论文部分内容阅读
目的:探讨n 99Tcn 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。n 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n 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n t检验和Mann-Whitney n 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。n 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(n χ2＝5.729，n 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; n z＝-2.802，n P＝0.005]及血钙水平[2.78(2.51，2.87)和(2.59±0.21) mmol/L；n z＝-1.978，n 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；n t＝3.300，n P＝0.002]。T/Ne与术前血清PTH(n rs＝0.511，n P<0.001)、术后病灶最大径(n r＝0.381，n P＝0.012)呈正相关，T/Nd与术前血清PTH(n rs＝0.538，n P<0.001)、血钙(n rs＝0.348，n P＝0.022)及术后病灶最大径(n r＝0.463，n 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。n 结论:99Tcn 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n 99Tcn 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。n “,”Objective:To investigate the preoperative diagnostic value of n 99Tcn m-methoxyisobutylisonitrile (MIBI) planar imaging and SPECT/CT imaging for primary hyperparathyroidism (PHPT), and analyze the relevant factors affecting the imaging results.n 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 n 99Tcn m-MIBI planar imaging and SPECT/CT imaging were compared using n χ2 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 n t test and Mann-Whitney n 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.n Results:The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62) and 87.10%(54/62) respectively (n χ2=5.729, n 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; n z values: -2.802, -1.978, n t=3.300, all n P<0.05). T/Ne was positively correlated with preoperative serum PTH (n rs=0.511, n P<0.001) and the maximum diameter of lesion (n r=0.381, n P=0.012), and T/Nd was positively correlated with preoperative serum PTH (n rs=0.538, n P<0.001), Ca (n rs=0.348, n P=0.022) and the maximum diameter of lesion (n r=0.463, n 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.n Conclusions:Preoperative serum PTH, Ca and the maximum diameter of lesion are positively correlated with n 99Tcn 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.n