摘要
目的:探讨碳-11胆碱(^(11)C-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99m Tc-MIBI显像后定位困难。静脉注射111~333 MBq(3~9 mCi)^(11)C-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^(11)C-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,SUV_(max))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:^(11)C-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。
Objective:To investigate the value of 11 C-choline positron emission tomography/computed tomography(PET/CT)in the preoperative localization diagnosis of difficult cases of primary hyperparathyroidism(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 99m Tc -MIBI were enrolled. PET/CT was performed at 20 minutes after the intravenous injection of 111-333MBq(3-9mCi) 11 C-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 11 C-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. 11 C-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(SUV max )and standardized uptake value (SUV)ratio than the 10 weakly positive lesions(SUV max :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: 11 C-choline PET/CT can be used for preoperative localization diagnosis of PHPT,with a high sensitivity and a poor specificity. The
作者
刘轶敏
党永红
霍力
胡亚
王鸥
刘赫
常晓燕
刘宇
吕京桥
邢小平
李方
廖泉
Liu Yimin;Dang Yonghong;Huo Li;Hu Ya;Wang Ou;Liu He;Chang Xiaoyan;Liu Yu;LüJingqiao;Xing Xiaoping;Li Fang;Liao Quan(Department of Nuclear Medicine,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Peking Union Medical College(PUMC)Hospital,Chinese Academy of Medical Science &PUMC;Surgery Department,Peking Union Medical College(PUMC)Hospital,Chinese Academy of Medical Science &PUMC;Ultrasound Department,Peking Union Medical College(PUMC)Hospital,Chinese Academy of Medical Science &PUMC;Pathology Department,Peking Union Medical College(PUMC)Hospital,Chinese Academy of Medical Science &PUMC;Endocrine Department,Peking Union Medical College(PUMC)Hospital,Chinese Academy of Medical Science &PUMC)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2018年第12期1647-1651,共5页
Journal of Chongqing Medical University
基金
国家自然科学基金资助项目(编号:81571713)
首都特色发展基金转化医学资助项目(编号:2016-2-40115)
中国医学科学院医学与健康科技创新工程重大协同创新资助项目(编号:2016-I2M-4-003,2017-12M-1-001)
北京协和医院创新团队资助项目(编号:2016).
