二维 CT 上动脉增强百分比在原发性甲状旁腺功能亢进症诊断中的应用：一项前瞻性验证研究及潜在陷阱。

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls.

机构信息

Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India.

Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India.

出版信息

Head Neck. 2022 Aug;44(8):1849-1856. doi: 10.1002/hed.27108. Epub 2022 May 31.

DOI:10.1002/hed.27108

PMID:35638259

Abstract

BACKGROUND

Parathyroid lesions are identified by subjective enhancement and washout patterns on computed tomography (CT). We have previously proposed "percentage arterial enhancement" (PAE) as an objective index and now aim to validate its performance prospectively.

METHODS

Dual-phase CT was performed in 40 consecutive primary hyperparathyroidism patients. PAE was calculated as [{arterial phase Hounsfield unit (HU)-unenhanced phase HU}/unenhanced phase HU] × 100. PAE > 128.9% was considered parathyroid.

RESULTS

PAE had 94.2% sensitivity, 100% positive predictive value (PPV) in lateralization, and sensitivity and PPV of 93.9% in quadrant localization of single-gland disease. PAE failed to identify two lesions: an intrathyroidal parathyroid carcinoma in the background of multinodular goiter and another lower enhancing cystic parathyroid adenoma. PAE had 60% sensitivity, and 100% PPV to identify multigland disease. The mean effective dose was 2.74 mSV.

CONCLUSIONS

PAE is a specific CT index for parathyroid lesions with less radiation exposure. Areas of caution include intrathyroidal and cystic lesions.

摘要

背景

甲状旁腺病变可通过 CT 上的主观增强和洗脱模式来识别。我们之前提出了“动脉增强百分比”（PAE）作为一个客观指标，现在旨在前瞻性验证其性能。

方法

对 40 例原发性甲状旁腺功能亢进症患者进行双期 CT 检查。PAE 计算为 [{动脉期 HU-平扫期 HU}/平扫期 HU]×100。PAE＞128.9%被认为是甲状旁腺病变。

结果

PAE 的敏感度为 94.2%，在侧位定位中的阳性预测值（PPV）为 100%，在单腺疾病的象限定位中的敏感度和 PPV 为 93.9%。PAE 未能识别两种病变：一种是甲状腺内甲状旁腺癌，背景为多结节性甲状腺肿；另一种是增强程度较低的甲状旁腺囊腺瘤。PAE 识别多腺体疾病的敏感度为 60%，PPV 为 100%。平均有效剂量为 2.74 mSv。