99mTc-MIBI SPECT/CT及颈部超声在原发性甲状旁腺功能亢进症术前诊断中的应用

  目的  探究99mTc-MIBI SPECT/CT及颈部超声在原发性甲状旁腺功能亢进症（PHPT）术前诊断中的应用。  方法  收集92例疑似PHPT患者资料，评价99mTc-MIBI SPECT/CT及颈部超声检查的诊断效能，分析99mTc-MIBI摄取情况与术前甲状旁腺素（PTH）及病灶最大直径的关系。  结果  颈部超声、99mTc-MIBI平面显像、SPECT/CT显像及联合检查敏感度分别为58.70%、71.74%、85.87%、93.48%，其中SPECT/CT显像、联合检查敏感度分别高于超声、99mTc-MIBI平面显像（P<0.05）；99mTc-MIBI平面显像阳性组患者术前PTH和术后病灶最大直径均高于阴性组（P<0.05），且阳性组患者早期相、延迟相病灶与正常组织的摄取比值T/Ne、T/Nd分别与术前PTH、术后病灶最大直径呈正相关关系（P<0.05）；ROC曲线显示，术前PTH预测99mTc-MIBI平面显像阳性的曲线下面积为0.780，95%CI为0.675~0.886，敏感度为80.30%，特异性为69.23%。  结论  患者术前PTH、病灶大小分别与99mTc-MIBI摄取呈正相关关系，99mTc-MIBI SPECT/CT及超声联合对PHPT术前诊断具有较高的应用价值。 

Application of 99mTc-MIBI SPECT/CT and neck ultrasound in the preoperative diagnosis of primary hyperparathyroidism

  Objective  To investigate the application of 99mTc-MIBI SPECT/CT and neck ultrasound in the preoperative diagnosis of primary hyperparathyroidism.  Methods  The data of 92 patients with suspected primary hyperparathyroidism were collected. The diagnostic efficiency of 99mTc-MIBI SPECT/CT and neck ultrasound was evaluated. The relationship between 99mTc-MIBI uptake and preoperative parathyroid hormone (PTH), the maximum diameter of lesions was analyzed.  Results  The sensitivity values of neck ultrasound, 99mTc-MIBI plane imaging, SPECT/CT imaging and combined detection were 58.70%, 71.74%, 85.87% and 93.48%, respectively. The sensitivity of SPECT/CT imaging and combined detection was higher than that of ultrasound and 99mTc-MIBI plane imaging (P<0.05). The preoperative PTH and postoperative maximum diameter of lesions in positive 99mTc-MIBI plane imaging group were higher than those in negative group (P<0.05). The uptake ratios T/Ne and T/Nd in early phase lesions, delayed phase lesions and normal tissues were positively correlated with preoperative PTH and postoperative maximum diameter of lesions (P<0.05). ROC curves showed that the AUC, 95%CI, sensitivity and specificity of preoperative PTH for predicting positive 99mTc-MIBI plane imaging were 0.780, 0.675-0.886, 80.30% and 69.23%, respectively.  Conclusion  The preoperative PTH and lesion size are positively correlated with 99mTc-MIBI uptake. The combination of 99mTc-MIBI SPECT/CT and ultrasound has high application value in the preoperative diagnosis of PHPT.