99Tcm-MIBI双时相显像在甲状旁腺素增高患者中的应用

目的 探讨99Tcm-甲氧基异丁基异腈(MIBI)双时相显像在高甲状旁腺素(PTH)患者中的应用。 方法 对73例手术确诊的甲状旁腺功能亢进症患者行99Tcm-MIBI双时相平面显像,必要时行全身显像、CT、SPECT/CT断层融合显像。检测患者术前PTH、血清钙、磷离子浓度以及术后血清钙、磷离子浓度,其中60例患者检测术后1周内PTH水平。 结果 原发性甲状旁腺功能亢进症(PHPT)患者29例,其中27例病理证实甲状旁腺瘤28处,99Tcm-MIBI显像阳性病灶27处(诊断敏感性为96.4%,27/28);另2例患者病理证实甲状旁腺增生病灶共3处,99Tcm-MIBI显像阳性病灶1处(诊断敏感性为33.3%,1/3);99Tcm-MIBI显像对PHPT总的诊断敏感性为90.3%(28/31)。继发性甲状旁腺功能亢进症(SHPT)患者44例,病理确诊甲状旁腺组织增生154处,99Tcm-MIBI发现118处浓聚病灶,诊断敏感性为76.6%(118/154)。大部分甲状旁腺瘤放射性浓聚程度高于甲状旁腺增生组织。PHPT以高钙低磷血症为主,SHPT往往血钙升高不明显,但血磷升高明显。患者术后1周内可见PTH不同程度降低。 结论 99Tcm-MIBI双时相显像对甲状旁腺瘤的诊断敏感性高于甲状旁腺增生组织;该检查方法能够对功能异常的甲状旁腺组织进行术前定位,有利于提高手术成功率。 

The diagnostic value of 99Tcm-MIBI double phase scintigraphy in patients with hyperparathyroidism

Objective To analyze the diagnostic value of99Tcm-sestamibi (MIBI) double phase scintigraphy in patients with hyperparathyroidism. Methods The clinical data of 73 patients with hyperparathyroidism confirmed by surgery pathology were retrospective analyzed.99Tcm-MIBI double phase scintigraphy was performed and whole body scan,computerized tomography (CT) or single photon emission computerized tomography/computerized tomography (SPECT/CT) were carried out when necessary.Serum calcium (Ca) and phosphorus (P) were measured for all patients before and after operation.Serum parathyroid hormone level was determined before operation and in most of patients in one week post-operation. Results Twenty-nine cases of patients were primary parathyroid hyperthyroidism who undertook99Tcm-MIBI double phase scintigraphy,28 lesions were detected.Thirty-one lesions were found in pathology,28 were hyperplasia parathyroid adenoma and 3 were parathyroid hyperplasia.The sensitivity of99Tcm-MIBI imaging for primary hyperparathyroidism lesions diagnosis was 90.3%(28/31).In 44 cases with secondary parathyroid function hyperthyroidism,there were 154 lesions with parathyroid hyperplasia confirmed by pathology,and 118 lesions were detected by99Tcm-MIBI imaging.The sensitivity for parathyroid hyperplasia diagnosis was 76.6%(118/154).In parathyroid adenoma with positive imaging,most of the tumors were clearly visualized with intensely radioactive concentration in tumor,and most patients characterized by hypercalcemia and hypophosphatemia.While in patients with parathyroid hyperplasia the radioactive concentration in hyperplastic tissue was mild and far lower than that in parathyroid adenoma.Although,there was not obvious increasing of serum calcium,significantly elevated serum phosphorus was observed in patients with parathyroid hyperplasia.However,in both of patients with parathyroid adenoma and parathyroid hyperplasia,the level of serum parathyroid hormone was decreased after operation in one week. Conclusion 99Tcm-MIBI had higher diagnosis sensitivity in parathyroid adenoma than parathyroid hyperplasia,and it's helpful in the discovery of ectopic parathyroid tissue and its preoperative localization.