目的：分析甲状旁腺功能亢进症患者99mTc-MIBI SPECT/CT双时相显像（简称MIBI显像）的特点，联合临床检测血清甲状旁腺激素（Parathyroidhormone，PTH）水平，探讨其与MIBI显像间的相关性。方法：回顾性分析2016年6月—2019年4月143例血清PTH升高的甲状旁腺功能亢进症患者MIBI显像资料。结果：①原发性（PHPT）和继发性（SHPT）甲状旁腺功能亢进者分别为107例和36例，两组PTH水平中位数分别为110（65.7~998.5） pg/mL和1 725（368.3~3 533.0） pg/mL，两组间差异有统计学意义（Z=－8.79，P=0.000），SHPT组明显高于PHPT组。②MIBI平面显像及断层显像阳性率分别为57.3%和68.5%。③PHPT组按MIBI显像结果分为阴性组和阳性组，两组PTH值中位数分别为92.4和138.5，两组间差异有统计学意义（Z=-5.33，P=0.000），阳性组PTH水平高于阴性组；④将年龄、性别、PTH值作为自变量，断层显像结果作为应变量行Logistic回归分析，PHPT组经筛选得出影响因素为PTH值（OR：1.014，95%CI：1.005~1.024），相关系数r=0.52，P=0.00；SHPT组无相关因素。⑤绘制PHPT组平面显像和断层显像的ROC曲线，对应最大曲线下面积分别为0.75和0.81，计算PTH cutoff值分别为115.6 pg/mL和112.9 pg/mL，阳性预测值分别为75.0%和86.5%。结论：SHPT患者血清PTH水平高于PHPT患者，PHPT血清PTH水平与MIBI显像结果具有中度相关性，血清PTH水平越高MIBI显像阳性率越高，平面显像及断层显像对应的cutoff值分别为115.6 pg/mL和112.9 pg/mL，对应的阳性预测值分别为75.0%和86.5%。
Abstract
Objective: To analyze the characteristics of 99mTc-MIBI SPECT/CT dual-phase imaging in patients with hyperparathyropathy, combined with the serum PTH levels, to explore the correlation with MIBI imaging results. Methods: Retrospective analysis of MIBI imaging data of 143 patients with elevated serum PTH which were suspected of hyperparathyropathy from June 2016 to April 2019. Results: ①The median PTH levels of primary(PHPT) and secondary(SHPT) hyperparathyropathy were 110(65.7~998.5) pg/mL and 1 725(368.3~3 533.0) pg/mL, respectively. There was significant difference between the two groups(Z=-8.79, P=0.000), SHPT group was significantly higher than that in PHPT group.②The positive rates of MIBI planar imaging and tomographic imaging were 57.3% and 68.5%, respectively. ③According to the MIBI imaging results, the PHPT patients were divided into positive group and negative group. The serum PTH levels were different between the two groups(Z=-5.32, P=0.00). The level of PTH was significantly higher in positive group. ④The age, gender and PTH value were taken as independent variables, and the results of tomographic imaging were used as dependent for logistic regression analysis. The influencing factor in PHPT group was PTH value(OR: 1.014, 95%CI: 1.005~1.024, r=0.52, P<0.00). Correlation coefficient r=0.52, P=0.00. No related factors was found in SHPT group. ⑤The ROC curves of planar imaging and tomographic imaging in PHPT group were drawn. The areas under the curve were 0.75 and 0.81, the cutoff values of PTH were 115.6 and 112.9, and the positive predictive values were 75.0% and 86.5%, respectively. Conclusion: The level of serum PTH in patients with secondary hyperthyroidism was higher than that in patients with primary hyperthyroidism. The level of serum PTH was correlated with the results of MIBI imaging in patients with primary hyperthyroidism. The higher level of serum PTH means the higher positive rate of MIBI imaging. The cutoff values were 115.6 pg/mL and 112.9 pg/mL, and the corresponding positive predictive values were 75.0% and 86.5%, respectively.
关键词
甲状旁腺功能亢进症 /
体层摄影术 /
发射型计算机 /
单光子 /
99m锝甲氧基异丁基异腈
Key words
Hyperparathyroidism /
Tomography, emission-computed, single-photon /
Technetium tc 99m sestamibi
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