【摘要】 目的探讨继发甲状旁腺功能亢进症的术前影像学定位诊断价值。资料与方法纳入60例手术成功（20 min术中甲状旁腺激素下降≥80%）的慢性肾病继发甲状旁腺功能亢进症,以病理诊断为"金标准",采用Mc Nemar检验比较99锝m-甲氧基异丁基异腈(⁹⁹Tc^m-MIBI)SPECT/CT、双时相平面显像、彩色多普勒超声联合应用术前定位甲状旁腺组织的敏感度、特异度和准确度。结果 60例患者共243个甲状旁腺灶和36个非甲状旁腺灶。术前SPECT/CT定位甲状旁腺的敏感度、特异度和准确度分别为85.60%（208/243）、94.44%（34/36）和86.74%（242/279）,其敏感度和准确度均优于平面显像[敏感度53.50%（130/243）,P<0.001;准确度57.35%（160/279）,P<0.001]、超声[敏感度53.09%（129/243）,P<0.001;准确度56.63%（158/279）,P<0.001]及平面显像+超声联合模式[敏感度71.19%（173/243）,P<0.001;准确度70.61%（197/279）,P<0.001]。SPECT/CT联合超声可使敏感度提高至86.01%（209/243）。结论继发甲状旁腺功能亢进症术前⁹⁹Tc^m-MIBI SPECT/CT定位甲状旁腺组织具有较高的敏感度和准确度,联合超声能进一步提高检出敏感度,并能发现更多的伴发甲状腺疾病。更多还原

【Abstract】 Purpose To investigate the value of preoperative imaging location for secondary hyperparathyroidism（sHPT）. Materials and Methods Sixty patients with chronic kidney disease combined with s HPT on hemodialysis were included in this study. All were performed total parathyroidectomy with autotransplantation, and 80% or more declined intra-operative parathyroid hormone at 20 minutes was considered successful. Preoperative color Doppler ultrasonography（CDUS）, ⁹⁹Tc^m-sestamibi（MIBI） dual-phase planar, hybrid SPECT/CT delayed scintigraphy were used to identify parathyroid lesions. Surgical pathological diagnosis served as the standard, the sensitivity, specificity and accuracy were determined and compared using McNemar test. Results There were 243 parathyroid positive lesions and 36 false-positive lesions in 60 sHPT patients. The sensitivity, specificity and accuracy of SPECT/CT was 85.60%（208/243）, 94.44%（34/36） and 86.74%（242/279）, respectively. The sensitivity and accuracy of SPECT/CT were significantly better than that of planar imaging [53.50%（130/243）, P<0.001 for sensitivity; 57.35%（160/279）, P<0.001 for accuracy], CDUS [53.09%（129/243）, P<0.001 for sensitivity; 56.63%（158/279）, P<0.001 for accuracy] and planar imaging+CDUS [71.19%（173/243）, P<0.001 for sensitivity; 70.61%（197/279）, P<0.001 for accuracy]. The sensitivity increased to 86.01%（209/243）, and more concomitant thyroid diseases were found by combining with CDUS. Conclusion ⁹⁹Tc^m-MIBI SPECT/CT has higher sensitivity and accuracy for preoperative localization parathyroid of sHPT patients, the sensitivity can be increased and more concomitant thyroid diseases can be found when combined with CDUS.更多还原