超声造影评估继发性甲状旁腺功能亢进症结节功能

目的分析超声造影(CEUS)评估继发性甲状旁腺功能亢进症(SHPT)结节功能的价值。方法回顾性分析16例SHPT(16枚结节),观察其CEUS特点;获取结节长宽乘积、总亮度计数(TBC)及时间-强度曲线(TIC)相关参数,包括绝对峰值强度(API)、相对峰值强度(RPI)、达峰时间(TTP)及上升支斜率(BPAS)等,分析其与全段甲状旁腺激素(iPTH)及钙、磷、碱性磷酸酶水平的相关性。结果二维超声声像图显示SHPT结节边界清晰,呈圆形或椭圆形,其中9枚为低回声-无回声囊实性结节,6枚为实性低回声结节,1枚呈等-低混合回声。CEUS示9枚呈高增强,相应患者血清iPTH为1 639.80(1 328.80,2 144.80)pg/ml; 7枚呈低增强,患者血清iPTH为974.20(211.00,1 221.80)pg/ml,差异有统计学意义(U=53.000,P=0.023)。Pearson相关分析结果显示,iPTH与BPAS(r~2=0.341,P=0.003)、RPI(r~2=0.465,P=0.002)及TBC(r~2=0.485,P=0.002)均呈正相关,与TTP呈负相关(r~2=0.790,P=0.001),与结节长宽乘积(r~2=0.029,P=0.248)及API(r~2=0.065,P=0.175)无明显相关性;CUES参数与钙、磷、碱性磷酸酶水平均无明显相关性(P均0.05)。结论 CEUS可用于初步预测SHPT结节的分泌功能。

Contrast-enhanced ultrasound in evaluating nodule function of secondary hyperparathyroidism

Objective To observe the value of contrast-enhanced ultrasound (CEUS) for evaluating nodule function of secondary hyperparathyroidism (SHPT). Methods Data of 16 patients with single SHPT nodule were retrospectively analyzed. CEUS characteristics of nodules were observed, and the product of nodule length and width, total brightness count (TBC) and time-intensity curve (TIC) related parameters, including absolute peak intensity (API), relative peak intensity (RPI), time to peak (TTP) and base-to-peak ascending slope (BPAS) were obtained. The correlations of the above parameters and the intact parathyroid hormone (iPTH) secreted by parathyroid glands and serum calcium, phosphorus and alkaline phosphatase were analyzed. Results Conventional ultrasound showed that the nodules shaped round or oval, with clear margins. There were 9 hypoechoic and anechoic solid-cystic nodules, 6 solid hypoechoic nodules and 1 isoechoic-hypoechoic mixed echo nodule. CEUS showed 9 hyperenhancement and 7 hypoenhancement nodules, no isoenhancement nodule was found. The median of serum iPTH in patients with hyperenhancement SHPT nodules was 1 639.80 (1 328.80, 2 144.80) pg/ml, in those with hypoenhancement nodules was 974.20 (211.00, 1 221.80) pg/ml, there was statistical significant difference between them (U=53.000, P=0.023). Pearson correlation analysis showed that iPTH was positively correlated with BPAS (r²=0.341, P=0.003), RPI (r²=0.465, P=0.002) and TBC (r²=0.485, P=0.002), but negatively correlated with TTP (r²=0.790, P=0.001), while no obvious correlation was found between iPTH and nodule length-width product (r²=0.029, P=0.248) nor API (r²=0.065, P=0.175). The above CUES parameters had no obvious correlation with the levels of calcium, phosphorus nor alkaline phosphatase (all P>0.05). Conclusion CEUS could be used to preliminaryly predict nodule function of SHPT.