<sup>99</sup>Tc<sup>m</sup>-MIBI SPECT/CT在慢性肾病继发性甲状旁腺功能亢进定位诊断中的应用

doi:10.3760/cma.j.issn.2095-7041.2019.04.010

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摘要目的探讨⁹⁹Tc^m-甲氧基异丁基异腈(MIBI)SPECT/CT显像在慢性肾病继发性甲状旁腺功能亢进症(SHPT)术前定位诊断中的应用价值。方法回顾性分析2014年1月—2017年12月东南大学医学院附属江阴医院乳腺甲状腺外科手术及病理证实的28例慢性肾病SHPT患者的临床资料。其中,男16例、女12例,年龄13～72(44.54±14.07)岁。28例患者术前行甲状旁腺⁹⁹Tc^m-MIBI SPECT/CT显像及超声检查,均采用甲状旁腺全切术加自体移植术(tPTX+AT)治疗。统计术中检出甲状旁腺的位置、数目、大小;比较⁹⁹Tc^m-MIBI SPECT/CT显像和超声检查的甲状旁腺检出率,并将术中检出甲状旁腺按最大线径分为≥1 cm和＜1 cm 两组,比较两种方法对两组不同大小甲状旁腺的检出率。结果 28例患者术中共检出甲状旁腺109枚,其中位于甲状腺背侧97枚;异位12枚,分别异位于颈动脉鞘内3枚、气管食管沟内2枚、纵隔内2枚、锁骨头平面2枚、甲状腺内2枚、胸腺内1枚。109枚甲状旁腺最大径线为0.7～3.8 cm,其中≥1 cm有57枚,＜1 cm有52枚。⁹⁹Tc^m-MIBI SPECT/CT显像对甲状旁腺总检出率及最大径线＜1 cm的甲状旁腺检出率分别为84.4%(92/109)、78.8%(41/52),均高于超声的69.7%(76/109)、55.8%(29/52),差异均有统计学意义(χ²=8.533、6.722,P值均＜0.05);而最大径线≥1 cm的甲状旁腺,⁹⁹Tc^m-MIBI SPECT/CT显像及超声的检出率差异无统计学意义(P＞0.05)。4例患者合并甲状腺微小癌,有3例仅由超声检出。结论 ⁹⁹Tc^m-MIBI SPECT/CT显像较超声对SHPT甲状旁腺的检出率高,能检出数目更多、直径更小的甲状旁腺;而超声对于合并甲状腺微小癌的患者,更具有优势。建议临床根据患者具体情况选择⁹⁹Tc^m-MIBI SPECT/CT显像联合超声对慢性肾病SHPT进行术前定位诊断。

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关键词 ：甲状旁腺功能亢进症,继发性, 肾疾病, 体层摄影术,发射型计算机,单光子, 体层摄影术,X线计算机, 甲氧基异丁基异腈, 超声检查

Abstract：Objective To assess the clinical value of ⁹⁹Tc^m-methoxyisobutvlisonitrile(MIBI) SPECT/CT and ultrasonography in preoperatively precise localization of parathyroid glands in patient with renal secondary hyperparathyroidism (SHPT).Methods Clinical data of 28 consecutive SHPT patients who underwent total parathyroidectomy with autotransplantation in the Department of Breast and Thyroid Surgery, Affiliated Jiangyin Hospital of Southeast University Medical College between January 2014 and December 2017 were retrospectively analyzed, including 16 males and 12 females with the age of 13-72 (44.54±14.07) years old. The location, number and size of parathyroid glands during operation were counted, and divided into ≥1 cm and ＜1 cm two groups according to longitudinal diameter, the accuracy localization of ⁹⁹Tc^m-MIBI SPECT/CT and ultrasonography parathyroid gland in two groups was compared.Results In 28 patients, 109 parathyroid glands were found in surgical exploration, including 97 parathyroid glands behind thyroid gland, 3 parathyroid glands in carotid sheath, 2 parathyroid glands in tracheoesophageal groove, 2 parathyroid glands in mediastinum, 2 parathyroid glands in clavicular plane, 2 parathyroid glands intrathyroid and 1 parathyroid gland intrathymus. The longitudinal diameter of 109 parathyroid glands ranged from 0.7 cm to 3.8 cm, 57 parathyroid glands were over 1 cm and 52 parathyroid glands were less than 1 cm. The total detection rate of ⁹⁹Tc^m-MIBI SPECT/CT and the detection rate of parathyroid gland with maximum diameter ＜1 cm were 84.4%(92/109)and 78.8%(41/52), respectively, which were higher than 69.7%(76/109)and 55.8%(29/52)of ultrasonography, with statistically significant differences (χ²=8.533, 6.722, all P values＜0.01). There was no significant difference in the detection rate of parathyroid gland with maximum diameter ＜1 cm between ⁹⁹Tc^m-MIBI SPECT/CT and ultrasonography(P＞0.05). The 4 cases of concomitant thyroid microcarcinoma, 3 cases were detected by ultrasonography alone.Conclusions ⁹⁹Tc^m-MIBI SPECT/CT has higher detection rate of parathyroid glands than ultrasonography, especially in small one; however, ultrasonography has more advantages for renal SHPT patients concomitant with thyroid microcarcinoma. It is suggested that combined ⁹⁹Tc^m-MIBI SPECT/CT with ultrasonography could do well in preoperative localization of parathyroid glands in patient with renal SHPT.

Key words： Hyperparathyroidism, secondary Nephrosis Tomography, emission-computed, single-photon Tomography, X-ray computed Methoxyisobutvlisonitrile Ultrasonography

收稿日期: 2018-12-16

基金资助:江阴市科技创新专项资金(JY0603A020201180015PB

通讯作者: 陈则君,Email:1770491937@qq.com

引用本文:

薛勤, 陈则君, 邵清, 赵可, 黄钱焕, 邹大中, 周斌. ⁹⁹Tc^m-MIBI SPECT/CT在慢性肾病继发性甲状旁腺功能亢进定位诊断中的应用[J]. 中华解剖与临床杂志, 2019, 24(4): 364-369.
Xue Qin, Chen Zejun, Shao Qing, Zhao Ke, Huang Qianhuan, Zou Dazhong, Zhou Bin. The clinical application of ⁹⁹Tc^m-MIBI SPECT/CT for preoperatively precise localization diagnosis of renal secondary hyperparathyroidism. Chinese Journal of Anatomy and Clinics, 2019, 24(4): 364-369.

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