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99mTc-MIBI SPECT/CT结合CT影像学特征在原发性甲状旁腺疾病中的价值

赵宇嘉 白侠

赵宇嘉, 白侠. 99mTc-MIBI SPECT/CT结合CT影像学特征在原发性甲状旁腺疾病中的价值[J]. 分子影像学杂志, 2023, 46(6): 957-963. doi: 10.12122/j.issn.1674-4500.2023.06.01
引用本文: 赵宇嘉, 白侠. 99mTc-MIBI SPECT/CT结合CT影像学特征在原发性甲状旁腺疾病中的价值[J]. 分子影像学杂志, 2023, 46(6): 957-963. doi: 10.12122/j.issn.1674-4500.2023.06.01
ZHAO Yujia, BAI Xia. Value of 99mTc-MIBI SPECT/CT combined with CT imaging features in the diagnosis of primary parathyroid diseases[J]. Journal of Molecular Imaging, 2023, 46(6): 957-963. doi: 10.12122/j.issn.1674-4500.2023.06.01
Citation: ZHAO Yujia, BAI Xia. Value of 99mTc-MIBI SPECT/CT combined with CT imaging features in the diagnosis of primary parathyroid diseases[J]. Journal of Molecular Imaging, 2023, 46(6): 957-963. doi: 10.12122/j.issn.1674-4500.2023.06.01

99mTc-MIBI SPECT/CT结合CT影像学特征在原发性甲状旁腺疾病中的价值

doi: 10.12122/j.issn.1674-4500.2023.06.01
基金项目: 

内蒙古自治区科技计划项目 2021GG0236

内蒙古自治区高等学校自然科学重点项目 NJZZ21039

青年科技人才发展项目 NJYT23074

详细信息
    作者简介:

    赵宇嘉,硕士,住院医师,E-mail: zhaoyujia1013@163.com

    通讯作者:

    白侠,副主任医师,硕士生导师,E-mail: libaiqiangxia@163.com

Value of 99mTc-MIBI SPECT/CT combined with CT imaging features in the diagnosis of primary parathyroid diseases

  • 摘要:   目的  探讨SPECT/CT及CT影像学特征在原发性甲状旁腺亢进症(PHPT)影像学定位不准确时的临床价值。  方法  选取90例手术病理证实为PHPT的患者,根据病理结果将其分为漏诊组(n=12)和诊断正确组(n=78);患者共切除110个病灶,按照病理结果分为甲状旁腺病灶组(n=81)和甲状腺病灶组(n=29),在SPECT/CT断层融合图像上的甲状旁腺病灶区、甲状腺病灶区、甲状旁腺病灶对侧正常区勾画大小相同的感兴趣区,并记录上述不同部位的放射性计数,计算靶与非靶比值(T/NT)和靶本比(TBR);在CT病灶截面收集连续3个层面CT密度最大值(CTmax)、最小值(CTmin)及平均值(CTavg)。对各组数据进行组间比较,绘制ROC曲线,评估各项数据的诊断效能。  结果  99mTc-MIBI SPECT/CT图像上,漏诊组病灶的T/NT、TBR、体积、直径均小于诊断正确组,两组间T/NT的差异具有统计学意义(P=0.002)且诊断效能最佳,两组间TBR、体积、直径的差异无统计学意义(P>0.05)。甲状旁腺病灶组和甲状腺病灶组比较中,两组间血钙、血磷的差异无统计学意义(P>0.05),甲状腺病灶组血清甲状旁腺素、TBR、CTmax、CTmin、CTavg均小于甲状旁腺病灶组(P<0.05)。CTmax的诊断效能最优,AUC为0.623,敏感度为74.10%,特异性为62.50%。  结论  SPECT/CT对PHPT进行术前定位时T/NT的诊断效能较TBR更好,可以为PHPT术前定位病灶提供更有价值的参考;与甲状腺病灶进行对TBR、CTmax有较好的临床价值。

     

  • 图  1  漏诊组病灶的代表性SPECT/CT图像

    Figure  1.  Representative SPECT/CT images of lesions in the missed group. A: Adenoma of the inferior parathyroid gland behind the right lobe of the thyroid; B: Adenoma of the inferior parathyroid gland behind the right lobe of the thyroid.

    图  2  诊断正确组病灶的代表性SPECT/CT图像

    Figure  2.  Representative SPECT/CT images of the lesions in the correct group. A: Adenoma of the inferior parathyroid gland behind the right lobe of the thyroid; B: Adenoma of the inferior parathyroid gland behind the left lobe of the thyroid; C: Adenoma of the inferior parathyroid gland behind the left lobe of the thyroid.

    图  3  漏诊组和诊断正确组ROC曲线图

    Figure  3.  ROC curves of the missed group and the correct group.

    图  4  甲状腺旁腺病灶组和甲状腺病灶组ROC曲线图

    Figure  4.  ROC curves of parathyroid lesion group and thyroid lesion group.

    表  1  两组临床数据分析

    Table  1.   Clinical data analysis of two groups.

    Clinical data analysis of enrolled patients Total(n=90) Missed diagnosis group(n=12) Correct diagnosis group(n=78) t2 P
    Gender [n(%)] - 0.31
       Male 16(17.78) 2(16.60) 14(17.94)
       Female 74(82.22) 10(62.50) 64(82.05)
    Clinical data (Mean±SD)
       Ca(mmol/L) 2.68±0.31 2.61±0.25 2.61±0.25 -1.51 0.13
       P(mmol/L) 0.91±0.49 0.97±0.59 0.84±0.35 0.84 0.41
       PTH(pg/L) 387.73±402.39 458.27±482.40 315.20±322.35 1.48 0.14
    Location [n(%)] 1.12 0.17
       Left lower 32(32.98) 5(31.25) 27(33.33)
       Right lower 35(36.08) 3(39.50) 32(39.50)
       Left upper 14(14.43) 4(12.34) 10(12.34)
       Right upper 16(16.49) 4(25.00) 12(14.81)
    Thyroid disease [n(%)] 0.30 0.58
       Yes 27(30.00) 4(33.33) 23(29.48)
       No 63(70.00) 8(66.67) 55(70.51)
    Ca:Calcium;P:Phosphorus;PTH:Parathyroid hormone.
    下载: 导出CSV

    表  2  漏诊组与诊断正确组组间数据分析

    Table  2.   Data analysis between missed diagnosis group and correct diagnosis group (Mean±SD)

    Index Missed diagnosis group(n=12) Correct diagnosis group(n=78) t2 P
    Radioactive uptake
       TBR 6.63±7.97 10.86±9.68 -1.641 0.104
       T/NT 2.10±1.67 3.85±2.51 -3.488 0.002
    Imaging data (Hu)
       CTmin 19.94±19.28 12.02±30.72 0.990 0.325
       CTmax 69.69±21.34 75.33±24.39 -0.862 0.391
       CTavg 54.15±21.22 45.58±18.98 1.619 0.109
    Tumor lesion
       Volume (cm3) 2.99±5.12 5.31±8.30 -1.077 0.284
       Diameter (cm) 1.87±1.16 2.28±1.21 -1.258 0.211
    TBR:Target background ratio;T/NT:Target and non-target ratio.
    下载: 导出CSV

    表  3  漏诊组和诊断正确组ROC最佳界值表

    Table  3.   ROC best threshold table for missed and correct diagnosis groups

    Radioactive uptake AUC Optimum value Sensitivity Specificity Cut-off
    T/NT 0.755 0.429 0.679 0.750 2.300
    TBR 0.721 0.443 0.568 0.875 7.200
    下载: 导出CSV

    表  4  是否伴甲状腺疾病对漏诊病灶的分析

    Table  4.   Analysis of missed lesions with or without thyroid disease [n(%)]

    Thyroid disease Missed diagnosis group Correct diagnosis group Total t2 P
    Yes 5(31.25) 20(24.69) 25(25.77) 0.30 0.58
    No 11(68.75) 61(75.31) 61(75.31)
    Total 16(100.00) 81(100.00) 97(100.00)
    下载: 导出CSV

    表  5  甲状旁腺病灶组与甲状腺病灶组数据分析

    Table  5.   Data analysis of parathyroid lesion group and thyroid lesion group (Mean±SD)

    Index Thyroid focus group (n=29) Parathyroid focus group (n=81) t2 P
    Clinical data
       Ca 2.66±0.25 2.75±0.36 -1.443 0.154
       P 0.79±0.17 0.83±0.35 -0.594 0.554
       PTH 206.06±130.75 315.20±322.35 -2.522 0.013
    Imaging data
       TBR 4.79±3.89 10.86±9.68 -4.680 <0.001
       CTmax 108.79±27.10 75.33±24.39 6.155 <0.001
       CTmin 59.83±20.36 12.02±30.72 7.777 <0.001
       CTavg 82.58±22.21 45.58±18.98 7.987 <0.001
    下载: 导出CSV

    表  6  甲状旁腺病灶组和甲状腺病灶组ROC最佳界值表

    Table  6.   ROC best threshold table for parathyroid and thyroid lesion groups

    Imaging data AUC Optimum value Sensitivity Specificity Cut-off
    CTmax 0.623 0.366 0.741 0.625 63.000
    CTmin 0.435 0.160 0.222 0.938 36.000
    CTavg 0.392 0.023 0.148 0.875 62.400
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-09-30
  • 网络出版日期:  2023-12-26
  • 刊出日期:  2023-11-20

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