99Tcm-MIBI双时相显像定位诊断原发性甲状旁腺机能亢进症的价值

目的:评价99Tcm-甲氧基异丁基异腈(MIBI)双时相显像对原发性甲状旁腺机能亢进症(PHPT)定位诊断的价值.方法:对15例正常对照者和51例临床表现及生化检查提示原发性甲状旁腺机能亢进的患者,行99Tcm-MIBI双时相甲状旁腺平面显像(患组于术前1周内安排检查),部分患者安排SPECT断层显像,同时采用ROI技术计算摄取比值.结果:①与手术结果对比,99Tcm-MIBI双时相甲状旁腺显像在早期相和延迟相对腺瘤的诊断灵敏度分别为78.3%(36/46)和91.3%(42/46),对增生灶的诊断灵敏度分别23.8%(5/21)和47.6%(10/21).有6个病灶通过SPECT断层显像得以确诊(包括1个异位腺瘤病灶).②术后证实甲状旁腺病灶重量大于1500 mg者99Tcm-MIBI双时相显像均为阳性,小于500 mg者均为阴性,重量在500～1500 mg者阳性率为82.4%.③阳性腺瘤组摄取比值,延迟相明显高于早期相(P＜0.01),两个时相均明显高于正常对照组(P＜0.01).结论:99Tcm-MIBI双时相显像对于定位诊断PHPT具有较高的临床价值,摄取比值测定和断层显像有利于提高阳性诊断率.

Value of 99Tcm-MIBI double-phase imaging on anatomical diagnosis of primary hyperparathyroidism

Objective:To evaluate the clinical value of 99Tcm-MIBI double-phase imaging on anatomical diagnosis of primary hyperparathyroidism(PHPT).Methods:Double phase 99Tcm-MIBI imaging was performed in 15 normal controls and 51 patients with primary hyperparathyroidism proven by physical examination and biochemical blood tests(for the latter group,the examination was performed in 1 week before the operation).Tomographic scanner was arranged for part of the patients.The uptake ratio was calculated and compared by ROI sequence.Results:Comparing the imaging results with those of histopathology,the sensitivity percentages of early and delayed phases to parathyroid adenomas were 78.3%(36/46)and 91.3%(42/46),and those to parathyroid hyperplasia were 23.8%(5/21)and 47.6%(10/21)respectively.Six lesions of parathyroid were demonstrated by SPECT tomographic imaging.The positive rate of lesions(weighting between 500 to 1500 mg)was 82.4%,and all lesions over 1500 mg appeared to be positive,those less than 500mg appeared to be negative in 99Tcm-MIBI double-phase imaging.For positive parathyroid adenoma group,the uptake ratio of delayed phase was significant higher than that of early phase(P<0.01),and the ratio of both phases were significant higher than that of the normal controls(P<0.01).Conclusion:99Tcm-MIBI double-phase imaging had higher clinical value on anatomical diagnosis of PHPT,and the measurement of uptake ratio and tomographic imaging were beneficial for improving the positive diagnosis rate.