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目的探讨~(99)Tc~m-甲氧基异丁基异腈(MIBI)双时相显像在高甲状旁腺素(PTH)患者中的应用。方法对73例手术确诊的甲状旁腺功能亢进症患者行~(99)Tc~m-MIBI双时相平面显像,必要时行全身显像、CT、SPECT/CT断层融合显像。检测患者术前PTH、血清钙、磷离子浓度以及术后血清钙、磷离子浓度,其中60例患者检测术后1周内PTH水平。结果原发性甲状旁腺功能亢进症(PHPT)患者29例,其中27例病理证实甲状旁腺瘤28处,~(99)Tc~m-MIBI显像阳性病灶27处(诊断敏感性为96.4%,27/28);另2例患者病理证实甲状旁腺增生病灶共3处,~(99)Tc~m-MIBI显像阳性病灶1处(诊断敏感性为33.3%,1/3);~(99)Tc~m-MIBI显像对PHPT总的诊断敏感性为90.3%(28/31)。继发性甲状旁腺功能亢进症(SHPT)患者44例,病理确诊甲状旁腺组织增生154处,~(99)Tc~m-MIBI发现118处浓聚病灶,诊断敏感性为76.6%(118/154)。大部分甲状旁腺瘤放射性浓聚程度高于甲状旁腺增生组织。PHPT以高钙低磷血症为主,SHPT往往血钙升高不明显,但血磷升高明显。患者术后1周内可见PTH不同程度降低。结论~(99)Tc~m-MIBI双时相显像对甲状旁腺瘤的诊断敏感性高于甲状旁腺增生组织;该检查方法能够对功能异常的甲状旁腺组织进行术前定位,有利于提高手术成功率。
Objective To investigate the application of 99Tc-m-methoxyisobutylisonitrile (MIBI) dual phase imaging in patients with hyperparathyroid hormone (PTH). Methods Totally 99 Tc m-MIBI dual-phase planar imaging was performed in 73 surgically-diagnosed hyperparathyroidism patients. Whole-body CT, SPECT / CT fusion imaging were performed if necessary. Preoperative PTH, serum calcium and phosphorus concentrations and postoperative serum calcium and phosphorus concentrations were measured. PTH levels in 60 patients were measured within 1 week after operation. Results Twenty-nine patients with primary hyperparathyroidism (PHPT) were diagnosed by pathological examination, including 28 parathyroid lesions and 27 (~ 99) Tc m-MIBI imaging positive lesions in 27 of them (sensitivity of diagnosis was 96.4 %, 27/28). In the other two cases, there were 3 lesions with hyperparathyroidism and 1 lesions with ~ (99) Tc m-MIBI imaging. The diagnostic sensitivity was 33.3% (1/3). The overall diagnostic sensitivity of ~ (99) Tc ~ m-MIBI imaging to PHPT was 90.3% (28/31). Forty - four patients with secondary hyperparathyroidism (SHPT) were enrolled in this study. Of the 154 patients with pathologically confirmed hyperplasia of parathyroid tissue, 118 were found in ~ 99 Tc m - MIBI with a diagnostic sensitivity of 76.6% (118 / 154). Most of the parathyroid adenoma radioactive concentration is higher than that of parathyroid hyperplasia. PHPT mainly hypocalcemia hyperplasia, SHPT tend to increase calcium is not obvious, but increased significantly phosphorus. Patients within 1 week after the PTH can be seen varying degrees of reduction. Conclusions ~ 99Tc m-MIBI dual-phase imaging is more sensitive to the diagnosis of parathyroid adenoma than parathyroid hyperplasia. This method can preoperatively locate the abnormal parathyroid tissue with Help to improve the success rate of surgery.