原发性甲状旁腺功能亢进的超声诊断(附30例报告)

1983～1986年,应用3.5MHz频率的实时超声显象仪,对30例原发性甲状旁腺功能亢进患者进行了检查。全部病例经手术及病理证实,结果:敏感性82％,特异性98％,正确率94％,假阴性5例,假阳性1例,超声诊断甲状旁腺腺瘤正确率较高,对甲状旁腺增生较差。本文描述了甲状旁腺腺瘤及增生的声象图特征,探讨了超声对本病的诊断价值,误诊原因及如何提高诊断水平。     

继发性甲状旁腺功能亢进的超声图像分析

目的：为了给临床诊断、治疗继发性甲状旁腺功能亢进（甲旁亢）提供可靠依据,观察分析继发性甲状旁腺增生的多普勒超声图像特点。方法：运用高频彩色多普勒超声观察、分析42例肾功能衰竭患者临床确诊的继发甲旁亮患者增生的甲状旁腺。结果：共检出31例患者76个甲旁腺增大,内呈低无回声;其周围及内部有丰富的动静脉血流。结论：1.超声检查甲状旁腺可为临床诊断治疗甲旁亢提供可靠信息;2.增生的甲状旁腺主要应与甲状旁腺腺瘤与颈部淋巴结鉴别;3.甲状腺疾病与异位甲状旁腺可影响超声对增生的检出甲旁腺。     

甲状旁腺占位性病变45例影像学表现与手术病理结果对照分析

目的 分析甲状旁腺占位性病变的影像学表现,探讨高频超声、核素显像和CT对甲状旁腺占位性病变的诊断价值.方法 回顾性分析45例甲状旁腺占位性病变患者的高频彩色多普勒超声、核素显像和薄层CT检查结果,与手术病理结果对照.结果 甲状旁腺腺瘤42例(异位3例),甲状旁腺囊肿3例.超声发现39个,检出率90.7%,高频超声诊断灵敏度为90.7%,特异度为99.2%,准确性97.6%.核素诊断甲状旁腺腺瘤的灵敏度为97.7%,特异度为99.2%,准确性98.8%.高频超声与99mTc-IBI显像的敏感度、特异度、准确性比较,差异无统计学意义.CT诊断8例甲状旁腺腺瘤定位与手术结果相符,但病灶测量均小于实际大小.结论 高频彩色多普勒超声对正常位置甲状旁腺腺瘤诊断准确性高,可作为术前诊断与定位的参考.     

高频彩色多普勒超声诊断甲状旁腺肿瘤的价值

目的探讨高频彩色多普勒超声对甲状旁腺肿瘤的诊断价值.方法使用高频彩色多普勒超声对13例甲状旁腺肿瘤患者行直接法检查,其中甲状旁腺腺瘤7例、甲状旁腺腺癌3例及甲状旁腺囊肿3例.所有患者均经手术、病理证实.结果高频彩色多普勒超声诊断甲状旁腺肿瘤与病理诊断符合11例.13例患者病变均位于甲状腺下极背侧,超声显示病变为圆形或椭圆形,腺瘤与腺癌内部回声低;4例腺瘤中探及彩色多普勒血流信号;3例腺癌均探及丰富血流信号;3例甲状旁腺囊肿为无回声,内部无彩色多普勒血流信号.结论高频彩色多普勒超声对甲状旁腺肿瘤的定位与定性诊断具有重要临床价值,应作为术前首选诊断方法.     

超声对甲状旁腺疾病的诊断（附35例报告）

为探讨超声对甲状旁腺疾病的诊断价值,本文总结了35例拟诊为甲状旁腺疾病的甲状旁腺声像图及临床特点。超声对3例原发性甲状旁腺功能亢进患者的诊断符合率为100％,对31例疑为继发性甲状旁腺功能亢进患者的诊断符合率为71％,对1例无功能性甲状旁腺囊肿仅作定性诊断。所有病例均经手术病理和/或临床证实。由此可见超声对甲状旁腺疾病有较高的诊断价值。     

原发性甲状旁腺功能亢进20例分析

目的：探讨原发性甲状旁腺功能亢进（PHPT）的临床特点与诊断方法。方法：回顾性分析11 a间收治的20例PHPT患者的临床资料。结果：20例中骨型15例,肾型3例。甲状旁腺腺瘤15例,甲状旁腺增生3例。20例行超声检查的阳性准确率为85.0%（17/20）。15例行放射性计算机X线断层扫描（ECT）检查的阳性准确率为93.3%（14/15）。结论：临床表现以肾型为主,病理改变以腺瘤为主,定性诊断主要依据血钙和血甲状旁腺素的同步升高。超声和ECT可作为首选的定位诊断方法。     

高频彩超对甲状旁腺肿瘤的诊断价值

目的：探讨运用高频彩超对甲状旁腺肿瘤的定位及定性诊断价值。方法：对1999～2002年间疑有原发性甲状旁腺功能亢进的21例高频彩超结果进行回顾性分析，全部病例经手术病理证实。结果：1．高频彩超扫查无1例假阳性及假阴性，敏感性及特异性均为100％，定位诊断精确率100％，定性诊断正确率95％；2．甲状旁腺肿瘤均有以下声像特征：(1)肿瘤均呈实性低回声，边界清楚；(2)肿瘤周边及内部均有较丰富的动静脉血流信号，呈“花环”样改变；(3)肿瘤位于正常甲状腺深面，随吞咽动作与甲状腺同步运动。结论：高频彩超对甲状旁腺肿瘤的诊断具有重要价值。     

10例甲状旁腺腺瘤的超声诊断

目的 为提高甲状旁腺肿瘤的超声诊断水平。方法 回顾性分析了由超声检查发现并经手术证实的甲状旁腺腺瘤10例。结果 高频超声对甲状旁腺肿瘤的定位和定性非常重要,尤以12MHz探头对发现较小瘤体极有价值;彩色多普勒可提供肿瘤血供情况,有助于甲状旁腺肿瘤与甲状腺肿瘤的鉴别。建议原发性甲旁亢患者均应进行高频超声检查,提高甲状腺肿瘤的诊断率。结论 高频超声能够诊断甲状旁腺肿瘤。     

甲状旁腺肿瘤的超声诊断及临床相关性探讨

目的加强对甲状旁腺肿瘤的临床表现、实验室检查结果及超声声像图的认识，达到提高超声诊断甲状旁腺肿瘤的目的。方法回顾性分析我院近15年经手术和病理证实并有超声检查资料的甲状旁腺肿瘤12例，包括甲状旁腺腺瘤10例，甲状旁腺腺癌2例。结果高频超声可以诊断和定位甲状旁腺肿瘤，彩超提供肿瘤血供信息，有助于鉴别甲状腺肿瘤和甲状旁腺肿瘤。结论高频超声能够诊断和鉴别诊断甲状旁腺肿瘤，对甲状旁腺功能亢进患者常规行高频超声检查有助于发现甲状旁腺肿瘤，减少漏诊。     

原发性甲状旁腺功能亢进诊断与手术治疗

目的：探讨原发性甲状旁腺功能亢进(甲旁亢)诊断与手术治疗方法、并发症处理。方法：对10例原发性甲状旁腺功能亢进病人的症状、体征、X线表现、超声、ECT、CT、生化检查结果进行综合分析，结合术中所见、冰冻切片检查、石蜡切片检查，得出正确诊断。10例病人均行手术治疗。结果：9例病人血钙为3．2～3．75mmol／L；碱性磷酸酶(AKP)：9例病人明显高于正常，最高达1404 IU／L，1例正常。甲状旁腺素(PTH)：6例病人检查均高于正常值5．3pmol／L。9例病人诊断为甲状旁腺腺瘤，1例诊断甲状旁腺腺癌。其中1例诊断为甲状旁腺腺瘤病人，随访2年再手术诊断为甲状旁腺癌。术中单侧探查均能找到病灶并切除，术后并发症主要是低血钙血症。所有病人术后随访未见有甲状旁腺功能低下表现。结论：临床诊断主要依靠对病史、辅助检查结果的综合分析以及病理检查。手术切除病变甲状旁腺是可靠的治疗方法。随访可以发现甲状旁腺恶变病人。     

正常甲状旁腺的高频超声表现

目的：探讨正常甲状旁腺高频超声检查的显示率、探查技巧、显示部位及超声表现。方法：应用高频超声检查300例健康体检者的甲状旁腺,记录其大小、形态、部位、数量、内部回声及血流情况,对检查的结果进行整理分析。结果：300例体检者中共检出甲状旁腺465枚,其中显示4枚者12例、3枚者27例、2枚者139例、1枚者58例,未显示者64例,显示率为78.7%（236/300）;正常甲状旁腺可呈椭圆形（73.5%）、梭形（18.1%）或不规则形（8.4%）;回声可呈高回声（78.3%）、低回声（16.5%）或等回声（5.2%）;彩色多普勒血流显像（CDFI）表现为无血流（81.9%）或少量血流（17.9%）,仅1例为丰富血流（0.2%）;纵切扫查时,甲状旁腺多位于甲状腺侧叶后缘及下极附近,横切扫查时,多位于甲状腺侧叶后缘,气管与颈总动脉之间的区域。结论：正常甲状旁腺的高频超声显示率较高,常表现为椭圆形高回声、无或乏血流信号。     

High-resolution parathyroid ultrasonography in familial benign hypercalcemia (familial hypocalciuric hypercalcemia)

Familial benign hypercalcemia, or familial hypocalciuric hypercalcemia (FHH), is frequently confused with primary hyperparathyroidism, but the consistent failure of subtotal parathyroidectomy to normalize serum calcium levels in FHH makes accurate distinction from familial hyperparathyroidism imperative. Because ultrasonography frequently demonstrates enlargement of the parathyroid glands in hyperparathyroidism, we examined 14 hypercalcemic adults (who had not undergone operation) from seven kindreds with FHH by using a high-resolution real-time scanner. We compared our results with those from 156 patients (who had undergone scanning preoperatively) with surgically confirmed hyperparathyroidism. Enlargement of the parathyroid glands was detected ultrasonographically in 137 of 156 (88%) of the total group of patients with hyperparathyroidism and in 17 of 24 patients (71%) with hyperparathyroidism who had hypercalcemia (serum calcium, 10.6 to 11.0 mg/dl) comparable to that of the FHH group (mean value, 10.7 mg/dl). In contrast, the single possible parathyroid lesion seen in the FHH group was substantially smaller (4 mm) than the smallest (7 mm, 75 mg) abnormal gland reliably detected by ultrasonography in the group with hyperparathyroidism and was conceivably normal in size. Patients with FHH have a dramatic absence of ultrasonographic parathyroid enlargement. High-resolution parathyroid ultrasonography may be of ancillary diagnostic benefit in patients with familial hypercalcemia.     

超声对继发性甲状旁腺功能亢进的诊断价值

目的为探讨高分辨力超声对继发性甲状旁腺功能亢进（ＨＰＴ）的诊断价值。方法本文对３０例尿毒症血透病人进行甲状旁腺的超声检查,并结合ＰＴＨ、血钙、血肌酐等资料进行分析。另外,我们选择５０例无慢性肾病、ＶｉｔＤ缺乏、骨病等原因引起的钙磷失调者作为对照。结果正常人甲状旁腺显示率为２４０％（１２／５０）,尿毒症病人显示率为６０％（１８／３０）,而且,随着尿毒症血透时间的延长,肿大的甲状旁腺数目及大小均增加,增大体积与血清ＰＴＨ的增高呈正相关,但与血钙、血肌酐无明确关系。结论超声对尿毒症引起的继发性甲旁亢病人的甲状旁腺肿大检测有诊断价值,并能初步估计尿毒症血透时间长短及甲旁亢严重程度     

Parathyroid adenoma: accuracy of preoperative localization by high-resolution real-time sonography

To assess the accuracy of high-resolution sonography of the parathyroid glands, a consecutive series of sonograms in 58 patients was reviewed. The study population was limited to patients thought clinically to have primary hyperparathyroidism and likely to have one enlarged adenomatous gland. Patients with renal failure or other evidence of secondary hyperparathyroidism were excluded. Typical sonographic features of parathyroid adenoma were observed. An overall accuracy of 92% was obtained for the identification of surgically confirmed parathyroid gland enlargement due to adenoma.     

Sjogren syndrome: comparison of sialography and ultrasonography.

Ultrasonography and sialography of parotid glands were prospectively performed on 30 patients with Sjogren syndrome and follow-up ultrasonography was done on 12 patients. Ultrasonography revealed multiple hypoechoic areas (MHA) 2 mm to 5 mm in diameter within the glands in 43% of the patients with intermediate severity of the disease, either homogeneous or slightly nonhomogeneous parotid glands in patients with early stage of the disease, and marked nonhomogeneous glands in patients with advanced diseases. Follow-up ultrasonography showed MHA in one patient, reduction in nonhomogeneity in another three, and no interval changes in the remaining cases. Pathologic studies suggested that MHA represent enlarged parotid lobules replaced by lymphocytic infiltration. We suggest that MHA are characteristic of Sjogren syndrome and that ultrasonography is useful in following the course of the disease and response to treatment.     

声触诊组织定量技术联合常规超声对慢性肾功能不全继发甲状旁腺功能亢进患者的诊断价值

目的研究声触诊组织定量技术（VTQ）在慢性肾功能不全致继发性甲状旁腺功能亢进症（SHPT）中甲状旁腺检查及切除术（PTX）指征的应用价值。 方法研究2013年10月至2014年6月在首都医科大学附属北京朝阳医院进行维持性血液透析的肾功能不全患者95例,以单个腺体任意一径≥5 mm为增生腺体,二维及彩色多普勒超声检查增生腺体数目、超声表现,计算腺体体积,应用VTQ技术测量腺体组织的剪切波速度值（SMV）。根据临床PTX指征,按照血清全段甲状旁腺激素（iPTH）、钙磷乘积以及增生腺体的体积大小分组,应用独立样本t检验比较不同组间增生腺体SMV的差异。并以SMV值绘制受试者操作特性（ROC）曲线。 结果33例检测到增大的甲状旁腺共59枚,检出率34%,VTQ技术显示增生腺体平均SMV值为（1.29±0.43）m/s。根据临床PTX指征分组,增生腺体的SMV值在单个腺体体积≥500 mm³组较大,为（1.75±0.59）m/s。SMV值区别增生腺体体积大小的最佳阈值为1.555 m/s,其ROC曲线下面积为0.794,敏感度79%,特异度76%。增生腺体的SMV值在钙磷乘积值≥4.52 mmol²/L²组较大,为（1.36±0.47）m/s。患者iPTH值对SMV值影响差异无统计学意义（P>0.05）。 结论本组VTQ显示钙磷乘积大于正常水平及甲状旁腺腺体体积较大的患者增生腺体SMV值较大,可能对SHPT患者的PTX指征有一定帮助。     

继发性甲状旁腺功能亢进症彩色多普勒超声学诊断意义及临床分析

目的 观察彩色多普勒超声探测维持性血液透析继发性甲状旁腺功能亢进症患者增殖腺体的数目及超声信号特点。方法 86例患者分为透析时间<8年组、透析时间≥8年两组。以彩色多普勒超声探测增殖腺体的数目、腺体的长、宽、厚以及腺体超声信号,计算腺体体积、记录血清学指标及超声图像。外科切除的腺体送病理检查。结果 不同透析时间的2组患者,增殖腺体的数目、腺体的体积、甲状旁腺激素水平及血磷存在统计学差异。透析时间<8年组甲状旁腺激素与增殖腺体的总体积之间无相关性,≥8年组甲状旁腺激素与增殖腺体的总体积之间存在相关性。病理检查示:腺体以节结节样增殖为主,主细胞及嗜酸性细胞均可见明显增殖。结论 以彩色多普勒超声行继发性甲状旁腺功能亢进腺体的筛查是一项简单有效的方法,同时也为下一步临床治疗提供依据。     

Experiences with total parathyroidectomy and autotransplantation of intraoperatively selected parathyroid tissue in reactive renal hyperparathyroidism]

Surgery is indicated in cases of therapy-resistant reactive renal hyperparathyroidism with clinical symptoms and signs. The method of choice is total parathyroidectomy, with autotransplantation of parathyroid tissue into the forearm musculature. Twenty-two patients were parathyroidectomized. In 19 cases the intraoperative selection of tissue for autotransplantation was made by means of a stereoscopic magnifying glass. With one exception, only fragments of type 1a glands and type 1a-like areas obtained from type 2 glands were transplanted. In 18 of the 22 cases parathyroid hormone levels decreased from 1131 +/- 657 preoperatively to 87 +/- 53 pg/ml postoperatively. In 4 patients with postoperative values over 200 pg/ml a transplant-related recurrence of hyperparathyroidism or a remaining 5th gland in the cervical region was suspected. In all 22 patients serum calcium, as well as alkaline phosphatase levels returned to normal and the clinical signs of hyperparathyroidism disappeared.     

Primary hyperparathyroidism with multiple parathyroid gland enlargement: review of 53 cases.

Of 53 patients who had hyperparathyroidism assocated with multiple parathyroid gland enlargement, 39 (74%) had primary hyperparathyroidism without clinical or laboratory evidence of associated endocrine gland dysfunction, 2 had documented familial primary hyperparathyroidism, and 12 had hyperparathyroidism as part of the multiple endocrine neoplasia syndrome. When last studied, 31 of the 39 patients with nonfamilial hyperparathyroidism had normal serum calcium levels, 3 had permanent hypoparathyroidism, 2 had recurrent hyperparathyroidism, and 3 were lost to follow-up. The two patients with familial hyperparathyroidism were treated by removal only of enlarged parathyroid glands, and in each, hyperparathyroidism recurred. Five patients with multiple endocrine neoplasia, type 1, were treated by removal only of enlarged parathyroid glands, and hyperparathyroidism recurred in four. Four patients with multiple endocrine neoplasia, type 1, were treated by removal of three or more parathyroid glands, and there were no instances of recurrent hyperparathyroidism. In one patient, permanent hypoparathyroidism developed. Three patients with multiple endocrine neoplasia syndrome, type 2, had total parathyroidectomies as a part of thyroidectomy for medullary thyroid carcinoma. In each patient, permanent hypoparathyroidism developed. When primary hyperparathyroidism occurs in the absence of a definite history of polyendocrine or familial disease, only the glands that are definitely enlarged should be removed, and normal-appearing glands should be tagged rather than risk the possibility of permanent hypoparathyroidism that may attend routine subtotal parathyroid gland excision.