CAJ | 학술논문

目的：评价放射性核素药物99Tcm-MIBI显像对继发性于尿毒症的甲状旁腺功能亢进症的术前定位诊断价值。方法回顾分析32例因尿毒症所致的甲状旁腺功能亢进症和肾性骨病患者的术前99Tcm-MIBI双时相显像资料，并对比患者术前超声和手术切除异常甲状旁腺组织的病理资料。所有32例患者术后病理均有甲状旁腺异常病变，其中甲状旁腺增生12例，甲状旁腺增生伴腺瘤14例，甲状旁腺腺瘤6例；在手术切除的79枚病灶中,77枚为甲状旁腺病变，2枚为甲状腺病变。结果32例患者术前99Tcm-MIBI显像均有甲状旁腺异常浓聚灶，即阳性病灶，共82枚；其中1枚病灶患者2例，2枚病灶16例，3枚病灶8例，4枚病灶6例，2枚以上病灶患者占93.7%；99Tcm-MIBI显像的82枚阳性病灶中，77枚手术证实为甲状旁腺病灶，另2枚手术为甲状腺腺瘤，3枚阳性病灶未行切除。术前32例患者的B超则显示：阳性病例26例，发现病灶65枚，其与手术所见一致59枚。与术后病理结果对比：99Tcm-MIBI显像对继发于尿毒症的甲状旁腺功能亢进症的病例定性诊断符合率100%（32/32），对可手术切除的甲状旁腺病灶的检出率为100%（77/77），对病灶的阳性预测值为93.9%（77/82）；而B超的病例定性诊断符合率为81.3%（26/32），对可手术切除的甲状旁腺病灶检出率为76.6%（59/77），对病灶的阳性预测值为90.7%（59/65）。结论99Tcm-MIBI显像对继发性于尿毒症的甲状旁腺功能亢进症患者的术前定位诊断有极高价值，明显高于B超检查，应作为术前的常规病灶定位检查。
목적：평개방사성핵소약물99Tcm-MIBI현상대계발성우뇨독증적갑상방선공능항진증적술전정위진단개치。방법회고분석32례인뇨독증소치적갑상방선공능항진증화신성골병환자적술전99Tcm-MIBI쌍시상현상자료，병대비환자술전초성화수술절제이상갑상방선조직적병리자료。소유32례환자술후병리균유갑상방선이상병변，기중갑상방선증생12례，갑상방선증생반선류14례，갑상방선선류6례；재수술절제적79매병조중,77매위갑상방선병변，2매위갑상선병변。결과32례환자술전99Tcm-MIBI현상균유갑상방선이상농취조，즉양성병조，공82매；기중1매병조환자2례，2매병조16례，3매병조8례，4매병조6례，2매이상병조환자점93.7%；99Tcm-MIBI현상적82매양성병조중，77매수술증실위갑상방선병조，령2매수술위갑상선선류，3매양성병조미행절제。술전32례환자적B초칙현시：양성병례26례，발현병조65매，기여수술소견일치59매。여술후병리결과대비：99Tcm-MIBI현상대계발우뇨독증적갑상방선공능항진증적병례정성진단부합솔100%（32/32），대가수술절제적갑상방선병조적검출솔위100%（77/77），대병조적양성예측치위93.9%（77/82）；이B초적병례정성진단부합솔위81.3%（26/32），대가수술절제적갑상방선병조검출솔위76.6%（59/77），대병조적양성예측치위90.7%（59/65）。결론99Tcm-MIBI현상대계발성우뇨독증적갑상방선공능항진증환자적술전정위진단유겁고개치，명현고우B초검사，응작위술전적상규병조정위검사。
Objective To evaluate the preoperative localization value of 99Tcm-MIBI double-phase imaging in uremic patients with secondary hyperparathyroidism. Methods The preoperative 99Tcm-MIBI double-phase imaging of 32 patients with hyperparathyroidism secondary to uremia was retrospective analyzed, comparing with their serum IPTH, neck ultrasonography, and pathological result. Results 82 foci of hyperparathyroidism were detected by 99Tcm-MIBI imaging, of those 2 cases with 1 focus, 16 with 2 foci, 8 with 3 foci, and 6 with 4 foci. All of 32 cases with 79 foci were confirmed as hyperparathyroidism with pathological results. Of those 12 were with hyperplasia, 14 with hyperplasia and adenoma, and 6 with adenoma. 77 positive foci by 99Tcm-MIBI imaging were concordant with the pathological results. Of 32 subjects the preoperative ultrasonography identified 26 as positive with 65 foci, among them 59 were concordant with the pathological results. Coincidence rate of 99Tcm-MIBI imaging in the diagnosis and localization for excised lesions and positive value for lesions of hyperparathyroidism secondary to uremia were 100%, 100%and 93.9%respectively. As for ultrasonography the diagnostic accordiance rates,operable focus detection rate,and positive predictive value were 81.3% , 76.6% and 90.7% , respectively. Conclusion 99Tcm-MIBI imaging is valuable in localizing hyperparathyroidism secondary to uremia and should be taken as routine before operation.