^99Tc^m—MIBI肿瘤阳性显像在甲状腺癌诊断中的价值

目的探讨^99Tc^m-MIBI肿瘤阳性显像在诊断甲状腺癌中的应用价值。方法临床怀疑为甲状腺癌患者54例,分别用SPECT进行^99Tc^mO4-甲状腺静态显像和^99Tc^m-MIBI肿瘤阳性显像,将显像结果与手术病理结果进行对照。结果54例患者中,病理结果显示共有甲状腺结节54个,均为单发结节,其中恶性甲状腺结节25个;^99Tc^m-O4-甲状腺静态显像共发现甲状腺结节52个,其中热结节2个,温结节4个,凉结节10个,冷结节36个;2例患者显像结果为阴性。25个恶性甲状腺结节中,发现16个有明显的^99Tc^m-MIBI摄取,均为冷结节;29个良性甲状腺结节中,发现15个有明显的^99Tc^m-MIBI摄取,其中温结节1个,凉结节2个,冷结节12个。^99Tc^mO4-和^99Tc^m-MIBI联合核素显像诊断多发性甲状腺结节伴甲状腺癌的灵敏度为64．00％（16／25）,特异度为48．28％（14／29）。甲状腺良、恶性结节的^99Tc^m-MIBI肿瘤显像阳性率差异无统计学意义（X^2=0．83,P〉0．05）。结论^99Tc^m-MIBI肿瘤阳性显像对甲状腺癌的诊断不具有特异性,其临床应用价值有限。     

双核素SPECT对甲状腺癌和亚急性甲状腺炎的诊断价值

目的评价99Tcm04-和99Tcm04-甲氧异腈(MIBI)双核素甲状腺显像对甲状腺癌和亚急性甲状腺炎的诊断价值。方法44例99Tcm04-甲状腺静态显像显示"冷"结节患者进行99Tcm04--MIBI显像和延迟显像,测定血清T3,T4,TSH水平。结果25例亚急性甲状腺炎患者和19例甲状腺癌患者99Tcm04-甲状腺显像显示"冷"结节,99Tcm04--MIBI甲状腺显像均表现出放射性填充,延迟显像甲状腺癌患者99Tcm04--MIBI清除减慢。亚急性甲状腺炎患者血清T3,T4水平升高,TSH反馈性降低。结论99Tcm04--MIBI甲状腺延迟显像对甲状腺癌和甲状腺炎鉴别有重要意义,血清T3,T4,TSH检测对甲状腺癌和亚急性甲状腺炎的诊断提供重要参考。     

高锝[99mTc]酸钠联合99mTc-MIBI显像诊断多发性甲状腺结节伴甲状腺癌的价值

目的 探讨高锝[99mTc]酸钠(99mTcO-4)和99mTc-MIBI联合核素显像在多发性甲状腺结节伴甲状腺癌中的价值.方法 对52例临床怀疑为多发性甲状腺结节伴甲状腺癌的患者,采用GE Millennium单探头MPR SPECT,分别进行99mTcO-4甲状腺静态显像和99mTc-MIBI双时相显像,将显像结果与手术病理结果进行对照.结果 52例患者中,病理结果显示共有甲状腺结节126个,其中恶性结节40个、良性结节86个;99TcO4甲状腺静态显像均显示为多发结节样改变,共发现甲状腺结节103个,其中热结节8个,温结节20个,凉结节35个,冷结节40个.40个恶性甲状腺结节中,15个有明显的99mTc-MIBI摄取,其中凉结节2个,冷结节13个;86个良性甲状腺结节中,32个有明显的99mTc-MIBI摄取,其中温结节3个,凉结节14个,冷结节15个.99mTcO-4和99mTc-MIBI联合核素显像诊断多发性甲状腺结节伴甲状腺癌的灵敏度为37.50%.特异度为62.79%.甲状腺良恶性结节的联合显像阳性率差异无统计学意义(x2=0.001,P>0.05).结论 99mTcO-4和99mTc-MIBI联合核素显像对于多发性甲状腺结节伴甲状腺癌的诊断不具有特异性,其临床应用价值有限.     

甲状腺全切除治疗原发性甲状腺功能亢进症合并甲状腺癌24例

目的:探讨甲状腺全切除治疗原发性甲状腺功能亢进症(原发性甲亢)合并甲状腺癌的可行性与安全性。方法:回顾分析24例原发性甲状腺功能亢进症合并甲状腺癌的临床诊断与治疗的资料。结果:24例患者术前明确诊断为原发性甲亢,超声检查均发现有结节(3～13mm),所有病例均行甲状腺全切除术,术后病理证实乳头状癌87.5%(21/24),滤泡状癌12.5%(3/24),微小癌87.5%(21/24),双叶癌45.8%(11/24)。术后无永久性喉返神经损伤及永久性低钙的并发症。91.7%(22/24)病例获随访(5个月～6年),均无甲亢及甲状腺癌复发的表现。结论:甲状腺全切除治疗原发性甲亢合并甲状腺癌是安全可靠的,兼顾了原发性甲亢及甲状腺癌的治疗,并发症发生率未明显增加。     

改良甲状腺功能亢进症术式体会

双侧甲状腺腺叶次全切除术是公认治疗甲状腺功能亢进症 (甲亢 )的经典术式。自 1997年开始 ,我们采用一侧腺叶切除加对侧甲状腺腺叶次全切除术的改良术 ,治疗甲亢病人 5 8例 ,效果满意。1　临床资料1.1　一般资料　共 5 8例 ,其中原发性甲亢 4 8例 ,继发性甲亢 8例 ,复发 2例。男 2 0例 ,女 38例 ,年龄 18～ 5 8岁 ,平均 32岁 ,病史 8个月至 10年 ,平均 3年。甲状腺Ⅲ度肿大以上 4 0例 ,合并有甲亢性心脏病 5例 ,桥本病 1例 ,甲状腺癌 1例 ,甲状腺腺瘤 5例 ,糖尿病 3例 ,精神病、肝损害各 1例。1.2　术前准备　药物控制病情稳定后均用Lugol…     

彩色多普勒超声与99mTc-MIBI对甲状腺冷结节性质的比较研究

目的目的：探讨彩色多普勒超声（CDFI）与99m^Tc-MIBI显像对甲状腺“冷”结节良恶性的诊断价值。方法对99m^Tco4^-显像提示为“冷”结节的182例患者，次日行99m^Tc-MIBI显像及CDFI检查，所有病例均经手术病理证实。结果99m^Tc-MIBI和CDFI诊断甲状腺癌的敏感度、特异度、准确率分别为69．8％和86．8％，88．4％和91．5％，83．0％和90．1％；两者联合应用时，甲状腺癌诊断的敏感度、特异度、准确率分别达到90．6％、95．3％、94．0％。结论CDFI结合99m^Tc-MIBI显像对鉴别甲状腺“冷”结节的良恶性具有较大的临床应用价值。     

99Tcm-MIBI肿瘤阳性显像在甲状腺癌诊断中的价值

目的 探讨99Tcm-MIBI肿瘤阳性显像在诊断甲状腺癌中的应用价值.方法 临床怀疑为甲状腺癌患者54例,分别用SPECT进行99TcmO4-甲状腺静态显像和99Tcm-MIBI肿瘤阳性显像,将显像结果与手术病理结果进行对照.结果 54例患者中,病理结果显示共有甲状腺结节54个,均为单发结节,其中恶性甲状腺结节25个;99TcmO4-甲状腺静态显像共发现甲状腺结节52个,其中热结节2个,温结节4个,凉结节10个,冷结节36个;2例患者显像结果为阴性.25个恶性甲状腺结节中,发现16个有明显的99Tcm-MIBI摄取,均为冷结节;29个良性甲状腺结节中,发现15个有明显的99Tcm-MIBI摄取,其中温结节1个,凉结节2个,冷结节12个.99TcmO4-和99Tcm-MIBI联合核素显像诊断多发性甲状腺结节伴甲状腺癌的灵敏度为64.00%(16/25),特异度为48.28%(14/29).甲状腺良、恶性结节的99Tcm-MIBI肿瘤显像阳性率差异无统计学意义(χ2=0.83,P＞0.05).结论 99Tcm-MIBI肿瘤阳性显像对甲状腺癌的诊断不具有特异性,其l临床应用价值有限.

Abstract：

Objective To evaluate the value of positive 99Tcm-MIBI tumor imaging for thyroid cancer diagnosis. Methods Fifty four suspected thyroid cancer patients underwent 99Tcm-O4 and 99Tcm-MIBI combined imaging procedure. The imaging data were confirmed by pathological findings. Results All the 54 cases had single throid nodules, and 25 of which were pathologically malignant. Fifty two cases of nodules were detected by the 99Tcm O4 thyroid static imaging, including 2 hot nodules,4 warm nodules, 10 cool nodules and 36 cold nodules;2 cases were negative by the imaging. Of the 25 malignant thyroid nodules, 16 nodules were visible by 99Tcm-MIBI uptake and were cold nodules;29 exhibited benign thyroid nodules,of which 15 could be seen by 99Tcm-MIBI uptake,including 1 warm nodules,2 cool nodules and 12 cold nodules. The sensitivity, specificity of the combined imaging of 99Tcm O4 and 99Tcm-MIBI were 64. 00% ( 16/25 ) and 48. 28% (14/29). No significant difference was found for the positivity between benign nodules and malignancy nodules by 99Tcm-MIBI tumor imaging ( χ2 = 0. 83, P ＞ 0. 05 ). Conclusion 99Tcm-MIBI tumor imaging is not specific for the diagnosis of thyroid malignancy.     

~(99m)Tc-MIBI显像在甲状腺结节诊断中的应用研究

目的探讨^99mTcO4-／^99mTc-MIBI联合显像在甲状腺结节术前诊断中的应用价值。方法^99mTc-MIBI显像检查的住院病人104例，结合病理及显像结果，计算阳性预测率和阴性预测率。结果^99mTc—MIBI显像阳性对甲状腺癌的阳性预测率为47．5％，显像阴性对甲状腺癌的阴性预测率为96．9％。结论^99mTc-MIBI甲状腺显像对甲状腺结节良恶性仍有较高的诊断价值。可以作为其他影像资料的有益补充。     

微粒子化学发光酶免疫法与放免法测定促甲状腺激素的临床价值比较

目的　为了比较微粒子化学发光酶免疫法 (chemiluminescentimmunoassay ,CLIA)及放射免疫法(radiomunoassay ,RIA)用于评价甲状腺功能的临床价值。 方法　分别采用这两种方法对 5 0例正常人 (对照组 )、5 0例甲状腺性甲亢患者 (甲亢组 )及 5 0例原发性甲减患者 (甲减组 )进行促甲状腺激素 (thyroidstimulatinghormone,TSH)、FT3 、FT4、TT3 、TT4等测定。结果　用CLIA测定sTSH甲亢患者与对照组比较具显著性差异 ,而用RIA测TSH则甲亢与对照组没有差别。对甲减患者 ,sTSH、TSH与对照组比较均具显著性差异。结论　表明CLIA测sTSH对甲状腺性甲亢诊断更具有临床价值     

甲状腺误诊再手术23例分析

我院自 1989- 0 1～ 1999- 0 6收治甲状腺癌 78例 ,术前术中误诊为甲状腺良性疾病 2 3例 ,经术后病理检查诊断为甲状腺癌又行再次扩大切除术。现对误诊的原因进行分析。1　临床资料本组男 3例 ,女 2 0例。年龄最小 18岁 ,最大 6 1岁 ,平均 36岁。病程 2个月～ 8a,右侧 11例 ,左侧 10例 ,峡部 2例。甲状腺肿块直径 1～ 8cm,多数在 4cm以下。术前诊断为甲状腺腺瘤16例 ,甲状腺腺瘤囊性变 5例 ,结节性甲状腺肿 2例。首次手术方式 :甲状腺腺瘤切除 4例 ,甲状腺腺叶大部切除 12例 ,腺叶局切 2例 ,腺叶及峡部切除 5例。病理诊断 :乳头状腺癌 16例 …     

CT对甲状腺肿瘤的诊断价值

目的：评价CT在甲状腺肿瘤诊断中的作用，重点探讨CT检查对肿瘤定性诊断的价值。材料与方法：分析经手术病理或穿刺活检证实的35例甲状腺肿瘤的CT扫描资料。结果：甲状腺癌17例，CT诊断符合率88．9％；甲状腺腺癌18例，CT诊断符合率83．3％。结论；CT对甲状腺肿瘤的定性诊断优于其它影像学方法，在判断肿瘤的良、恶性时，应重点观察病变与腺外结构的分界情况而非腺内结构的边缘。     

血清TT3、FT3、TT4、FT4以及TSH检测意义

目的探讨TT3、FT3、TT4、FT4以及TSH在甲状腺疾病患者中检测的价值;总结分析各指标变化情况。方法收集分析本院200例甲状腺疾病患者,并选取健康者50例作为对照组。用化学发光分析法检测各组甲状腺功能,并对各组各指标的检测值进行比较。结果甲亢组T3、T4、FT3、FT4均高于健康对照组,甲减组T3、T4、FT3、FT4均低于健康对照组。TSH含量甲亢组低于健康对照组,甲减组明显高于健康对照组。与健康对照组比较其差异均有统计学意义。甲亢组FT3诊断符合率为96%,TSH为96%,T3为92%,FT4为90%,T4为88%。甲减组TSH诊断符合率为100%,FT4为93%,T4为90%,FT3为77%,T3为70%。结论 FT3、T3、TSH在甲亢诊断中有临床意义;FT4、T4、TSH在甲减诊断中有临床意义。     

彩色多普勒超声在甲状腺功能亢进症诊断中的应用

目的探讨彩色多普勒超声在甲状腺功能亢进症中的应用价值。方法将140例原发性甲亢患者按实验室检查指标和临床症状分为轻度组50例、中度组50例及重度组40例,另选同期甲状腺功能正常者50例为对照组。常规超声观察甲状腺声像图特征并测量甲状腺右叶上动脉直径,彩色多普勒血流成像(CDFI)观察甲状腺内和甲状腺右叶上动脉的血流分布情况,应用彩色多普勒和脉冲技术测量甲状腺右叶上动脉部分血流参数。结果多数甲亢患者声像图表现为甲状腺普遍肿大(包括峡部),两叶对称性均匀性增大为主,边缘多规则,内部回声为密集细小的点状强回声,低、中等增粗增强,分布均匀或不均匀。CDFI显示甲状腺腺体内血流信号呈弥漫性分布,大多数呈弥漫性点状和分枝状彩色血流分布,呈"火海征"。甲状腺右叶上动脉的管径、收缩期最高流速及平均流速的变化与对照组比较,差异有统计学意义(P<0.05)。结论常规超声和CDFI能准确测量甲亢患者甲状腺右叶上动脉的管径和收缩期最高流速,为临床诊断提供客观依据,有一定的实用价值。     

~(131)I治疗甲状腺机能亢进症260例近期疗效观察

目的 观察~(131)碘(~(131)Ⅰ)治疗甲状腺机能亢进症(甲亢)的近期临床疗效。方法 选择适合~(131)Ⅰ治疗的病例,测定甲状腺吸~(131)Ⅰ率并行甲状腺显像,估算甲状腺的重量。根据经验公式并参考病人的病情、年龄、病程,确定较为确切的治疗量,呆用一次性口服法。治疗后3个月、6个月、12个月复诊。结果 治疗260例甲亢中,225侧痊愈,治愈率86.5％,16例未完全缓解者,其中8例1年后给予第2次~(131)Ⅰ治疗。随访1年时发生甲状腺功能减低(甲低)19例,甲低发生率为7.3％。甲低者口服甲状腺素片替代治疗,维持甲状腺功能正常。结论 ~(131)Ⅰ治疗甲亢是一种安全、有效、复发率低的方法。     

异位甲状腺的超声成像特征

  目的  探讨灰阶超声和彩色多普勒超声在异位甲状腺诊断中的应用价值。  方法  回顾性分析北京协和医院1997年9月至2014年5月收治的13例异位甲状腺患者的临床资料及超声图像资料, 对照核医学检查、手术及病理结果, 分析其超声图像特征。  结果  13例中9例行异位甲状腺切除, 病理结果示单纯异位甲状腺3例(23.1%), 异位甲状腺乳头状癌1例(7.7%), 异位甲状腺合并甲亢治疗后改变1例(7.7%), 合并结节性甲状腺肿2例(15.4%), 合并结节性甲状腺肿伴淋巴细胞性甲状腺炎1例(7.7%), 合并结节性甲状腺肿伴纤维化、钙化及腺瘤样增生1例(7.7%)。超声声像图显示13例(100%)异位甲状腺均边界清晰; 12例(92.3%)为形态规则的圆形、类圆形或椭圆形, 1例(7.7%)形态欠规则; 6例(46.2%)呈混合回声, 3例(23.1%)呈中等回声, 4例(30.8%)呈低回声; 6例(46.2%)为囊实性, 7例(53.8%)为实性。彩色多普勒显示10例(76.9%)内部可见较丰富血流信号, 2例(15.4%)内部可见条状血流信号, 1例(7.7%)内部可见点状血流信号。  结论  异位甲状腺具有典型的超声成像特征, 可为临床决策提供有价值的诊断信息。     

Thyroid abnormalities in lithium-treated patients with bipolar affective disorder

The thyroid functions of 42 subjects with bipolar affective disorder receiving regular lithium therapy were analysed and their thyroid glands were examined by ultrasonography. Following the receipt of lithium therapy (duration 4-156 months), three subjects displayed subclinical hypothyroidism (7.1%), three subclinical hyperthyroidism (7.1%) and one hyperthyroidism (2.4%). Moreover, goitre was detected in 16 (38.1%) subjects. An increase in the conversion of free thyroxine (T4) to free tri-iodothyrosine (T3), which is an indication of mild thyroid dysfunction, was identified in 20 (47.6%) subjects, and was mostly seen in male subjects under 40 years of age and in those having weight gain. In conclusion, some thyroid dysfunctions were observed in the patients treated with lithium.     

血清游离甲状腺激素放免测定临床应用价值的探讨

用国产放免试剂盒测定了各种甲状腺功能状态患者血清FT_3、FT_4水平,并与其他几项参数进行了对比。对甲状腺功能体外试验的优选程序进行了讨论和评价。     

Thyroid function, thyroid immunoglobulin status, and urinary iodine excretion after enteral contrast-agent administration by endoscopic retrograde cholangiopancreatography

BACKGROUND AND STUDY AIMS: The aim of this study was to examine the occurrence of clinically relevant changes in thyroid function after enteral administration of contrast agent by endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: In this study 70 patients without a history of thyroid disease who had not recently undergone thyroid-specific or thyroid-influencing therapy were examined. Patients were examined on two or three occasions using a standardized questionnaire regarding symptoms of hypothyroidism and hyperthyroidism. The parameters of thyroid function (TT3, TT4, FT4, thyroid-stimulating hormone (TSH)) and urinary iodine excretion were measured on day 0 and on day 21 post-ERCP, and in 23 patients additionally on day 42 post-ERCP. Based on ultrasonographic results, four groups differing in thyroid morphology were distinguished. RESULTS: The data show that an average amount of only 4.7 g of enterally applied iodine is associated with a lasting decrease of TSH, especially in patients with enlarged organs with nodular transformation. As far as TT3 is concerned, there was a significant increase in all patient groups; regarding FT4 we only observed a marked increase in the group with enlarged, nodular thyroid glands. There was a notable increase in urinary iodine excretion on day 21, and a further increase on day 42 post-ERCP. Clinical symptoms of hyperthyroidism did not occur. CONCLUSIONS: We conclude that before administration of iodine-containing contrast agent for ERCP in patients without a history of thyroid disease, thyroid ultrasonographic examination, rather than TSH measurements, should be performed, in order to identify patients already at risk for hyperthyroidism before diagnostic enteral contrast-medium application.     

血游离甲状腺激素测定对甲亢的诊断价值

作者用放免法测定了57例甲亢患者血中游离甲状腺激素(FT_3、FT_4)水平,并与总甲状腺激素(TT_3、TT_4)测定结果进行了比较。结果表明:FT_3诊断符合率达100％,FT_3及FT_4升高的幅度比TT_3及TT_4大,对TT_3及TT_4升高不明显或在正常高限的病人,测FT_3及FT_4有诊断价值;对不典型甲亢的诊断及甲亢治疗期代谢控制情况的判断,FT_3及FT_4优于TT_3及TT_4。     

Pre-operative Detection of Thyroid Pyramidal Lobes by Ultrasound and Computed Tomography

This study aimed to assess the diagnostic accuracy of pre-operative ultrasound (US) and computed tomography (CT) for detecting thyroid pyramidal lobe (TPL). A single radiologist prospectively performed thyroid US and retrospectively reviewed neck CT to detect TPLs in 135 consecutive patients scheduled for thyroid surgery. The location, size and superior extent of each TPL and its separation or continuity with the main thyroid gland were assessed by thyroid US, neck CT and surgery. The prevalence of TPLs as diagnosed by thyroid US, neck CT and surgery was 58.5% (79/135), 56.3% (76/135) and 60% (81/135), respectively. We compared US and CT detection of TPLs with surgical data to determine their sensitivity (85.2% and 91.4%), specificity (81.5% and 94.4%), positive (87.3% and 96.1%) and negative (78.6% and 87.9%) predictive values and accuracy (83.7% and 92.6%). For detecting TPLs, both neck CT and thyroid US have good diagnostic value, although neck CT is more accurate than thyroid US.