核素显像对甲状旁腺功能亢进的诊断价值

目的评价3种核素显像方法在甲状旁腺功能亢进症(甲旁亢)诊断中的应用价值。方法35例拟诊甲旁亢患者进行了核素显像,包括201Tl/99mTcO4-减影法8例和99mTc-MIBI双时相法27例,后者有20例同时做了99mTc-MIBI/99mTcO4-减影法显像。阳性指标为减影或延迟图像上出现异常增高的放射性聚集灶,所有显像资料均参照临床最终诊断结果进行了评价,并与同期的B超或CT检查作了对比分析。结果确诊的35例甲旁亢患者,其中甲状旁腺腺瘤31例(异位1例)、甲状旁腺增生3例与甲状旁腺腺癌1例。201Tl/99mTcO4-减影法、99mTc-MIBI双时相法及99mTc-MIBI/99mTcO4-减影法显像诊断甲旁亢的灵敏度分别达62.5%、88.9%、90.0%,特异度均为100%,同期B超的灵敏度和特异度分别为74.3%和85.7%。另28例甲旁亢患者有CT资料,22例有阳性发现(78.6%)。99mTc-MIBI/99mTcO4-减影法显像较其它方法具有更高的诊断效能。结论核素显像能较准确地检测功能亢进的甲状旁腺,是患者术前定位的重要辅助诊断手段。

Nuclide imaging in hyperparathyroidism: diagnostic value

Objective To evaluate the diagnostic value of three nuclide imaging methods in patients with hyperparathyroidism. Methods Thirty five patients with hyperparathyroidism underwent 201 Tl/ 99m TcO-4 (8 cases), double phase 99m Tc MIBI imaging methods (27 cases) and 99m Tc MIBI/ 99m TcO-4 substraction imaging (20 cases). Abnormal increase of radioactivity in substraction imaging or delay imaging denoted positive result. All data of nuclide imaging were evaluated according to final clinical results and were compared with ultrasound or CT. Results 35 cases of hyperparathyroidism were proved, including 31 adenomas (ectopic 1), 3 hyperplasia and 1 carcinoma. The sensitivity of 201 Tl/ 99m TcO-4 , double phase 99m Tc MIBI imaging and 99m Tc MIBI/ 99m TcO-4 substraction imaging was 62.5%, 88.9%,90.0%, respectively. The specificity of 3 nuclide imaging methods was 100%. The sensitivity and specificity of ultrasound were 74.3%, 85.7%, respectively. The sensitivity of CT was 78.6%. The results showed that 99m Tc MIBI/ 99m TcO-4 was superior to other imaging. Conclusion An accurate diagnosis of hyperparathyroidism and preoperative anatomic localization can be determined by means of nuclide imaging.