诊断学理论与实践

诊断学理论与实践 ›› 2018, Vol. 17 ›› Issue (06): 682-686.doi: 10.16150/j.1671-2870.2018.06.011

• 论著 • 上一篇    下一篇

99mTc-MIBI SPECT/CT甲状旁腺显像发现颈部恶性肿瘤的价值及与超声对比

冯国伟, 陈刚   

  1. 上海交通大学医学院附属瑞金医院核医学科, 上海 200025
  • 收稿日期:2017-12-04 出版日期:2018-12-25 发布日期:2018-12-25
  • 通讯作者: 陈刚 E-mail: rjchengang@189.cn
  • 基金资助:
    国家临床重点专科建设项目

The value of 99mTc-MIBI SPECT/CT parathyroid imaging and ultrasound in incidental detection of neck carcinoma

FENG Guowei, CHEN Gang   

  1. Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2017-12-04 Online:2018-12-25 Published:2018-12-25

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摘要： 目的：评价99mTc-甲氧基异丁基异腈（99mTc-methoxyisobutyl isonitrile, 99mTc-MIBI）单光子发射计算机断层扫描（single-photon emission computed tomography, SPECT）/CT甲状旁腺显像检查在意外发现颈部恶性肿瘤中的价值, 并与超声检查进行对比。方法：回顾性分析952例临床疑似原发性甲状旁腺功能亢进症（primary hyperparathyroidism, PHPT）, 同时行颈部SPECT/CT和超声检查的患者, 以手术及病理检查结果作为诊断金标准, 对比影像学检查结果进行分析, 计算SPECT/CT及超声检查对疑似PHPT患者伴发的颈部恶性肿瘤, 特别是甲状腺癌的发病情况, 以及定位诊断的灵敏度、特异度、准确率。结果：952例患者中有304例患者行手术治疗, 并得到352个术后病理学结果, 其中颈部恶性肿瘤共64例（83个病灶）, 包括22例（34.38%）甲状旁腺癌, 24例（37.50%）甲状腺乳头状癌, 4例（6.25%）甲状腺滤泡状癌, 7例（10.94%）甲状腺髓样癌, 7例（10.94%）其他肿瘤。SPECT/CT和超声检查诊断颈部恶性肿瘤的灵敏度分别为51.56%和76.56%, 特异度分别为91.32%和95.14%, 诊断准确率分别为84.10%和91.76%。其中, SPECT/CT和超声检查诊断甲状腺癌的灵敏度分别为54.29%和85.71%, 特异度分别为91.18%和94.01%, 准确率分别为87.50%和93.18%。结论：PHPT伴发颈部恶性肿瘤并不少见。尽管99mTc-MIBI SPECT/CT显像在诊断和定位PHPT病变时非常重要, 可以发现并定位颈部恶性肿瘤, 但超声检查对伴发PHPT病变的颈部恶性肿瘤及甲状腺癌的诊断灵敏度更高。

关键词: 原发性甲状旁腺功能亢进症, 颈部恶性肿瘤, 甲状腺癌, 99mTc-MIBI SPECT/CT, 超声

Abstract: Objective: To investigate the value of 99mTc-MIBI SPECT/CT parathyroid imaging and ultrasound in incidental detection of neck carcinoma. Methods: A total of 952 patients with clinically suspected primary hyperparathyroidism (PHPT) undertaken ultrasonography and 99mTc-MIBI SPECT/CT of base of skull, neck and thorax were enrolled. Each case with suspected lesion was analyzed and correlated with pathological finding. The frequency of carcinoma on SPECT/CT performed for PHPT was calculated. Sensitivity, specificity and accuracy for head and neck carcinoma, especially thyroid carcinoma of both the SPECT/CT and ultrasound were calculated. Results: Among the 952 patients, a total of 304 patients were treated with surgery and 352 pathological results were obtained. And finally, 64 carcinoma (83 sites) were found. The anatomical distribution was as follows: 22 (34.38%) were parathyroid carcinoma, 24 (37.50%) were papillary thyroid carcinoma, 4 (6.25%) were follicular thyroid carcinoma, 7 (10.94%) were medullary thyroid carcinoma and 7 (10.94%) were other tumors. The sensitivity of SPECT/CT and ultrasound for neck carcinoma were 46.99% and 74.70%, respectively. Specificity was 91.21% for SPECT/CT and 94.79% for ultrasound. Accuracy was 81.79% for SPECT/CT and 90.51% for ultrasound. The sensitivity of SPECT/CT and ultrasound for thyroid carcinoma were 39.31% and 80.43%, respectively. Specificity was 90.12% for SPECT/CT and 92.73% for ultrasound. Accuracy was 84.10% for SPECT/CT and 91.28% for ultrasound. Conclusions: The concomitant occurrence of PHPT and neck carcinoma is not uncommon. Although 99mTc-MIBI SPECT/CT plays an important role for the diagnosis and location of PHPT lesions, ultrasound is a better choice for detecting neck carcinoma, such as thyroid carcinoma accompanied the PHPT.

Key words: Primary hyperparathyroidism (PHPT), Neck carcinoma, Thyroid carcinoma, 99mTc-MIBI SPECT/CT, Ultrasound

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