超声及99mTc-MIBI核素显像对甲状旁腺腺瘤 诊断价值的评价

Value of ultrasound versus 99mTc-MIBI radionuclide imaging in the diagnosis of parathyroid adenoma

摘要:

目的：探讨超声及核素显像在诊断甲状旁腺腺瘤（parathyroid adenoma，PTA）中的价值。方法：对2012年6月至2016年7月在重庆医科大学附属第一医院行超声及核素扫描检查发现的150例甲状旁腺结节患者，其中经手术后病理证实的89例PTA患者进行回顾性分析，总结病灶超声及核素显像的影像学表现，分析2种不同检查方法的优势。结果：超声检查和核素显像可显示甲状旁腺腺瘤，超声和核素显像识别PTA病灶的灵敏度分别为86.9%、66%，特异度分别为88.1%、70.2%。差异有统计学意义（P=0.000）。在ROC曲线中，超声检查的95%CI下限为0.464，上限为0.588。核素检查的95%CI下限为0.310，上限为0.437。两者联合诊断的灵敏度为96.7%，特异度为90.1%。在ROC曲线中95%CI下限为0.542，上限为0.658，较单独超声检查差异有统计学意义（P=0.005）。结论：超声识别PTA的灵敏度、特异度较核素检查高，与核素显像联合可进一步提高检出率。

Abstract:

Objective：To investigate the value of ultrasound versus radionuclide imaging in the diagnosis of parathyroid adenoma （PTA）. Methods：A retrospective analysis was performed for 150 patients who were found to have parathyroid nodules on ultrasound or radionuclide imaging in The First Affiliated Hospital of Chongqing Medical University from June 2012 to July 2016，among whom 89 patients were diagnosed with PTA by postoperative pathology. The imaging findings of the lesions on ultrasound and radionuclide imaging were summarized to analyze the advantages of these two methods. Results：Both ultrasound and radionuclide imaging showed the presence of PTA，with sensitivities of 86.9% and 66%，respectively，and specificities of 88.1% and 70.2%，respectively，and there was a significant difference between the two methods（P=0.000）. According to the receiver operating characteristic（ROC） curve，the 95% confidence interval（CI） for the area under the ROC curve（AUC） of ultrasound was 0.464-0.588，while that of radionuclide imaging was 0.310-0.437. Ultrasound combined with radionuclide imaging had a sensitivity of 96.7% and a specificity of 90.1% in the diagnosis of PTA，and the 95% CI for the AUC of this combination was 0.542-0.658；there was a significant difference in 95%CI for AUC between ultrasound combined with radionuclide imaging and ultrasound alone（P=0.005）. Conclusion：Ultrasound has higher sensitivity and specificity than radionuclide imaging in detecting PTA，and ultrasound combined with radionuclide imaging can further improve detection rate.