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99 Tcm-MIBI显像定位诊断功能亢进性异位甲状旁腺 总被引:16,自引:1,他引:15
目的:探讨99Tc^m-甲氧基异丁基异腈(MIBI)显像对于异位甲状旁腺所致原发性甲状旁腺功能亢进(简称甲旁亢)的显像特点,提高甲状旁腺术前定位的准确性。方法:61例原发性甲旁患者采用99Tcm-MIBI显像(减影法6例,双时相法55例),其中52例有B超(US),15例有CT检查,全部病例均经手术和病理检查证实。结果:61例中发现异位甲状帝腺16例(26.2%),位置分别为:颈动脉鞘内3例,下颈部处伸至胸骨后6例,纵隔内7例,99Tcm-MIBI显像全部检出(100%),与手术部位一致,US检查15例,检出8例(53.3%),均位于颈部,纵隔内6例及颈动脉鞘内1例未检出。CT检查7例,纵隔内6例检出2例(28.6%),病理检查诊断:腺瘤14例,增生2例,病灶最小1g,最大>60d,99Tcm-MIBI显像示病灶小者为放射性均匀浓聚,大者常有囊性变,甚至完全为囊肿样。位于甲状腺影像外者,双时相法的初始相即可显示,但位于纵隔深部病变的解剖关系不能精确表达,结论:99Tcm-MIBI显像是最有效的探测异位甲状旁腺的方法,缺点是对于纵隔深部病灶的解剖定位不够清楚,应加断显像或加做CT检查。 相似文献
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目的 探讨血清甲状旁腺激素(PTH)升高的甲状旁腺相关疾病的核医学诊断方法和体会.方法 对25例甲状旁腺相关疾病患者进行99Tcm-MIBI SPECT双时相法甲状旁腺显像及99Tcm-亚甲基二膦酸盐(99Tcm-MDP)全身骨静态显像法显像,同时测定血清PTH和血清钙、磷及碱性磷酸酶含量.结果 ①原发性甲状旁腺功能亢进(PHPT)和继发性甲状旁腺功能亢进(SHPT)者血清PTH水平呈不同程度升高,其中PHPT较明显.②PHPT和SHPT患者手术前后PTH水平的变化明显,t分别为6.24和6.85,P均<0.01;③PHPT患者全身骨显像常呈典型的代谢性骨病骨显像特点,甲状旁腺99Tcm-MIBI双时相显影阳性率为90%以上;④SHPT患者全身骨显像表现多样,常因血本底偏高,骨/组织放射性计数值降低,使骨显像的清晰度受到影响,但通常以骨摄取显像剂增多为主.99Tcm-MIBI双时相甲状旁腺显像多有不同程度的甲状旁腺增生,达56%以上.结论 甲状旁腺、全身骨SPECT检查结合血清PTH水平测定的方法对甲状旁腺相关疾病的诊断及指导治疗具有很高的临床应用价值. 相似文献
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笔者报道了1例三发性甲状旁腺功能亢进(HPT)伴巨大甲状旁腺腺瘤的99Tcm-MIBI SPECT/CT显像病例。从临床症状、实验室检查及影像学检查结果综合分析了该病的特点,通过文献复习加深了对三发性HPT的认识。三发性HPT常见于慢性肾功能不全的透析患者,其甲状旁腺长期受到低血钙的刺激,部分组织增生后转变为具有自主分泌功能的腺瘤,其发病率较低,内科治疗效果欠佳,及时进行99Tcm-MIBI SPECT/CT显像可以进一步定性、定位,利于为患者选择更为合适的治疗方案。 相似文献
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Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. 总被引:5,自引:0,他引:5
William C Lavely Sibyll Goetze Kent P Friedman Jeffrey P Leal Zhe Zhang Elizabeth Garret-Mayer Alan P Dackiw Ralph P Tufano Martha A Zeiger Harvey A Ziessman 《Journal of nuclear medicine》2007,48(7):1084-1089
Various methodologies for (99m)Tc-sestamibi parathyroid scintigraphy are in clinical use. There are few direct comparisons between the different methods and even less evidence supporting the superiority of one over another. Some reports suggest that SPECT is superior to planar imaging. The addition of CT to SPECT may further improve parathyroid adenoma localization. The purpose of our investigation was to compare hybrid SPECT/CT, SPECT, and planar imaging and to determine whether dual-phase imaging is advantageous for the 3 methodologies. METHODS: Scintigraphy was performed on 110 patients with primary hyperparathyroidism and no prior neck surgery. Of these, 98 had single adenomas and are the subject of this review. Planar imaging and SPECT/CT were performed at 15 min and 2 h after injection. Six image sets (early and delayed planar imaging, SPECT, and SPECT/CT) and combinations of the 2 image sets were reviewed for adenoma localization at 13 possible sites. Each review was scored for location and certainty of focus by 2 reviewer groups. Surgical location served as the standard. Sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, and kappa-values were determined for each method. RESULTS: The overall kappa-coefficient (certainty of adenoma focus) between reading groups was 0.68 (95% confidence interval, 0.66-0.70). The highest values were for dual-phase studies that included SPECT/CT. Dual-phase planar imaging, SPECT, and SPECT/CT were statistically significantly superior to single-phase early or delayed imaging in sensitivity, area under the curve, and positive predictive value. Neither single-phase nor dual-phase SPECT was statistically superior to dual-phase planar imaging. Early-phase SPECT/CT in combination with any delayed imaging method was superior to dual-phase planar imaging or SPECT for sensitivity, area under the curve, and positive predictive value. CONCLUSION: Early SPECT/CT in combination with any delayed imaging method was statistically significantly superior to any single- or dual-phase planar or SPECT study for parathyroid adenoma localization. Localization with dual-phase acquisition was more accurate than with single-phase (99m)Tc-sestamibi scintigraphy for planar imaging, SPECT, and SPECT/CT. 相似文献
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吸氧99Tcm-MIBI SPECT与定位CT结合对肺部病灶的鉴别诊断价值 总被引:2,自引:0,他引:2
目的 探讨吸氧99Tcm-甲氧基异丁基异腈(MIBI)SPECT与定位CT结合对肺部病灶的鉴别诊断价值,为肺部病灶的良恶性鉴别建立一种高性价比方法。方法对2008年9月至2009年3月47例可疑恶性肺部病灶患者进行前瞻性研究,对疑似炎性反应病例短期应用抗生素。所有受检者于注射99TcmMIBI前开始经鼻腔导管吸氧,注射后10min进行SPECT与CT定位融合显像,2h后进行延迟显像。对良、恶性肺部病灶(T)与对侧相应肺组织(N)的摄取比值(早期:EUR,延迟:DUR)比较应用独立样本t检验,并对EUR和DUR的诊断效率进行受试者工作特征(ROC)曲线分析。结果47例患者(32例原发性肺癌,4例肺转移,11例良性病变)共51个肺部病灶,恶性病灶39个,良性病灶12个。99TcmMIBISPECT与定位CT融合显像诊断肺部良恶性病灶的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为94.9%(37/39)、83.3%(10/12)、92.2%(47/51)、94.9%(37/39)和83.3%(10/12)。恶性病灶EUR为2.95±1.16[95%可信区间(CI):2.57~3.32)],良性病灶EUR为1.43±0.33(95%CI:1.22~1.64),两者差异有统计学意义(t=-4.44,P〈0.01);恶性病灶DUR为3.19±1.74(95%CI:2.62—3.75),良性病灶DUR为1.60±0.32(95%CI:1.39—1.81),两者差异有统计学意义(t=-3.12,P〈0.01)。半定量ROC分析显示:以EUR≥1.625为诊断肺部恶性病灶的界值,灵敏度97.4%(38/39),特异性83.3%(10/12);以DUR≥1.75为诊断肺部恶性病灶的界值,灵敏度94.9%(37/39),特异性83.3%(10/12)。结论吸氧99TcmMIBISPECT与定位CT结合显像对肺部病灶的良恶性鉴别具有较高的临床价值。 相似文献
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Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. 总被引:7,自引:0,他引:7
Mordechai Lorberboym Irit Minski Sorina Macadziob Galina Nikolov Pinhas Schachter 《Journal of nuclear medicine》2003,44(6):904-908
The purpose of this prospective study was to evaluate the diagnostic value of early parathyroid SPECT combined with quantitative analysis as compared with planar imaging in patients undergoing minimally invasive radioguided surgery. METHODS: A total of 52 consecutive patients with primary hyperparathyroidism underwent planar and SPECT parathyroid scintigraphy 2-5 d before surgery. Each patient had a single-tracer dual-phase technique using (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) and a double-tracer subtraction technique using a delayed (99m)Tc-pertechnetate scan. Immediately after the first (99m)Tc-MIBI planar image, a SPECT study was acquired. Before radioguided parathyroidectomy, each patient was reinjected with (99m)Tc-MIBI. Serum calcium levels were available for all patents before surgery and at 8 and 24 h after surgery. Serum parathyroid hormone (PTH) levels were also available for all patients. Quantitative analysis was performed using the average count ratio of parathyroid to left thyroid lobe, right thyroid lobe, and maximum thyroid activity. All patients had histopathologic examination of the removed glands. RESULTS: The average time for radioguided surgery was 30 min (range, 20-40 min). Postsurgical calcium levels correlated significantly with the adenoma weight (r = 0.5; P = 0.016). Combined planar scintigraphy correctly identified 41 adenomas (79%). SPECT increased the sensitivity to 96%. SPECT was superior to planar imaging in 9 patients, mainly in patients with ectopic adenomas or with multinodular goiters. Gland size did not affect significantly the detectability of SPECT. (99m)Tc-MIBI retention was noted in only 31 adenomas (60%). The average uptake ratios of parathyroid counts to the left lobe, right lobe, and maximum thyroid activity were 1.20 +/- 0.42, 1.29 +/- 0.45, and 0.84 +/- 0.35, respectively. The latter ratio was significantly correlated with PTH levels before surgery (r = 0.408; P = 0.04). CONCLUSION: Our data indicate that early preoperative SPECT in patients with primary hyperparathyroidism is essential for accurate localization of parathyroid adenomas and for the selection of patients who are candidates for minimally invasive radioguided surgery. Planar parathyroid imaging is less sensitive compared with SPECT, and washout kinetics of (99m)Tc-MIBI are unreliable in the dual-phase technique. Patients with higher presurgical PTH levels may especially benefit from radioguided surgery. 相似文献
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目的探讨^99Tc^m-MIBI双时相显像在定位诊断继发性甲状旁腺功能亢进症(SHPT)中的临床价值。方法回顾性分析2010年至2013年间20例(男8例,女12例,平均年龄49.6岁)行甲状旁腺切除术的肾性SHPT患者影像学资料,以术后病理结果为“金标准”,计算^99Tc^m-MIBI双时相SPECT/CT显像结果与彩色多普勒超声(CDUS)对SHPT的诊断效能,同时对延迟显像中甲状旁腺摄取的最高放射性比值(T/NT)与患者近期全段PTH(iPTH)水平及术中切除的相应甲状旁腺体积的关系作分析。采用x^2检验、Pearson相关或Spearson相关分析数据。结果^99Tc^m-MIBI双时相显像和CDUS诊断SHPT的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为66.67%(44/66)、100%(14/14)、100%(44/44)、38.89%(14/36)、72.50%(58/80)和78.19%(43/55)、52.38%(11/21)、81.13%(43/53)、47.83%(11/23)、71.05%(54/76)。二者诊断SHPT的特异性和阳性预测值差异有统计学意义(x^2=9.33和9.26,均P〈0.05),其余3个指标差异均无统计学意义(x^2=1.97、0.04和0.46,均P〉0.05)。最高T/NT与患者iPTH水平及手术切除的相应甲状旁腺体积均呈正相关(r=0.638,rs=0.571,均P〈0.05)。结论^99Tc^m-MIBISPECT/CT显像诊断SHPT的特异性高于CDUS0^99Tc^m-MIBI双时相显像可准确定位功能亢进的甲状旁腺,为手术治疗提供依据。 相似文献