99mTc-MIBI平面显像及断层显像诊断原发性甲状旁腺功能亢进的效能评价

目的 探讨^{99 m}Tc-甲氧基异丁基异腈(Tc-99m methoxyisobutylisonitrile,MIBI)平面显像及断层显像诊断原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)的效能。 方法 回顾性分析2019年1月至2021年1月于首都医科大学附属北京朝阳医院疑诊PHPT并在术前完善甲状旁腺^{99 m}Tc -MIBI平面显像及断层显像的78例患者的临床及影像资料。分别计算^{99 m}Tc-MIBI早期平面显像、延迟平面显像及延迟断层显像的诊断效能,采用χ ²检验进行比较。 结果 78例患者术后病理证实PHPT 75例。从患者水平分析,早期平面显像的灵敏度为 60.00% (45/75),特异度为 66.67% (2/3),准确率为 60.26% (47/78);延迟平面显像的灵敏度为 81.33% (61/75),特异度为 0% (0/3),准确率为 78.21% (61/78);延迟断层显像的灵敏度为 89.33% (67/75),特异度为 66.67% (2/3),准确率为 88.46% (69/78);延迟平面显像及断层显像的灵敏度、准确率均显著高于早期平面显像(χ ² =8.233,P=0.004;χ² =17.058,P ＜ 0.001和χ² =5.898,P=0.015;χ ² =16.272,P ＜ 0.001)。从病灶水平分析,早期平面显像的灵敏度、特异度和准确率分别为 55.42% (46/83),83.33% (5/6)和 57.30% (51/89),延迟平面显像的灵敏度、特异度和准确率分别为 73.49% (61/83),16.67% (1/6)和 69.66% (62/89),延迟断层显像的灵敏度、特异度和准确率分别为 90.36% (75/83),66.67% (4/6)和 88.76% (79/89);延迟平面显像的灵敏度显著高于早期平面显像(χ²=5.916, P=0.015);延迟断层显像的灵敏度及准确率均显著高于早期平面显像和延迟平面显像(χ²=25.639, P ＜ 0.001;χ²=22.364, P ＜ 0.001和χ²=7.975, P=0.005;χ²=9.860, P=0.002)。 结论 ^{99 m}Tc-MIBI延迟平面显像在原发性甲状旁腺功能亢进术前的诊断效能明显优于早期显像,延迟断层显像可进一步提高诊断的灵敏度和准确率。

Value of 99 mTc-MIBI SPECT planar imaging and tomographic imaging in diagnosis of primary hyperparathyroidism

Objective To assess the diagnostic values of ^{99 m}Tc-MIBI SPECT/CT planar imaging and tomographic imaging in preoperative primary hyperparathyroidism (PHPT). Methods A total of 78 patients in Beijing Chaoyang Hospital from 2019 to 2021 with suspected PHPT who underwent pre-operative^99mTc-MIBI SPECT/CT from January 2019 to January 2021 were retrospectively reviewed.The diagnostic efficacy of early planar imaging, late planar imaging, and tomographic imaging were calculated respectively.The results were compared by χ² test. Results Of all the 78 patients, 20 males (25.64%) and 58 females (74.36%) were included, aged 14-78 (49.36±14.21) years old.Postoperative pathology confirmed 75 patients with PHPT.At patient level, the sensitivity, specificity, and accuracy of early planar imaging were 60.00%, 66.67%, and 60.26%, respectively.The sensitivity, specificity, and accuracy of late planar imaging were 81.33%, 0%, and 78.21%, respectively.The sensitivity, specificity, and accuracy of tomographic imaging were 89.33%, 66.67%, and 88.46%, respectively.The sensitivity and accuracy were significantly higher in late planar imaging and tomographic imaging than that in early planar imaging (χ ²=8.233,P=0.004 and χ ²=17.058,P ＜ 0.001, χ² =5.898,P=0.015 and χ²=16.272,P＜0.001, respectively).At lesion level, the sensitivity, specificity, and accuracy of early planar imaging were 55.42%, 83.33%, and 57.30%, respectively.The sensitivity, specificity, and accuracy of late planar imaging were 73.49%, 16.67%, and 69.66%, respectively.The sensitivity, specificity, and accuracy of tomographic imaging were 90.36%, 66.67%, and 88.76%, respectively.The sensitivity was significantly higher in late planar imaging than that in early planar imaging (χ²=5.916, P=0.015).The sensitivity and accuracy were significantly higher in tomographic imaging than that in early planar imaging and late planar imaging (χ²=25.639, P ＜ 0.001;χ²=22.364, P ＜ 0.001 and χ²=7.975,P=0.005 and χ ² =9.860,P=0.002, respectively). Conclusion The diagnostic values of ^{99 m}Tc-MIBI late imaging in preoperative primary hyperparathyroidism is more significant than that of early imaging.The late tomographic imaging can improve the sensitivity and accuracy.