SPECT/CT 在甲状旁腺功能亢进中的诊断价值及其与多种影像学方法的比较

目的：比较单光子发射型计算机断层显像/计算机断层扫描(single photon emission computed tomography/computed tomography，SPECT/CT)与99m锝-甲氧基异丁基异腈(99mTc-sestamibi，99mTc-MIBI)平面显像、超声、CT对甲状旁腺功能亢进(hyperparathyroidism，HPT)的诊断价值。方法：回顾性分析经手术治疗及病理学检查确诊的HPT患者59例，其中行SPECT/CT 31例，99mTc-MIBI平面显像28例，超声检查56例，CT检查26例，分别比较SPECT/CT与99mTc-MIBI平面显像对HPT病灶定位、定性敏感性差异，以及SPECT/CT与99mTc-MIBI平面显像、超声、CT对HPT诊断准确性、敏感性、特异性差异。结果：SPECT/CT与99mTc-MIBI平面显像比较，病灶定位诊断敏感性差异无统计学意义(P>0.05)，但增生病灶的定性诊断敏感性高于99mTc-MIBI平面显像(P<0.05)；SPECT/CT与99mTc-MIBI平面显像、超声、CT比较， SPECT/CT对HPT诊断的准确性最高，与99mTc-MIBI平面显像比较差异有统计学意义(P<0.05)，CT的敏感性最低，与SPECT/CT及超声的比较差异均有统计学意义(均P<0.05)；当甲状旁腺病灶最大直径>1 cm时，SPECT/CT的敏感性最高(均P<0.05)，而在直径<1 cm时，超声敏感性最高(均P<0.05)。结论：SPECT/CT较99mTc-MIBI平面显像对HPT(特别是增生性病灶)有更高的诊断价值；术前联合SPECT/CT与超声检查，可为甲状旁腺微创外科手术提供更为精准的解剖信息。

Value of single photon emission computed tomography/computerized tomography in the diagnosis of hyperparathyroidism and the comparative study with multiple imaging modality

Objective: To compare the diagnostic value among the single photon emission computed tomography/computerized tomography (SPECT/CT), 99mTc-sestamibi (MIBI) planarscintigraphy, ultrasonography (US) and computerized tomography (CT) in diagnosis of patientswith hyperparathyroidism (HPT).Methods: A total of 59 patients were retrospectively recruited for this study. The patients receivedparathyroidectomy and were verified by pathological examination. Among them, 31, 28 and 26patients received SPECT/CT, 99mTc-MIBI planar scintigraphy, US and CT, respectively, before theparathyroidectomy. The sensitivity for localization or qualitation was compared between SPECT/CT and 99mTc-MIBI planar scintigraphy; the sensitivity, specificity and accuracy were comparedamong the SPECT/CT, 99mTc-MIBI planar scintigraphy, US and CT.Results: There was no statistical difference in the sensitivity of localization between SPECT/CTand 99mTc-MIBI planar scintigraphy (P>0.05); however, the SPECT/CT exhibited more sensitivethan the 99mTc-MIBI planar scintigraphy in detection of hyperplastic lesions (P<0.05). Among thefour imaging modalities, SPECT/CT had advantages over 99mTc-MIBI planar scintigraphy in termsof accuracy (P<0.05). In contrast, the sensitivity of CT was not as good as that of SPECT/CT andUS (both P<0.05). For the diagnosis of lesions with a diameter more than 1 cm, the sensitivity ofSPECT/CT was the best (all P<0.05). However, the sensitivity of US was the best in diagnosis oflesions with a diameter less than 1 cm (all P<0.05).Conclusion: The SPECT/CT is more effective than 99mTc-MIBI planar scintigraphy in diagnosis ofHPT, especially in diagnosis of hyperplastic lesions. Both of SPECT/CT and US are recommendedto localize the target parathyroid lesions of HPT before the parathyroidectomy.