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。
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.
[1] Suliburk JW, Perrier ND.Primary hyperparathyroidism[J]. Oncologist,2007,12(6):644-653.
[2] Taillefer R, Boucher Y, Potvin C, et al.Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study)[J]. J Nucl Med,1992,33(10):1801-1807.
[3] Gühne F, Mothes H, Freesmeyer M.Allocation of parathyroid adenoma and suspicious thyroid nodule by real-time 99mTc-MIBI SPECT/US fusion imaging[J]. Endocrine,2016,54(2):560-561.
[4] García-Talavera P, Díaz-Soto G, Montes AA, et al.Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters[J]. Rev Esp Med Nucl Imagen Mol,2016,35(6):351-357.
[5] 吕学民, 于淑红, 韩建奎, 等. (99)Tc~m-MIBI SPECT结合定位CT显像诊断功能亢进异位甲状旁腺的价值[J]. 中华核医学与分子影像杂志,2010,30(1):42-45.
[6] Hopkins CR, Reading CC.Thyroid and parathyroid ima-ging[J]. Semin Ultrasound CT MR,1995,16(4):279-295.
[7] Kluijfhout WP, Pasternak JD, Drake FT, et al.Use of PET tracers for parathyroid localization: a systematic review and meta-analysis[J]. Langenbecks Arch Surg,2016, 401(7):925-935.
[8] Fraser WD.Hyperparathyroidism[J]. Lancet,2009,374(9684):145-158.
[9] Sherman SI, Angelos P, Ball DW, et al.Thyroid carcinoma[J]. J Natl Compr Canc Netw,2005,3(3):404-457.
[10] Mahmoodzadeh H, Harirchi I, Hassan Esfehani M, et al.Papillary thyroid carcinoma associated with parathyroid adenoma[J]. Acta Med Iran,2012,50(5):353-354.
[11] Shane E.Clinical review 122: Parathyroid carcinoma[J]. J Clin Endocrinol Metab,2001,86(2):485-493.
[12] Krubsack AJ, Wilson SD, Lawson TL, et al.Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors[J]. Surgery,1989,106(4):639-646.
[13] Ahuja AT, Wong KT, Ching AS, et al.Imaging for primary hyperparathyroidism--what beginners should know[J]. Clin Radiol,2004,59(11):967-976.
[14] Melloul M, Paz A, Koren R, et al.99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance[J]. Eur J Nucl Med,2001,28(2):209-213.
