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中华医学超声杂志(电子版) ›› 2018, Vol. 15 ›› Issue (07) : 522 -529. doi: 10.3877/cma.j.issn.1672-6448.2018.07.010

所属专题: 文献

浅表器官超声影像学

高频超声、超声造影与99mTc-MIBI SPECT/CT在难治性甲状旁腺功能亢进术前定位中的比较
李秀梅1, 李军1, 王宏桥1,(), 宁春平1, 姜彩云1, 周茂平1, 牟爽1, 杨景茹1, 吴红梅1   
  1. 1. 266003 青岛大学附属医院超声科
  • 收稿日期:2017-11-21 出版日期:2018-07-01
  • 通信作者: 王宏桥

Localization value of ultrasonography, contrast-enhanced ultrasound and 99mTc-MIBI SPECT/CT in refractory secondary hyperparathyroidism

Xiumei Li1, Jun Li1, Hongqiao Wang1,(), Chunping Ning1, Caiyun Jiang1, Maoping Zhou1, Shuang Mou1, Jingru Yang1, Hongmei Wu1   

  1. 1. Department of Ultrasound, the Affiliated Hospital of Qingdao University, Shandong 266003, China
  • Received:2017-11-21 Published:2018-07-01
  • Corresponding author: Hongqiao Wang
  • About author:
    Corresponding author: Wang Hongqiao, Email:
引用本文:

李秀梅, 李军, 王宏桥, 宁春平, 姜彩云, 周茂平, 牟爽, 杨景茹, 吴红梅. 高频超声、超声造影与99mTc-MIBI SPECT/CT在难治性甲状旁腺功能亢进术前定位中的比较[J/OL]. 中华医学超声杂志(电子版), 2018, 15(07): 522-529.

Xiumei Li, Jun Li, Hongqiao Wang, Chunping Ning, Caiyun Jiang, Maoping Zhou, Shuang Mou, Jingru Yang, Hongmei Wu. Localization value of ultrasonography, contrast-enhanced ultrasound and 99mTc-MIBI SPECT/CT in refractory secondary hyperparathyroidism[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(07): 522-529.

目的

探讨高频超声、超声造影、99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射型计算机断层显像/计算机断层扫描(SPECT/CT)在难治性甲状旁腺功能亢进症术前定位中的诊断效能。

方法

收集2015年8月至2017年8月青岛大学附属医院收治的难治性甲状旁腺功能亢进症18例,患者术前均接受高频超声、超声造影及99mTc-MIBI SPECT/CT显像等检查,以术后病理结果为"金标准",比较3种检查方法的诊断效能。

结果

18例患者共手术切除73枚结节,经病理证实71枚为甲状旁腺增生结节,高频超声、超声造影及99mTc-MIBI SPECT/CT显像敏感度分别为98.59%、94.37%、78.87%,准确性分别为97.26%、94.52%、78.08%。高频超声与超声造影在定位甲状旁腺增生结节中的优势差异无统计学意义(P=0.250),两者的诊断效能均优于99mTc-MIBI SPECT/CT显像(P=0.001、0.012),联合检查可提高定位的特异度(50.00% vs 100.00%),与99mTc-MIBI SPECT/CT显像联合后可进一步提高定位的准确性(98.63% vs 100.00%)。

结论

高频超声与超声造影及99mTc-MIBI SPECT/CT显像联合后可对难治性甲状旁腺功能亢进做出较为全面的术前定位诊断。

Objective

To explore the diagnostic value of ultrasonography (US), contrast-enhanced ultrasonography (CEUS), (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in refractory secondary hyperparathyroidism.

Methods

From August 2015 to August 2017, 18 cases of refractory hyperparathyroidism admitted to the Affiliated Hospital of Qingdao University were collected. All patients underwent US, CEUS, 99mTc-MIBI SPECT/CT imaging before operation. The diagnostic efficiency of the three methods was compared with the pathological results as the gold standard.

Results

A total of 73 nodules were removed from 18 cases, 71 of them were parathyroid nodules confirmed by pathology. The imaging sensitivity of US, CEUS, 99mTc-MIBI SPECT/CT was 98.59%, 94.37% and 78.87% respectively, and the accuracy was 97.26%, 94.52% and 78.08% respectively. There was no significant difference between US and CEUS in locating parathyroid hyperplasia nodules (P=0.250). The diagnostic value of US and CEUS was superior to 99mTc-MIBI SPECT/CT (P=0.001, 0.012), and the specificity was increased when combination of US with CEUS (50.00% vs 100.00%). When combined with 99mTc-MIBI SPECT/CT imaging, the accuracy of localization was further improved (98.63% vs 100.00%).

Conclusion

For refractory secondary hyperparathyroidism, comprehensive preoperative diagnosis can be made after combined application of US, CEUS and 99mTc-MIBI SPECT/CT.

图1~4 甲状旁腺增生结节高频超声声像图。图1为甲状腺左叶下1/3后方低回声结节,周边可见清晰包膜线(箭头所示);图2为甲状腺左叶中部1/3后方低回声结节,部分位于甲状腺实质内,彩色多普勒检查可见周边血流信号向结节内部呈树枝状走形;图3为甲状腺左叶中部1/3后方低回声结节,部分位于甲状腺实质内,周边可见清晰包膜线,内可见小无回声区(箭头所示);图4为甲状腺左叶上2/3后方低回声结节,内可见环状钙化(箭头所示)
图5~8 甲状旁腺增生结节微血管成像图。图5,6为甲状旁腺增生结节纵切面及横切面二维声像图,甲状腺右叶中部低回声结节,椭圆形,包膜完整,结节基本位于甲状腺腺体内;图7,8为甲状旁腺增生结节纵切面及横切面微血管成像图,显示血流围绕甲状旁腺呈树枝状走行
表1 甲状旁腺增生部位
图9~12 甲状旁腺增生结节及淋巴结超声造影声像图。图9为左侧二维声像图显示甲状腺左叶中下部后方低回声结节,内回声欠均匀,可见小无回声区,右侧造影成像显示该结节与甲状腺实质在第11秒同时开始增强;图10与图9为同一结节,右侧造影成像显示该结节与甲状腺实质在第18秒同时达峰并且增强强度高于甲状腺实质,同时内部可见无增强区(箭头所示),即二维声像图中的无回声区;图11为甲状腺右叶下极下方显示低回声结节(虚线所示),位置较深高频超声显示血流困难,行超声造影显示甲状腺实质开始增强时该结节无增强;图12为对图11中的结节继续观察,甲状腺实质明显增强时该结节开始增强,呈中心门样增强(箭头所示)
表2 99mTc-MIBI SPECT/CT融合显像对增生结节检出大小(±s
图13 3种检查方法单独定位异常甲状旁腺的诊断效能
表3 3种检查方法单独和联合检测的敏感度、特异度及准确性
图14 3种检查方法联合定位异常甲状旁腺的诊断效能
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