碳-11胆碱 PET/CT显像在原发性甲状旁腺功能亢进 疑难病例术前定位诊断中的应用研究

Value of 11C-choline positron emission tomography/computed tomography in preoperative localization diagnosis of difficult cases of primary hyperparathyroidism

摘要:

目的：探讨碳-11胆碱（11C-choline）PET/CT对原发性甲状旁腺功能亢进（primary hyperparathyroidism，PHPT）疑难病例术前定位诊断价值。方法：临床诊断PHPT拟采取手术治疗的患者92例[男21例，（54.2±14.1）岁]，B超及99mTc-MIBI显像后定位困难。静脉注射111~333 MBq（3~9 mCi）11C-choline，20 min后行PET/CT显像，采用视觉及定量方法分析图像，以病理为金标准，与血清学检查结果对照，采用IBM SPSS 23进行统计分析。结果：92例患者11C-choline PET/CT显像共检出病灶103个，分别为甲状旁腺腺瘤或增生（83个）、甲状旁腺癌或其转移灶（5个）、肺神经内分泌瘤（4个）、结节性甲状腺肿（7个）和甲状腺髓样癌转移灶（4个），其中强阳性86个，弱阳性17个；未检出病灶2个，分别为甲状旁腺瘤囊性变和甲状旁腺组织，总体诊断灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为98.9%、6.3%、84.8%、85.4%、50.0%。78个PHPT强阳性病灶平均最大标准摄取值（standard uptake value，SUVmax）及与甲状腺SUV比值（SUV ratio，SUVR）均明显高于10个PHPT弱阳性病灶[3.95（2.77，7.73） vs. 2.60（1.95，4.42），P=0.036；1.72（1.43，2.42） vs. 1.19（1.11，1.51），P=0.002]。PHPT与非PHPT组显像结果与血PTH（P=0.115）、血钙（P=0.217）、血磷（P=0.901）无关。结论：11C-choline PET/CT显像可用于原发性甲状旁腺旁腺亢进术前定位诊断，灵敏度高，但特异性差，需注意与结节性甲状腺肿及恶性肿瘤鉴别。

Abstract:

Objective：To investigate the value of 11C-choline positron emission tomography/computed tomography（PET/CT） in the pre－operative localization diagnosis of difficult cases of primary hy－perparathyroidism（PHPT）. Methods：A total of 92 patients with PHPT（including 21 male patients aged 54.2±14.1 years） who planned to undergo surgical treatment and had difficulties in localization after ultrasound and 99mTc-MIBI were enrolled. PET/CT was performed at 20 minutes after the intravenous in－jection of 111-333MBq（3-9mCi）11C-choline. Visual and quantitative methods were used for image analysis，and with pathological results as the gold standard，PET/CT findings were compared with the results of serological examination. IBM SPSS 23 was used for statistical analysis. Results：A total of 103 lesions were detected by 11C-choline PET/CT in 92 patients，among which there were 83 lesions of parathyroid adenoma or hyperplasia，5 lesions of parathyroid carcinoma or its metastatic lesions，4 lesions of pulmonary neuroendocrine tumor，7 lesions of nodular goiter，and 4 lesions of metastatic lesions of medullary thyroid carcinoma；86 lesions were strongly positive and 17 were weakly positive. One lesion of cystic degeneration of parathyroidoma and one of parathyroid tissue were not detected. 11C-choline PET/CT had an overall sensitivity of 98.9%，a specificity of 6.3%，an accuracy of 84.8%，a positive predictive value of 85.4%，and a negative predictive value of 50%. The 78 strongly positive lesions of PHPT had significantly higher maximum standard uptake value（SUVmax） and standardized uptake value（SUV） ratio than the 10 weakly positive lesions（SUVmax：3.95（2.77，7.73） vs. 2.60（1.95，4.42），P=0.036；SUV ratio：1.72（1.43，2.42） vs. 1.19（1.11，1.51），P=0.002）. There were no significant differences between the PHPT group and the non-PHPT group in blood PTH，serum calcium，and serum phosphate（P=0.115，0.217，and 0.901）. Conclusion：11C-choline PET/CT can be used for preoperative local－ization diagnosis of PHPT，with a high sensitivity and a poor specificity. The differentiation of PHPT from nodular goiter and malignant tumor should be taken seriously in clinical practice.