状旁腺激素(PTH)升高患者行99Tcm-MIBI SPECT/CT双时相显像,并按照PTH及血钙水平分为A、B、C组[A组(PTH≤130pg/ml、血钙<2.7mmol/L),B组(PTH>130pg/ml、血钙<2.7mmol/L),C组(PTH>130pg/ml、血钙≥2.7mmol/L)],比较其对不同PTH、血钙水平患者显像的阳性率,并以手术病理及随访结果作为参考,评价其对甲状旁腺疾病的诊断准确性。结果 A、B、C组SPECT/CT阳性率分别为3.23%、46.15%、75.00%,准确性分别为3.70%、60.00%、85.71%;B、C组阳性率、准确性均明显高于A组(P<0.001)。结论 99Tcm-MIBI SPECT/CT双时相显像对于PTH>130pg/ml、血钙≥2.7mmol/L的pHPT患者具有较高的诊断价值,对于PTH≤130pg/ml、血钙正常的患者诊断价值较低,需结合临床资料进行诊断。 相似文献
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SPECT一直被认为不能进行定量分析,但SPECT/CT、物理校正(光子衰减、散射等技术)及图像重建算法等技术的出现推动了SPECT/CT定量技术的发展,目前SPECT/CT已经可以进行类似PET的定量分析。多种技术的整合使SPECT/CT在图像采集及处理方面的性能进一步提高,使定量更加准确。笔者主要对SPECT/CT的硬件、物理校正、图像重建算法的临床应用及不足进行综述。 相似文献
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甲状旁腺功能亢进症(HPT)是由于甲状旁腺本身病变或继发于各种原因所致甲状旁腺激素分泌过多的一类内分泌疾病,其主要根据病史和生化检查来确诊,目前最有效的治疗方法是外科手术切除亢进的甲状旁腺组织或腺瘤,可用于术前定位诊断的影像学方法主要有放射性核素显像、超声、CT、MRI等。该文主要针对HPT放射性核素显像进行综述。 相似文献
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继发性甲状旁腺功能亢进的99Tcm-MIBI双时相显像 总被引:2,自引:0,他引:2
目的评价99Tcm甲氧基异丁基异腈(MIBI)双时相显像法在肾性继发性甲状旁腺功能亢进(SHP)患者中的诊断价值。方法20例因慢性肾功能衰竭行血液透析患者,临床诊断为SHP,均行双时相法99TcmMIBI甲状旁腺显像。运用甲状旁腺/甲状腺(PT/T)比值及甲状旁腺指数(PTI)观察阳性病灶对MIBI的清除。3例行颈部探查术并作甲状旁腺自体移植。结果8例显像阳性,其中3例手术摘除9枚甲状旁腺,均经病理证实为增生。99TcmMIBI显像发现其中的8枚,其灵敏度为889%。在透析年限长、甲状旁腺素分泌高的患者中,有更高的阳性率。发现有3种MIBI清除类型。结论99TcmMIBI双时相显像在SHP患者中有较高的定位诊断价值。阅片时应考虑病灶清除MIBI的多样性,以免漏诊 相似文献
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MRI及99Tcm-MIBI显像对甲状旁腺机能亢进症的诊断价值 总被引:15,自引:1,他引:14
目的:评价MRI及^99Tcm-甲氧基异丁基异腈(MIBI)显像在原发性甲状旁腺机能亢进症(PHT)中检出病理性腺体的临床价值。方法:25例经手术证实的PHT患者实行了术前定位MRI检查,若甲状旁腺部位发现可凝软组织肿物,其信号高于周围正常甲状腺,则认为是病理性甲状旁腺,其中23例同时进行了双时相99Tcm-MIBI显像,如早期相出现放射性浓聚区且延迟相持续存在则考虑为异常甲状旁腺,MRI和99Tcm-MIBI显像阅片结果与病理检查结果对照。结果:术中共发现39个异常甲状旁腺,包括19个腺瘤(18例),19个增生(6例)和1个上皮细胞癌(1例),MRI和99Tcm-MIBI显像对检出病理性腺体的准确性分别为84.1%和85.0%,但前者灵敏度(74.4%)高于后者(67.6%),而后者的特异性(97.8%)高于前者(91.8%),两种方法联合应用准确性提高到91.3%,灵敏度为91.2%,特异性为91.3%,结论:99Tcm-MIBI显像可作为继B超检查之后的首选术前定位检查法,但最理想的最联合应用MIR和99Tcm-MIBI显像。 相似文献
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目的 评价99Tcm-亚甲基二膦酸盐(MDP) SPECT/CT融合显像对肿瘤患者骨盆转移病灶的诊断价值。 方法 回顾性分析2018年8至12月于四川省肿瘤医院经组织病理学检查确诊为恶性肿瘤且临床疑似有骨转移的148例患者的临床资料,其中男性77例、女性71例,年龄29~86(48.8±14.5)岁。将患者分为原发盆腔肿瘤组(63例)和非原发盆腔肿瘤组(85例)。所有患者在首次行SPECT全身平面骨显像后,对骨盆的异常浓聚灶行SPECT/CT融合显像。经组织病理学检查和(或)影像学检查(SPECT、CT、SPECT/CT、MRI)随访6个月至1年,通过随访结果,比较SPECT平面骨显像与SPECT/CT融合显像诊断骨转移的符合率、准确率和阳性预测值。定性资料的比较采用Pearson χ2检验;采用单因素方差分析比较多个影像学检查的阳性预测值。 结果 SPECT平面骨显像共检出309个代谢增高病灶,其中239个与随访结果相符,诊断符合率为77.3%(239/309),诊断骨转移的准确率为92.9%(208/224),诊断良性病变的准确率为77.3%(34/44)。SPECT/CT融合显像共检出367个代谢增高病灶,其中349个与随访结果相符,诊断符合率为95.1%(349/367),诊断骨转移的准确率为98.4%(299/304),诊断良性病变的准确率为87.7%(50/57)。SPECT平面骨显像与SPECT/CT融合显像在诊断符合率、骨转移的诊断准确率、良性病变的诊断准确率间的差异均有统计学意义(χ2=0.595、28.795、4.546,均P<0.01)。SPECT/CT融合显像在骨盆病变中检出的病灶数多于SPECT平面骨显像,原发盆腔肿瘤组检出病灶数多于非原发盆腔肿瘤组,且差异有统计学意义(χ2=17.385,P=0.036)。各种影像学检查的阳性预测值以SPECT/CT最高(84%,52/62),其余依次为SPECT(79%,48/61)、MRI(76%,47/62)和 CT(65%,39/60),其阳性预测值间的差异有统计学意义(F=5.492,P=0.003)。 结论 与SPECT平面骨显像相比,99Tcm-MDP SPECT/CT可以提高肿瘤患者骨盆转移灶鉴别诊断的准确率和原发性盆腔肿瘤骨转移灶的检出率。 相似文献
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Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. 总被引:7,自引:0,他引:7
Mordechai Lorberboym Irit Minski Sorina Macadziob Galina Nikolov Pinhas Schachter 《Journal of nuclear medicine》2003,44(6):904-908
The purpose of this prospective study was to evaluate the diagnostic value of early parathyroid SPECT combined with quantitative analysis as compared with planar imaging in patients undergoing minimally invasive radioguided surgery. METHODS: A total of 52 consecutive patients with primary hyperparathyroidism underwent planar and SPECT parathyroid scintigraphy 2-5 d before surgery. Each patient had a single-tracer dual-phase technique using (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) and a double-tracer subtraction technique using a delayed (99m)Tc-pertechnetate scan. Immediately after the first (99m)Tc-MIBI planar image, a SPECT study was acquired. Before radioguided parathyroidectomy, each patient was reinjected with (99m)Tc-MIBI. Serum calcium levels were available for all patents before surgery and at 8 and 24 h after surgery. Serum parathyroid hormone (PTH) levels were also available for all patients. Quantitative analysis was performed using the average count ratio of parathyroid to left thyroid lobe, right thyroid lobe, and maximum thyroid activity. All patients had histopathologic examination of the removed glands. RESULTS: The average time for radioguided surgery was 30 min (range, 20-40 min). Postsurgical calcium levels correlated significantly with the adenoma weight (r = 0.5; P = 0.016). Combined planar scintigraphy correctly identified 41 adenomas (79%). SPECT increased the sensitivity to 96%. SPECT was superior to planar imaging in 9 patients, mainly in patients with ectopic adenomas or with multinodular goiters. Gland size did not affect significantly the detectability of SPECT. (99m)Tc-MIBI retention was noted in only 31 adenomas (60%). The average uptake ratios of parathyroid counts to the left lobe, right lobe, and maximum thyroid activity were 1.20 +/- 0.42, 1.29 +/- 0.45, and 0.84 +/- 0.35, respectively. The latter ratio was significantly correlated with PTH levels before surgery (r = 0.408; P = 0.04). CONCLUSION: Our data indicate that early preoperative SPECT in patients with primary hyperparathyroidism is essential for accurate localization of parathyroid adenomas and for the selection of patients who are candidates for minimally invasive radioguided surgery. Planar parathyroid imaging is less sensitive compared with SPECT, and washout kinetics of (99m)Tc-MIBI are unreliable in the dual-phase technique. Patients with higher presurgical PTH levels may especially benefit from radioguided surgery. 相似文献
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目的 探讨SPECT/CT图像融合技术在诊断骨转移瘤中的应用价值.方法 回顾性分析2010年1月~2013年1月在我院核医学科进行肺癌术前查体的患者资料,其中376例为全身骨显像(whole-body bone scintigraphy,WBBS),172例为局部SPECT/CT(single photon emission computed tomography-computed tomography)融合图像检查,对两种检查能够提供有效诊断的比例进行统计学比较.以临床诊断或随访结果为最终判定标准,对两组显像方式的灵敏度、特异度、阳性预测值、阴性预测值、准确度进行比较.结果 SPECT/CT的诊断效能明显高于WBBS(Z=2.769,P =0.006).SPECT/CT显像的灵敏度为94.4%、特异度为89.0%、阳性预测值为86.1%、阴性预测值为95.7%、准确度为91.5%,明显高于SPECT的82.4%(χ^2 =4.281,P=0.039)、80.1%(χ^2=4.085,P=0.043)、54.7%(χ^2=21.658,P =0.000)、94.0%(χ^2 =0.392,P=0.531)、80.6%(χ^2=10.012,P=0.002).结论 SPECT/CT图像融合较WBBS能够提高骨转移瘤患者的诊断符合率,能够为临床医生提供更多有价值的诊断信息. 相似文献
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目的 评价SPECT/CT融合显像对^99Tc^m-MDP全身骨显像难于确诊的乳腺癌骨病灶的鉴别诊断价值.方法 对^99Tc^m-MDP全身骨显像难于确诊的132例乳腺癌患者的210个病灶行局部SPECT/CT同机融合断层显像,以临床随访及病理检查获得最终诊断结果,计算SPECT/CT融合显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值,并对比不同部位病灶的诊断准确率差异.结果 ①210个病灶经SPECT/CT融合断层显像正确诊断的恶性病灶82个(39.0%),良性病灶112个(53.3%),诊断准确率为92.4%(194/210),灵敏度为94.3%,特异度为91.1%,阳性预测值为88.2%,阴性预测值为95.7%.②SPECT/CT同机融合断层显像对不同部位的病灶的诊断准确率不一致,脊椎的诊断准确率最高,为95.9%(94/97),肋骨最低,为83.7%(36/43),其差异有统计学意义(χ^2=7.81,P<0.05).结论 SPECT/CT同机融合显像能够对^99Tc^m-MDP全身骨显像难于确诊的病灶进行准确诊断,其对不同部位的病灶的诊断准确率有差异,脊椎的诊断准确率最高,肋骨最低. 相似文献
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目的评价单电子发射断层成像(SPECT)/CT同机图像融合显像对全身骨显像难于确诊乳腺癌骨病灶的鉴别诊断价值。方法对单纯全身骨显像难于确诊的75例乳腺癌患者的153个病灶行局部SPECT/CT同机融合断层显像。以临床病理、磁共振成像(MRI)、CT、骨扫描复查或PET/CT检查为确诊依据,计算诊断符合率、灵敏度、特异度、阳性预测值及阴性预测值。结果单纯全身骨显像无法确诊的153个病灶,经SPECT/CT融合断层正确诊断的恶性病灶51个(33.3%),良性病灶89个(58.2%)。诊断符合率91.5%,灵敏度92.7%,特异度90.8%,阳性预测值85.0%,阴性预测值95.7%。结论 SPECT/CT同机图像融合显像能够对单独SPECT骨扫描难于确诊的病灶进行准确诊断,明显地提高了乳腺癌骨转移病灶的诊断准确性,在女性乳腺癌患者骨病灶的鉴别诊断中具有很高的临床应用价值。 相似文献
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Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. 总被引:5,自引:0,他引:5
William C Lavely Sibyll Goetze Kent P Friedman Jeffrey P Leal Zhe Zhang Elizabeth Garret-Mayer Alan P Dackiw Ralph P Tufano Martha A Zeiger Harvey A Ziessman 《Journal of nuclear medicine》2007,48(7):1084-1089
Various methodologies for (99m)Tc-sestamibi parathyroid scintigraphy are in clinical use. There are few direct comparisons between the different methods and even less evidence supporting the superiority of one over another. Some reports suggest that SPECT is superior to planar imaging. The addition of CT to SPECT may further improve parathyroid adenoma localization. The purpose of our investigation was to compare hybrid SPECT/CT, SPECT, and planar imaging and to determine whether dual-phase imaging is advantageous for the 3 methodologies. METHODS: Scintigraphy was performed on 110 patients with primary hyperparathyroidism and no prior neck surgery. Of these, 98 had single adenomas and are the subject of this review. Planar imaging and SPECT/CT were performed at 15 min and 2 h after injection. Six image sets (early and delayed planar imaging, SPECT, and SPECT/CT) and combinations of the 2 image sets were reviewed for adenoma localization at 13 possible sites. Each review was scored for location and certainty of focus by 2 reviewer groups. Surgical location served as the standard. Sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, and kappa-values were determined for each method. RESULTS: The overall kappa-coefficient (certainty of adenoma focus) between reading groups was 0.68 (95% confidence interval, 0.66-0.70). The highest values were for dual-phase studies that included SPECT/CT. Dual-phase planar imaging, SPECT, and SPECT/CT were statistically significantly superior to single-phase early or delayed imaging in sensitivity, area under the curve, and positive predictive value. Neither single-phase nor dual-phase SPECT was statistically superior to dual-phase planar imaging. Early-phase SPECT/CT in combination with any delayed imaging method was superior to dual-phase planar imaging or SPECT for sensitivity, area under the curve, and positive predictive value. CONCLUSION: Early SPECT/CT in combination with any delayed imaging method was statistically significantly superior to any single- or dual-phase planar or SPECT study for parathyroid adenoma localization. Localization with dual-phase acquisition was more accurate than with single-phase (99m)Tc-sestamibi scintigraphy for planar imaging, SPECT, and SPECT/CT. 相似文献
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目的回顾性比较SPECT/CT和全身131I核素显像联合应用与仅行核素显像对于高分化甲状腺癌放射碘治疗后的新增诊断价值。材料与方法本回顾性研究经单位伦理委员会批准,无需签署知情同意书。研究包括2009年10月—2010年8月经放射碘治疗的高分化甲状腺癌病人147例(男53例,女94例,平均年龄51岁)。每例病人均于放射碘治疗的同一天进行全身核素显像和SPECT/CT检查。全身核素显像中的每个放射性浓聚灶,根据甲状腺床内、淋巴结和远隔转移的摄取情况分为阳性和不能确定。采用常规McNemar检验对全身核素显像与SPECT/CT的检查结果进行比较评价。结果 SPECT/CT清晰地确定了甲状腺床内全身核素显像不能确定的全部5个"高摄取"病灶的起源(正常甲状腺残余组织或淋巴结转移)。对于核素显像诊断为转移淋巴结的108个放射性浓聚灶,其中的24个(22.2%)SPECT/CT改变了原来的结论(P<0.0001)。在SPECT/CT检查中,85个全身核素显像阳性的病灶中有1个证实为阴性(假阳性);在20个全身核素显像不能确定的病灶中,13个证实为阳性,7个证实为阴性。SPECT/CT检查还纠正了3个核素显像为假阴性的病灶。对于远隔转移灶,52个病灶中有24个(40%)的诊断结论被SPECT/CT修正(P<0.0001)。在SPECT/CT检查中,32个全身核素显像诊断为阳性的病灶中有1个被证实为阴性;20个全身核素显像不能确定的病灶中,11个证实为阳性,9个证实为阴性。对于全部147例病人,通过SPECT/CT检查改变了9例(6.1%)病人的临床分期和3例(2.0%)病人的治疗方案。结论与全身核素显像相比,SPECT/CT提高了131I在淋巴结转移和远隔转移内浓聚的发现和定位准确性。 相似文献