99Tcm-MIBI SPECT/CT融合断层显像在甲状旁腺功能亢进症中的应用价值

目的评价99Tcm-MIBI SPECT/CT双时相融合断层显像在原发性甲状旁腺功能亢进症（PHPT）与继发性甲状旁腺功能亢进症（SHPT）中的应用价值。方法回顾性分析97例（PHPT 28例，SHPT 69例）HPT患者的99Tcm-MIBI SPECT/CT显像图像特征、症状、血清甲状旁腺激素（PTH）、血钙、磷及碱性磷酸酶（AKP）等结果。分析比较PHPT和SHPT两组患者的显像特点、手术病理、实验室检查以及诊断的灵敏度、特异度与临床指标之间的相关性。结果（1）99Tcm-MIBI SPECT/CT显像对PHPT的术前诊断灵敏度为96.55%，特异度为98.78%；对SHPT的术前诊断灵敏度为68.77%，特异度为79.17%。（2）PHPT多表现为单发病灶，而SHPT多表现为多个亢进的甲状旁腺病灶，病灶平均直径较小（Z=-2.591，P=0.010），且容易合并钙化（χ2=9.588，P < 0.01），差异均有统计学意义。（3）PHPT中无特殊不适主诉的患者比例明显高于SHPT中的比例（χ2=11.713，P < 0.001），PHPT出现结石的比例高于SHPT（χ2=6.075，P < 0.001），SHPT出现骨痛的比例高于PHPT（χ2=24.382，P < 0.01），差异均有统计学意义；SHPT患者血清PTH和AKP水平均明显高于PHPT，差异有统计学意义（Z=-6.663、-4.326，均P < 0.001），PHPT具有高钙低磷的特点，SHPT患者血钙正常或轻度升高，血磷明显升高。结论99Tcm-MIBI SPECT/CT双时相显像在PHPT患者的术前定位中有重要价值，特别是在PHPT中有极高的准确率。与PHPT相比，SHPT血清PTH、AKP水平升高更明显，多表现为多个病灶，病灶小，易合并钙化。

Importance of 99Tcm-MIBI SPECT/CT fusion imaging in primary and secondary hyperparathyroidism

ObjectiveThe value of 99Tcm-MIBI SPECT/CT fusion imaging in primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) was evaluated.MethodsA total of 97 HPT patients (28 PHPT patients and 69 SHPT) were enrolled in this retrospective study. The 99Tcm-MIBI SPECT/CT imaging features, clinical symptoms, serum PTH, Ca, P, and AKP were analyzed. The following data were compared between PHPT and SHPT patients:imaging features; pathological findings; laboratory examination results; and relevance of diagnostic efficiency and clinical index.Results(1) The sensitivity and specificity of 99Tcm-MIBI SPECT/CT in PHPT were 96.55% and 98.78%, respectively. By contrast, the sensitivity and specificity of 99Tcm-MIBI SPECT/CT SHPT were 68.77% and 79.17%, respectively. (2) PHPT generally exhibited single lesion with average diameter was 17.4 mm. Compared with PHPT, SHPT generally displayed more lesions with smaller diameter of 12.8 mm (Z=-2.591, P=0.010) and more likely to be found with calcification(χ2=9.588, P < 0.01). (3) The percentage of patients without special clinical symptoms was higher in PHPT(χ2=11.713, P < 0.001). The percentage of patients with calculus in urinary system was also higher in PHPT(χ2=6.075, P < 0.001). However, the percentage of patients with ostalgia was higher in SHPT(χ2=24.382, P < 0.001). Serum PTH and AKP were significantly higher in SHPT(Z=-6.663, -4.326, both P < 0.001). PHPT had high serum calcium level and low phosphorus level, whereas SHPT showed normal or slightly higher calcium level and significantly high phosphorus level.Conclusions99Tcm-MIBI SPECT/CT fusion imaging had a significant value in preoperation localization of HPT, especially in PHPT. Compared with PHPT, SHPT had a greater increase in serum PTH and AKP and usually exhibited several lesions which are smaller and more likely to accompany calcification.