原发性甲状旁腺功能亢进症的影像学诊断

目的:探讨超声、CT、99mTc-MIBI和MRI对原发性甲状旁腺功能亢进症(PHPT)的诊断价值。方法:对手术病理证实的142例PHPT患者的影像学资料进行回顾性分析。其中行CT检查113例,B超检查126例,99mTc-MIBI检查81例,MRI检查8例。结果:142例PHPT患者中,手术确诊为单发甲状旁腺腺瘤123例,占86.6%;异位甲状旁腺病变7例;多发性内分泌腺瘤病(MEN)伴甲状旁腺功能亢进症6例;甲状旁腺腺癌8例。CT检查98例诊断为甲状旁腺腺瘤或占位(98/113),B超检查100例诊断为甲旁腺腺瘤(100/126),99mTc-MIBI检查76例诊断为甲状腺腺瘤或病变。结论:PHPT的定性诊断主要靠临床及生化检查,定位诊断靠B超、CT及99mTc-MIBI等影像学检查。如B超、CT和99mTc-MIBI检查相结合,可有助于提高本病诊断的准确度。我们应提高对异位甲状旁腺病变、MEN伴HPT和甲状旁腺腺癌影像表现的认识,避免误诊、漏诊。

Imaging diagnosis of primary hyperparathyroidism

Objective To evaluate the value of ultrasonography (US), computed tomography(CT), 99mTc-MIBI and MRI in diagnosis of primary hyperparathyroidism (PHPT). Methods The imaging characteristics and the values of multiple modalities (CT, US, 99mTc-MIBI, MRI) in diagnosis of PHPT were analyzed respectively. Among 142 cases of PHPT proved by surgical pathology, CT scan was performed in 113, B ultrasound in 126, nuclear examination in 81 and MRI in 8. Results It was confirmed by operation that 123 (86.6%) had parathyroid adenomas, 7(4.9%) had ectopic parathyroid lesions, 6(4.2%) had multiple endocrine neoplasia(MEN) with PHPT and 8 (5.6%) had parathyroid carcinomas. Ninety-eight cases of parathyroid tumors were detected by CT, 100 of parathyroid adenomas by B ultrasound and 76 by 99mTc-MIBI before the operation. Conclusions The diagnosis of PHPT mainly depends on clinical history and laboratory examination and the lesion location of PHPT mainly depends on B ultrasound, CT scan and 99mTc-MIBI. The combined use of 99mTc-MIBI, B ultrasound and CT may improve the diagnostic accuracy of PHPT. The knowledge about the imaging findings of ectopic parathyroid adenoma, MEN with HPT and parathyroid carcinoma should be enhanced in order to avoid the misdiagnosis.