摘要
目的探讨^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)平面显像及SPECT/CT融合显像对原发性甲状旁腺功能亢进症(PHPT)的术前诊断价值,并分析影响显像结果的相关因素。方法回顾性分析2016年6月至2019年9月期间青岛大学附属医院经手术病理证实的PHPT患者62例(男15例,女47例,年龄27~80岁)。采用χ2检验比较平面显像、融合显像的诊断效能,采用两独立样本t检验和Mann-Whitney U检验比较平面显像阳性组及阴性组术前血清甲状旁腺激素(PTH)水平、血钙水平及术后病灶最大径的差异。在平面显像阳性病例中应用感兴趣区(ROI)技术测量并计算早期相及延迟相病灶与正常组织的摄取比值(T/Ne、T/Nd),并采用Pearson相关及Spearman秩相关分析其与血清PTH、血钙水平及术后病灶最大径的相关性。分别建立血清PTH、血钙与平面显像阳性关系的受试者工作特征(ROC)曲线,确定最佳临界值。结果62例PHPT患者平面显像灵敏度69.35%(43/62),融合显像灵敏度87.10%(54/62),融合显像灵敏度高于平面显像(χ2=5.729,P=0.017)。平面显像阳性患者较阴性患者有较高的术前血清PTH[253.32(107.00,331.70)和(111.86±44.29)ng/L;z=-2.802,P=0.005]及血钙水平[2.78(2.51,2.87)和(2.59±0.21)mmol/L;z=-1.978,P=0.048],且前者术后病灶最大径大于后者[(2.01±0.88)和(1.42±0.55)mm;t=3.300,P=0.002]。T/Ne与术前血清PTH(rs=0.511,P<0.001)、术后病灶最大径(r=0.381,P=0.012)呈正相关,T/Nd与术前血清PTH(rs=0.538,P<0.001)、血钙(rs=0.348,P=0.022)及术后病灶最大径(r=0.463,P=0.002)均呈正相关。术前血清PTH、血钙与平面显像阳性关系的ROC曲线下面积分别为0.725、0.646;术前血清PTH具有较好的预测价值,最佳临界值为150.4 ng/L。结论^(99)Tc^(m)-MIBI平面显像阳性的PHPT患者血清PTH、血钙水平及病灶最大径与^(99)Tc^(m)-MIBI摄取呈正相关;当血清PTH低于150.4 ng/L,平面显像易出现假阴性,SPECT/CT融合显像更具诊断价值,结合术前血清PTH及CT图像能进一步提高检出率。
Objective To investigate the preoperative diagnostic value of ^(99)Tc^(m)-methoxyisobutylisonitrile(MIBI)planar imaging and SPECT/CT imaging for primary hyperparathyroidism(PHPT),and analyze the relevant factors affecting the imaging results.Methods From June 2016 to September 2019,a total of 62 patients(15 males,47 females,age range:27-80 years)confirmed as PHPT by postsurgical pathology in Affiliated Hospital of Qingdao University were retrospectively enrolled.The diagnostic efficacies of ^(99)Tc^(m)-MIBI planar imaging and SPECT/CT imaging were compared usingχ2 test.The differences of preoperative serum parathyroid hormone(PTH),Ca and the maximum diameter of lesion between the positive and negative groups of planar imaging were analyzed using independent-sample t test and Mann-Whitney U test.The region of interest(ROI)method was applied to calculate the uptake ratio of lesions to normal tissues at the early phase(T/Ne)and delayed phase(T/Nd)in positive cases of planar imaging.Pearson or Spearman correlation analysis was used to evaluate the correlation of T/Ne,T/Nd with preoperative serum PTH,Ca and the maximum diameter of lesion.The receiver operating characteristic(ROC)curves of preoperative serum PTH,Ca and positive planar imaging were drawn and the cut-off values were obtained.Results The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62)and 87.10%(54/62)respectively(χ2=5.729,P=0.017).The preoperative serum PTH,Ca levels and the maximum diameter of lesion in patients with positive planar imaging(253.32(107.00,331.70)ng/L,2.78(2.51,2.87)mmol/L,(2.01±0.88)mm)were higher than those with negative planar imaging((111.86±44.29)ng/L,(2.59±0.21)mmol/L,(1.42±0.55)mm;z values:-2.802,-1.978,t=3.300,all P<0.05).T/Ne was positively correlated with preoperative serum PTH(rs=0.511,P<0.001)and the maximum diameter of lesion(r=0.381,P=0.012),and T/Nd was positively correlated with preoperative serum PTH(rs=0.538,P<0.001),Ca(rs=0.348,P=0.022)and the maximum diameter of lesion(r=0.463,P=0.002).The area under the ROC curve between preoperative serum PTH,Ca and planar imaging was 0.725 and 0.646,respectively.Preoperative serum PTH had a better predictive value with the optimal cut-off value of 150.4 ng/L.Conclusions Preoperative serum PTH,Ca and the maximum diameter of lesion are positively correlated with ^(99)Tc^(m)-MIBI uptake in PHPT patients with positive planar imaging results.When preoperative serum PTH is lower than 150.4 ng/L,planar imaging is prone to false negative.SPECT/CT imaging has a significant value in preoperative diagnosis and the combination of PTH and CT can improve the positive rate.
作者
张莹莹
韩娜
武凤玉
李娇
卢承慧
刘新峰
王国强
王增华
王叙馥
Zhang Yingying;Han Na;Wu Fengyu;Li Jiao;Lu Chenghui;Liu Xinfeng;Wang Guoqiang;Wang Zenghua;Wang Xufu(Department of Nuclear Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《中华核医学与分子影像杂志》
CAS
CSCD
北大核心
2021年第6期345-349,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
