99mTc-MIBI甲状旁腺显像及99mTc-MDP全身骨显像综合判断甲状旁腺功能亢进

99mTc-MIBI甲状旁腺显像及99mTc-MDP全身骨显像综合判断甲状旁腺功能亢进
2009-12-14 朱瑞森　陆汉魁　马寄晓　于建芳


【摘要】　目的　比较99mTc-MIBI双时相法与MIBI-99mTcO4-图像相减法两种显像法对甲状旁腺功能亢进(甲旁亢)的诊断价值，同时结合99mTc-MDP全身骨显像综合判断甲旁亢患者的病情。方法　对18例甲旁亢患者进行静注99mTc-MIBI 740-925MBq，分别在第15分钟、第2小时作颈前位平面显像；显像结束后立即予床边静注99mTcO4-74-111MBq，15分钟后再作显像。以99mTc-MIBI延迟显像图减去99mTcO4-显像图，获得MIBI-99mTcO4-相减图。结果　99mTc-MIBI早期显像(第15分钟)检测甲旁亢病灶的灵敏度为61.1%(11/18)、延迟相(2小时)的灵敏度83.3%(15/18)。15例阳性显像中14例为腺瘤，1例为癌；3例阴性者均为腺体增生。MIBI-99mTcO4-相减法除同样显示15例99mTc-MIBI延迟显像的病灶外，也检出1例增生型甲旁亢病灶。全身骨显像结果，2例出现“棕色瘤”样病灶，10例呈多灶性骨放射性异常集聚改变，6例骨显像正常；全身骨显像图病灶范围及放射性集聚程度与甲旁亢病程关系明显。结论　99mTc-MIBI双时相法及MIBI-99mTcO4-图像相减法都是检测甲旁亢病灶的灵敏手段，但对于增生型病灶检测能力有限；结合全身骨显像结果有助于提高对甲旁亢患者病情及病程的综合判断力。
【关键词】　甲状旁腺功能亢进 99mTc-MIBI 99mTc-MDP 核素显像

Combined study of 99m Tc-MIBI parathyroid imaging with 99m Tc-MDP bone scintigraphy in the diagnosis of hyperparathyroidism Zhu Ruiseng,Lu Hankui,Ma Jixiao,et al.Shanghai Sixth Hospital,Shanghai,200233
【Abstract】　Objective　To compare the diagnostic values between double phase 99m　Tc-MIBI imaging and MIBI-99mTcO4-substraction imaging in localizing lesions of hyperparathyroidism and to evaluate the conditions of patients with hyperparathyroidism by 99m　Tc-MDP bone scintigraphy. Methods　In eighteen patients with hyperparathyroidism, parathyroid imagings were performed both at 15 min (early phase imaging, EPI) and at 2hr (delayed phase imaging, DPI) after injection of 740～925MBq 99m　Tc-MIBI, followed by thyroid imaging 15 min after IV injection of 74～111 MBq of 99m　TcO4-MIBI-99mTcO4-substractionimagingswereobtainedby substracting 99m　TcO4-thyroid imaging from99mTc-MIBI DPI.Results　The sensitivity of 99m Tc-MIBI DPI in detecting lesions of hyperparathyroidism was up to 83.3%(15/18), while that of EPI was only 61.1%(11/18)(P＜0.01). Positive lesions consisted of 14 cases of adenomas and 1 case of carcinoma, while 3 negative cases were hyperplasia. From MIBI-99mTcO4-imagings, one positive case was due to hyperplasia and other 15 lesions shown on DPI were also clearly depicted. As to bone scintigraphs, brown tumors were present in t

wo cases, multi-lesions of increased bone uptake of radioactivities in 10 and normal in rest 6. The sites of abnormal uptake and their severities on bone scintigraph were correlated with the duration of the disease. Conclusions　Double phase 99m　Tc-MIBI imagings and MIBI-99mTcO4- substraction imaging are both sensitive methods in detecting the lesions of hyperparathyroidism, though they have limited value in determining the disffuse hyperplasia. Combined with bone scintigraphy they may well reflect the stage and progress of hyperparathyroidism.
【Key words】　Hyperparathyroidism 99mTc-MIBI 99mTc-MDP Imaging

(Chin J Endocrinol Metab, 1998, 14:85-87)


甲状旁腺功能亢进(甲旁亢)是由于甲状旁腺腺体增生、腺瘤或腺癌组织分泌过量的甲状旁腺素(PTH)所致的一组症候群。针对甲旁亢的影像学诊断方法有多种，其中包括高分辨超声检查，X-CT，磁共振成像(MRI)及核素显像等。核素显像手段对甲旁亢有很高的诊断价值，但过去一直采用的显像剂为201Tl，因其价格昂贵而在国内无法推广应用〔1〕。目前很多的文献报道采用99mTc-MIBI双时相法进行甲状旁腺显像〔2〕，该方法简便易行，大大提高了诊断的特异性和灵敏度。
本文采用99mTc-MIBI作甲状旁腺显像的方法，通过延迟显像及99mTc-MIBI减99mTcO4-相减法显像以提高诊断甲旁亢的特异性和得到优质的显像图。

材料和方法


一、病例资料：18例甲旁亢患者，男性7例，女11例，平均年龄46(35～74)岁。18例均经手术病理证实为甲旁亢，其中14例单发甲状旁腺腺瘤，1例甲状旁腺腺癌，3例为弥漫性甲状旁腺增生。
二、99mTc-MIBI甲状旁腺双时相显像方法：检查前病人无需特殊准备。静脉注入99mTc-MIBI 740-925MBq(20～25mCi)，第15分钟开始作前位平面显像(早期显像)，采用针孔型准直器(视野大小视需要作适当调节)，采集矩阵256×256(仪器Toshiba-901A/SA SPECT)，一帧总计数为2000K。根据前位显像结果选择增加斜位和侧位显像。2小时后再作一次平面显像(延迟显像)。
三、MIBI-99mTcO4-甲状旁腺相减图法显像方法：延迟显像结束后立即予床边静注99mTcO4-74-111MBq，继续保持相同显像位，15分钟后再作显像，显像条件同99mTc-MIBI甲状旁腺显像。以延迟显像减去99mTcO4-显像图，获得MIBI-99mTcO4-相减图〔3〕。
四、全身骨显像方法：同常规骨显像。静注99mTc-MDP 925-1110MBq(25-30mCi)。3小时后配低能高分辨平行孔准直器作全身骨扫描。

结 果


一、99mTc-MIBI双时相甲状旁腺显像：在18例甲旁亢患者中，11例在早期及延迟显像中均为阳性。早期显像中病灶/周围组织放射比为1.31±0.24，延迟图像为1.53±0.28，两组差异明显(P＜0.05)(图1)。4例早期显像阴

性，延迟阳性病灶/周围组织放射比为1.27±0.20。该15例病理证实14例为腺瘤，1例为癌。余3例患者99mTc-MIBI的双时相图及相减图均未见异常，手术探查结果显示为甲状旁腺增生。
99m Tc-MIBI早期显像诊断甲旁亢灵敏度为61.1%，延迟显像灵敏度为83.3%，两个结果差异显著(P＜0.05)。15例阳性显像病灶区域分布为：右下叶7个(46.7%)，左下叶5个(33.3%)，右上叶2个(13.3%)，左上叶1个(6.7%)。所检出的病灶中最大腺瘤直径2.5cm，最小为0.5cm。