Tc-MIBI SPECT/CT 对甲状旁腺病变与结节性甲状腺肿的鉴别价值。
Value of Tc-MIBI SPECT/CT in distinguishing between parathyroid lesions and nodular goiter.
机构信息
Department of Nuclear Medicine (PET Center), Xiangya Hospital, Central South University, Changsha 410008, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021;46(9):1018-1023. doi: 10.11817/j.issn.1672-7347.2021.190641.
OBJECTIVES
Hyperfunctioning parathyroid lesions require surgical resection. Tc-methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) plays an important role in the diagnosis of parathyroid lesions. Some nodular goiters have a higher uptake of Tc-MIBI, which is difficult to distinguish from hyperfunctioning parathyroid lesions. This study aims to explore the value of Tc-MIBI SPECT/CT in the differential diagnosis of parathyroid lesions and nodular goiter.
METHODS
This study was a retrospective analysis. A total of 68 patients who were diagnosed as parathyroid lesions by Tc-MIBI SPECT/CT were enrolled, with a total of 81 lesions. According to the results of pathological examination after surgical resection, the lesions were divided into a parathyroid lesion group (=69) and a nodular goiter group (=12). The target maximum radioactivity count (Tmax) of all lesions was measured. The mean radioactivity count of the aortic arch was used as the background mean radioactivity count (Bmean), and the ratio of the Tmax to Bmean was calculated. The difference in Tmax/Bmean between the 2 groups was compared. The minimum, mean, and maximum of CT density in the lesion were measured. The difference of CT density between the 2 groups was compared. The receiver operating characteristic (ROC) curve of patients with parathyroid lesions and patients with nodular goiter was drawn, and the diagnostic efficacy of each CT density value was evaluated.
RESULTS
The Tc-MIBI radioactive uptake in parathyroid lesions and nodular goiter lesions was significantly concentrated. The CT density values of the 2 lesions were lower than normal thyroid tissue, and the boundary between the 2 lesions and the thyroid was clear or blurred. There was no significant difference in Tmax/Bmean between the 2 groups (=0.221). The differences in the minimum, mean and maximum of CT density between the 2 groups were statistically significant (all <0.05). The diagnostic efficiency of maximum of CT density was the best, area under the ROC curve was 0.894 (<0.001), the cut-off was 91 HU, the sensitivity was 83.3%, and the specificity was 94.2%.
CONCLUSIONS
The degree of Tc-MIBI radiation uptake in the focus has limited value in differentiating parathyroid lesions from nodular goiter, and the maximum density of CT possesses high diagnostic efficiency.
目的
甲状旁腺功能亢进病变需要手术切除。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）在甲状旁腺病变的诊断中具有重要作用。一些结节性甲状腺肿对 Tc-MIBI 的摄取较高，难以与甲状旁腺功能亢进病变相鉴别。本研究旨在探讨 Tc-MIBI SPECT/CT 在甲状旁腺病变与结节性甲状腺肿鉴别诊断中的价值。
方法
本研究为回顾性分析。共纳入 68 例经 Tc-MIBI SPECT/CT 诊断为甲状旁腺病变的患者，共 81 个病灶。根据手术切除后的病理检查结果，将病灶分为甲状旁腺病变组（=69）和结节性甲状腺肿组（=12）。测量所有病灶的靶最大放射性计数（Tmax）。以主动脉弓的平均放射性计数作为背景平均放射性计数（Bmean），计算 Tmax 与 Bmean 的比值。比较两组 Tmax/Bmean 的差异。测量病灶 CT 密度的最小值、平均值和最大值。比较两组 CT 密度的差异。绘制甲状旁腺病变患者和结节性甲状腺肿患者的受试者工作特征（ROC）曲线，评价各 CT 密度值的诊断效能。
结果
甲状旁腺病变和结节性甲状腺肿病灶的 Tc-MIBI 放射性摄取明显集中。2 种病灶的 CT 密度值均低于正常甲状腺组织，病灶与甲状腺之间边界清晰或模糊。两组 Tmax/Bmean 无统计学差异（=0.221）。两组 CT 密度的最小值、平均值和最大值差异均有统计学意义（均<0.05）。最大 CT 密度的诊断效能最佳，ROC 曲线下面积为 0.894（<0.001），截断值为 91 HU，灵敏度为 83.3%，特异度为 94.2%。
结论
病灶 Tc-MIBI 辐射摄取程度对鉴别甲状旁腺病变与结节性甲状腺肿的价值有限，CT 最大密度具有较高的诊断效能。
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