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目的探讨99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射型计算机断层显像/计算机断层扫描(SPECT/CT)对原发性甲状旁腺功能亢进症(PHPT)病灶定位诊断的增益价值。方法原发性甲状旁腺功能亢进症(PHPT)患者71例,静注99mTc-MIBI 740 MBq,于注射后15分钟和2~3小时分别采集颈胸部早期和延迟平面显像,延迟平面显像后行颈胸部SPECT/CT同机融合显像。两位阅片者独立分析99mTc-MIBI双时相平面显像与SPECT/CT融合显像,每一个诊断结果分配一个解剖位置,并分为5个等级。对两位阅片者的分析结果进行一致性分析;根据手术和病理结果,分别比较两种显像方法诊断PHPT病灶的敏感度、特异度、阳性预测值、阴性预测值和ROC曲线下面积。分析影响99mTc-MIBI甲状旁腺显像敏感度的因素。结果 SPECT/CT融合图像比平面图像的分析一致性明显提高。手术的55例甲状旁腺病变患者共病理确诊59个病灶,SPECT/CT融合显像对PHPT病灶诊断的敏感度为98.3%,明显高于双时相平面显像88.1%的敏感度(P<0.05)。MGD是影响甲状旁腺显像敏感度的因素。SPECT/CT融合显像可提供病灶的解剖位置,尤其方便异位PHPT病灶的定位或术中探查。结论99mTc-MIBI SPECT/CT是探查PHPT病灶的有效诊断方法,综合临床价值高于双时相平面显像。
Objective To investigate the localization of 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography / computed tomography (CT) in the diagnosis of primary hyperparathyroidism (PHPT) Gain value. Methods 71 patients with primary hyperparathyroidism (PHPT) were intravenously injected with 740 MBq of 99mTc-MIBI. Early and delayed cervical plain imaging and delayed planar imaging were collected at 15 minutes and 2 to 3 hours after injection. Cervical and thoracic SPECT / CT fusion imaging. The two readers independently analyzed 99mTc-MIBI dual-phase planar imaging and SPECT / CT fusion imaging. Each diagnostic result was assigned an anatomic location and divided into five levels. According to the results of surgery and pathology, the sensitivity, specificity, positive predictive value, negative predictive value and area under the ROC curve of PHPT lesions were compared respectively by two imaging methods. Factors affecting the sensitivity of 99mTc-MIBI parathyroid imaging were analyzed. Results The consistency of SPECT / CT fusion images was significantly improved compared with that of planar images. Fifty-five patients with pathologically confirmed parathyroid lesions underwent pathologic diagnosis of 59 lesions. The sensitivity of SPECT / CT fusion imaging in diagnosis of PHPT lesions was 98.3%, which was significantly higher than that of biphasic phase imaging 88.1% (P < 0.05). MGD is a factor affecting the sensitivity of parathyroid imaging. SPECT / CT fusion imaging can provide the anatomic location of the lesion, especially for the location or intraoperative exploration of ectopic PHPT lesions. Conclusion 99mTc-MIBI SPECT / CT is an effective method for the diagnosis of PHPT lesions. The clinical value of 99mTc-MIBI SPECT / CT is higher than that of double-phase planar imaging.