99mTc-MIBI SPECT/CT显像在原发性甲状旁腺功能亢进症术前诊断中的应用价值

doi:10.3969/j.issn.1006-7795.2022.06.007

摘要/Abstract

摘要： 目的通过与^99m 锝-甲氧基异丁基异腈(^99mTc-sestamibi,^99mTc-MIBI)双时相平面显像和超声检查比较,评价^99mTc-MIBI 单光子发射计算机断层显像(single photon emission computed tomography,SPECT)/电子计算机断层显像(computed tomography,CT)在原发性甲状旁腺功能亢进症(primary hyperparathyroidism, PHPT)患者术前诊断中的应用价值。方法回顾性分析在首都医科大学宣武医院病理确诊PHPT的101例患者(男性23例,女性78例,年龄14~74岁)的^99mTc-MIBISPECT/CT显像结果,并与双时相平面显像和超声检查结果进行比较,以手术病理结果为“金标准”,分别计算3种检查方法诊断PHPT的灵敏度、特异度、准确率、阳性预测值和阴性预测值,并应用SPSS 23.0软件进行χ²检验,对不同检查方法的诊断效能进行比较。同时,对SPECT/CT与双时相平面显像的阳性和阴性病灶大小行t检验进行比较分析。结果 101例患者经术后病理证实共有120枚甲状旁腺病灶、93例为单发病灶,8例为多发病灶。120枚甲状旁腺病灶含89枚腺瘤(其中8枚为异位腺瘤)、5枚非典型腺瘤、24枚增生病灶(含异位3枚)、2枚甲状旁腺癌。^99mTc-MIBI SPECT/CT显像对PHPT病灶诊断的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为90.00%、99.64%、96.78%、99.08%和95.93%,平面显像对应的结果分别为76.67%、99.30%、92.57%、97.87%和90.97%,超声检查对应的结果分别为82.50%、99.64%、94.55%、99.00%和93.09%,其中^99mTc-MIBI SPECT/CT显像的灵敏度(χ²=14.062,P<0.001)、准确率(χ²=15.059,P<0.001)和阴性预测值(χ²=6.034,P<0.05)均高于平面显像,而与超声检查的灵敏度和准确率差异无统计学意义(P>0.05)。SPECT/CT和平面显像阳性病灶的最大径分别为(1.90±0.98)cm和(2.01±0.99)cm,明显大于其显像阴性病灶(1.36±0.54)cm和(1.25±0.67)cm (t值分别为2.311和3.827,均P<0.05)。结论 ^99mTc-MIBI SPECT/CT显像诊断PHPT具有较高的灵敏度、准确率和阴性预测值,对PHPT术前定位定性诊断有重要临床应用价值。

关键词: 甲状旁腺功能亢进症, 原发性, 单光子发射计算机断层显像/电子计算机断层显像, 甲氧基异丁基异腈

Abstract: Objective To evaluate the clinical value of ^99mTc-sestamibi (^99mTc-MIBI) single photon emission computed tomography (SPECT)/computed tomography (CT) in preoperative diagnosis of primary hyperparathyroidism (PHPT) by comparing with ^99mTc-MIBI dualphase planar imaging and ultrasonography. Methods　A total of 101 patients (23 males, 78 females, 14-74 yearsold) who had received parathyroidectomy from Xuanwu Hospital, Capital Medical University were enrolled into this retrospective study. The pathological results were considered as the gold standard. The diagnostic efficiencies (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value) of ^99mTc-MIBI SPECT/CT were compared with ^99mTc-MIBI dual-phase planar imaging and ultrasound examination using χ2 test. The size of positive lesions was compared with negative lesions in ^99mTc-MIBI SPECT/CT and 99mTc-MIBI dual-phase planar imaging usingt test respectively. Results　A total of 120 PHPT lesions were found in 101 patients, of which 93 cases had single lesion and 8 cases had multiple lesions, and 120 lesions included 89 parathyroid adenomas (8 ectopic adenomas), 5 atypical adenomas, 24 hyperplastic lesions (3 ectopic lesions), and 2 parathyroid carcinomas. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ^99mTc-MIBI SPECT/ CT for PHPT were 90.00%,99.64%,96.78%,99.08%, and 95.93% respectively. The corresponding results of dual-phase planar imaging were 76.67%,99.30%,92.57%,97.87%, and 90.97% respectively. The corresponding results of ultrasound examination were 82.50%,99.64%,94.55%,99.00%, and 93.09% respectively. The sensitivity (χ2 =14.062, P<0.001), accuracy (χ2=15.059, P<0.001), and negative predictive value (χ2=6.034, P<0.05) of ^99mTc-MIBI SPECT/CT for PHPT were higher than those of planar imaging. In contrast there were no significant differences in sensitivity and accuracy between ^99mTc-MIBI SPECT/CT and ultrasound examination (P>0.05). The maximum diameters of positive lesions of SPECT/CT and planar imaging were (1.90±0.98)cm and (2.01±0.99)cm, respectively, which were significantly larger than those of negative lesions (1.36±0.54) cm and (1.25±0.67) cm (t=2.311,3.827, both P<0.05), respectively. Conclusion There were higher sensitivity, accuracy, and negative predictive value of ^99mTc-MIBI SPECT/CT in the diagnosis of PHPT, which has important clinical application value in preoperative localization and qualitative diagnosis of PHPT.

Key words: hyperparathyroidism, primary, single photon emission computed tomography/computed tomography, sestamibi

中图分类号:

王曼, 候亚琴, 崔碧霄, 毕晟, 王渤钧, 张春, 卢洁. ^99mTc-MIBI SPECT/CT显像在原发性甲状旁腺功能亢进症术前诊断中的应用价值[J]. 首都医科大学学报, 2022, 43(6): 861-866.

Wang Man, Hou Yaqin, Cui Bixiao, Bi Sheng, Wang Bojun, Zhang Chun, Lu Jie. Value of ^99mTc-MIBI SPECT/CT in pre-operative diagnosis of primary hyperparathyroidism[J]. Journal of Capital Medical University, 2022, 43(6): 861-866.

参考文献

[1] Raruenrom Y, Theerakulpisut D, Wongsurawat N, et al. Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism[J]. Nucl Med Rev Cent East Eur, 2018, 21(1): 20－25.
[2] Urbano N, Scimeca M, Di Russo C, et al. [⁹⁹mTc]sestamibi SPECT can predict proliferation index, angiogenesis, and vascular invasion in parathyroid patients: a retrospective study[J]. J Clin Med, 2020, 9(7): 2213.
[3] Andersen T B, Aleksyniene R, Boldsen S K, et al. Contrast-enhanced computed tomography does not improve the diagnostic value of parathyroid dual-phase MIBI SPECT/CT[J]. Nucl Med Commun, 2018, 39(5): 435－440.
[4] Silverberg S J, Bilezikian J P. Asymptomatic primary hyperparathyroidism: a medical perspective[J]. Surg Clin North Am, 2004, 84(3): 787－801.
[5] Wermers R A, Khosla S, Atkinson E J, et al. Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993－2001: an update on the changing epidemiology of the disease[J]. J Bone Miner Res, 2006, 21(1): 171－177.
[6] 李春红, 刘雪辉, 田洁, 等. ⁹⁹mTc-MIBI SPECT/CT与超声检查在继发性甲状旁腺功能亢进症术前定位中的应用[J]. 国际生物医学工程杂志, 2020, 43(4): 304－308.
[7] Vaz A, Griffiths M. Parathyroid imaging and localization using SPECT/CT: initial results[J]. J Nucl Med Technol, 2011, 39(3): 195－200.
[8] Sandqvist P, Nilsson I L, Grybäck P, et al. SPECT/CT's advantage for preoperative localization of small parathyroid adenomas in primary hyperparathyroidism[J]. Clin Nucl Med, 2017, 42(2): e109-e114.
[9] Monzen Y, Tamura A, Okazaki H, et al. SPECT/CT fusion in the diagnosis of hyperparathyroidism[J]. Asia Ocean J Nucl Med Biol, 2015, 3(1): 61－65.
[10] Wei W J, Shen C T, Song H J, et al. Comparison of SPET/CT, SPET and planar imaging using ⁹⁹mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: a meta-analysis[J]. Hell J Nucl Med, 2015, 18(2): 127－135.
[11] 郑玉婷, 池晓华, 齐永帅, 等. ⁹⁹mTc-MIBI SPECT/CT显像结合半定量分析在甲状旁腺功能亢进症中的诊断价值及影响因素[J]. 南方医科大学学报, 2021, 41(10): 1577－1582.
[12] 刘斌, 李玉琴, 黄蕊, 等. 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[J]. 分子影像学杂志, 2022, 45(4): 595－598.
[13] Kairemo K, Jessop A C, Vija A H, et al. A prospective comparative study of using ultrasonography, 4D-CT and parathyroid dual-phase scintigraphy with SPECT in patients with primary hyperparathyroidism[J]. Diagnostics (Basel), 2021, 11(11): 2006.
[14] Kissin M, Bakst H. Co-existing myxedema and hyperparathyroidism: case report[J]. J Clin Endocrinol,1947,7(2):152-158.
[15] Jovanovic M D, Zivaljevic V R, Diklic A D, et al. Surgical treatment of concomitant thyroid and parathyroid disorders: analysis of 4882 cases[J]. Eur Arch Otorhinolaryngol, 2017, 274(2): 997－1004.
[16] D'cruz R T, Seet J E, Parameswaran R. Synchronous symptomatic parathyroid carcinoma and parathyroid adenoma with incidental follicular thyroid carcinoma[J]. Ann R Coll Surg Engl, 2020, 102(8): e192-e195.