Song A, Wang O, Liu C X, Wang M, Liu H, Jing H L, Hu Y, Xia W B, Zhang Z H, Jin Z Y, Xing X P
Key Laboratory of Endocrinology of National Health Commission of the People's Republic of China, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2020 Oct 1;59(10):788-795. doi: 10.3760/cma.j.cn112138-20200413-00367.
To provide more options for preoperative localization diagnosis in patients with primary hyperparathyroidism (PHPT), the diagnostic efficacy of parathyroid 4-dimensional computed tomography (4D-CT) in patients with PHPT was evaluated. This was a single-center retrospective study including 57 patients with surgical proved PHPT. All of the patients underwent 4D-CT, Tc -sestamibi parathyroid imaging (MIBI), and ultrasonography (US) preoperatively. The reference standard for correct localization was based on operation reports and pathology confirmation. The patients were grouped according to the preoperative serum calcium levels, tumor diameter, or ectopic lesions (yes/no), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of 4D-CT, MIBI and US, alone or in combination, were analyzed in total and each subgroup patients. Fifty-seven patients (39 women, 18 men; mean age of 56.5 years) were evaluated, including four cases with multi-gland disease and thirteen cases with ectopic parathyroid lesions. In all the patients, similar diagnostic efficacy was found in 4D-CT (AUC: 0.943) and MIBI (AUC: 0.927), both of which were higher than that of US (AUC: 0.847) ( = 0.01 for 4D-CT vs. US; = 0.04 for MIBI vs. US). In a subset analysis for ectopic quadrants, the diagnostic efficacy of 4D-CT was significantly higher than that of MIBI ( = 0.04) or US ( = 0.01), with the sensitivity of 100%, 69.2%, and 61.5%, and AUC of 0.989, 0.846, and 0.808 for 4D-CT, MIBI and US, respectively. 4D-CT has similar diagnostic efficacy for preoperative localization to MIBI in patients with PHPT, and it is superior to MIBI and US in identifying the ectopic parathyroid gland. 4D-CT can be recommended as an alternative preoperative localization method, especially when parathyroid lesions could not be precisely located by US and MIBI.
为了给原发性甲状旁腺功能亢进症（PHPT）患者的术前定位诊断提供更多选择，评估了甲状旁腺四维计算机断层扫描（4D-CT）对PHPT患者的诊断效能。这是一项单中心回顾性研究，纳入了57例经手术证实为PHPT的患者。所有患者术前均接受了4D-CT、锝-甲氧基异丁基异腈甲状旁腺显像（MIBI）和超声检查（US）。正确定位的参考标准基于手术报告和病理证实。患者分别根据术前血清钙水平、肿瘤直径或异位病变（是/否）进行分组。分析了4D-CT、MIBI和US单独或联合应用时在全部患者及各亚组患者中的敏感性、特异性、阳性预测值、阴性预测值和曲线下面积（AUC）。共评估了57例患者（39例女性，18例男性；平均年龄56.5岁），其中包括4例多腺体疾病患者和13例异位甲状旁腺病变患者。在所有患者中，4D-CT（AUC：0.943）和MIBI（AUC：0.927）的诊断效能相似，两者均高于US（AUC：0.847）（4D-CT与US比较，P = 0.01；MIBI与US比较，P = 0.04）。在异位象限的亚组分析中，4D-CT的诊断效能显著高于MIBI（P = 0.04）或US（P = 0.01），4D-CT、MIBI和US的敏感性分别为100%、69.2%和61.5%，AUC分别为0.989、0.846和0.808。4D-CT对PHPT患者术前定位的诊断效能与MIBI相似，且在识别异位甲状旁腺方面优于MIBI和US。4D-CT可被推荐为一种替代的术前定位方法，尤其是当甲状旁腺病变不能通过US和MIBI准确定位时。
