Li Panli, Liu Qiufang, Tang Daoqiang, Zhu Yinyan, Xu Lian, Sun Xiaoguang, Song Shaoli
Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China.
SJTU-USYD Joint Research Alliance for Translational Medicine, Shanghai, 200240, China.
BMC Med Imaging. 2017 Dec 12;17(1):60. doi: 10.1186/s12880-017-0235-3.
We aimed to evaluate the diagnostic performance of Tc-MIBI SPECT/CT and ultrasonography in patients with secondary hyperparathyroidism (SHPT), and explored the factors that affect the diagnostic performance.
Tc-MIBI SPECT/CT and ultrasonography were performed in 50 patients with SHPT within 1 month before they underwent surgery. Imaging results were confirmed by the pathology. Pearson correlation analysis was used to determine the correlation of PTH level with clinical data. The optimal cutoff value for predicting positive Tc-MIBI results was evaluated by ROC analysis in lesions diameter.
Forty-nine patients had a positive Tc-MIBI imaging results and 39 patients had positive ultrasonography results. The sensitivities of Tc-MIBI and ultrasonography were 98.00% and 78.00%, respectively. A total of 199 lesions were resected in 50 patients. Among them, 183 lesions were proved to be parathyroid hyperplasia. On per-lesion basis analysis, the sensitivity and specificity of Tc-MIBI and ultrasonography were 59.34% and 75.00% vs 46.24% and 80.00%, respectively. The Pearson correlation analysis showed that the serum AKP and PTH level had a significant linear association (r = 0.699, P < 0.001). The lesion diameter was a statistically significant predictive factor in predicting positive Tc-MIBI SPECT/CT. The optimal cutoff value for predicting positive Tc-MIBI results evaluated by ROC analysis in lesions diameter was 8.05 mm.
Dual phase Tc-MIBI SPECT/CT imaging had a higher sensitivity in patients with SHPT than ultrasonography. Therefore, using Tc-MIBI positioning the lesion could be an effective method pre-surgical in patients with SHPT.
我们旨在评估锝-甲氧基异丁基异腈（Tc-MIBI）单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）和超声检查在继发性甲状旁腺功能亢进症（SHPT）患者中的诊断性能，并探讨影响诊断性能的因素。
对50例SHPT患者在手术前1个月内进行Tc-MIBI SPECT/CT和超声检查。影像学结果经病理证实。采用Pearson相关分析确定甲状旁腺激素（PTH）水平与临床资料的相关性。通过病变直径的ROC分析评估预测Tc-MIBI阳性结果的最佳截断值。
49例患者Tc-MIBI成像结果为阳性，39例患者超声检查结果为阳性。Tc-MIBI和超声检查的敏感性分别为98.00%和78.00%。50例患者共切除199个病变。其中，183个病变被证实为甲状旁腺增生。在基于每个病变的分析中，Tc-MIBI和超声检查的敏感性和特异性分别为59.34%和75.00%，以及46.24%和80.00%。Pearson相关分析显示，血清碱性磷酸酶（AKP）和PTH水平呈显著线性相关（r = 0.699，P < 0.001）。病变直径是预测Tc-MIBI SPECT/CT阳性的统计学显著预测因素。通过病变直径的ROC分析评估预测Tc-MIBI阳性结果的最佳截断值为8.05 mm。
双期Tc-MIBI SPECT/CT成像在SHPT患者中的敏感性高于超声检查。因此，使用Tc-MIBI定位病变可能是SHPT患者术前的一种有效方法。
