中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (12): 828-831.doi: 10.3969/j.issn.1671-4091.2014.12.006

• 临床研究 • 上一篇    下一篇

99mTc-MIBI SPECT-CT在持续性甲旁亢患者手术治疗中的作用

尹立杰1,续蕊1,张凌2,刘杰1,颜珏1   

  1. 1. 中日友好医院核医学科
    2. 中日友好医院肾内科
  • 收稿日期:2014-05-12 修回日期:2014-09-09 出版日期:2014-12-12 发布日期:2014-12-12
  • 通讯作者: 颜珏,张凌: yanjne@163.ocm;zhangling5@medmail.com.cn E-mail:zhangling5@medmail.com.cn

The role of 99mTc-MIBI SPECT-CT in reoperation therapy for persistent hyperparathyroidism patients

  • Received:2014-05-12 Revised:2014-09-09 Online:2014-12-12 Published:2014-12-12

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摘要： 目的比较甲状旁腺99mTc-MIBI SPECT/CT 显像与超声检查在持续性甲状旁腺功能亢进患者再次手术治疗中的作用。方法8 例持续性甲状旁腺功能亢进患者，评价患者再次术前超声及99mTc-MIBISPECT-CT 显像在诊断和定位中的敏感性和准确性。结果8 例持续性甲状旁腺功能亢进患者共切除共切除14 处组织，甲状旁腺增生结节9 枚,其余5 处未见增生的甲状旁腺组织。99mTc-MIBI SPECT-CT显像诊断敏感性为100%，准确性为78.6%；而超声诊断敏感性为77.8%，准确性为50%。统计学分析显示二者之间有显著性差异(P=0.021)，99mTc-MIBI SPECT-CT 显像与超声检查发现的甲状腺上、下极甲状旁腺的数目一致，但99mTc-MIBI SPECT-CT 显像比超声检查多发现2 枚异位甲状旁腺结节，二者之间无明显统计学意义(P=0.300)。99mTc-MIBI SPECT-CT 检查发现的另两例异位于食管旁沟、升主动脉旁的结节结节虽然未能取得病理结果，但随后随访中这2 例患者的iPTH 分别为800、1429pg/ml，远远高于其余4 位患者的iPTH(＜400)pg/ml。结论再次甲状旁腺全切术是治疗持续性甲状旁腺功能亢进的一种安全和有效的手段，与超声检查比较，99mTc-MIBI SPECT/CT 显像通过病灶摄取99mTc-MIBI 及与CT 结合从而对功能增强的甲状旁腺组织准确定位，并能发现纵隔内异位甲状旁腺组织，能为持续性甲状旁腺功能亢进术前定位提供更多帮助。

关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺全切+自体移植, 99mTC-甲氧基异丁基异腈, 单光子发射计算机断层显像, 持续性甲状旁腺功能亢进

Abstract: Objective To compare the role of 99mTc-MIBI SPECT-CT image and ultrasonography in reoperation therapy for persistent secondary hyperparathyroidism patients. Methods Eight persistent secondary hyperparathyroidism patients underwent parathyroidectomy. The sensitivity and accuracy of 99mTc-MIBI image and ultrasonography before operation were compared. Results Nine of the 14 surgically resected tissues from the 8 persistent secondary hyperparathyroidism patients were confirmed to be parathyroid hyperplasia. The sensitivity was 77.8% and 100% for ultrasonography and 99mTc-MIBI SPECT-CT image, respectively, and the accuracy was 50% and 78.6% for ultrasonography and 99mTc-MIBI dual time planar image and SPECT-CT, respectively. These differences were statistically significant (P=0.021). The glands located in superior and inferior poles could be detected by either ultrasonography or the scintigraphy, and two ectopic parathyroid nodules were found only by 99mTc-MIBI SPECT-CT but not by ultrasonography. However, the two methods for the detection of nodules were statistically similar (P=0.300). Despite the absence of pathological findings, the nodules located in the paraesophagus sulcus and ascending aorta were detected by 99mTc-MIBI SPECT-CT in two cases who had high iPTH of 800 and 1,429 pg/ml, respectively, higher than the iPTH of <
400 pg/ml in other 4 cases. Conclusion Re-operation for parathyroidectomy is a safe and effective treatment for patients with persistent secondary hyperparathyroidism. 99mTc-MIBI planar and SPECT-CT imaging based on fusion of anatomical and functional images is better than ultrasonography in localization of hyperparathyroidism glands. This method can display ectopic parathyroid glands and help clinicians accurately localize the hyperparathyroidism glands.

Key words: Secondary hyperparathyroidism, Parathyroidectomy with auto transplantation, 99mTc-MIBI, SPECT-CT, Persistent hyperparathyroidism