Three combined imaging studies' diagnostic value for preoperative position of hyperthyroidism
-
摘要: 目的:研究MRI、99m锝-甲氧基异丁基异腈(99mTc-MIBI)核素显像及彩色多普勒超声等3种影像学联用在继发性甲状旁腺功能亢进症(SHPT)术前定位的诊断价值。方法:回顾性分析2010-2017年期间首次行甲状旁腺切除术的72例SHPT患者,72例患者均通过上述3种影像学对病变甲状旁腺进行术前定位。以手术后病理诊断结果为金标准,分别统计出3种影像学检查联用及各自所诊断甲状旁腺的确诊数及误诊数,并计算敏感度及特异度,通过SPSS 19.0软件运用率的χ2检验将3种影像学检查联用同每种影像学方法的敏感度及特异度分别加以对比分析。结果:术后病理所报甲状旁腺共282枚,MRI、99mTc-MIBI核素显像、彩色多普勒超声及3种影像学检查联用的敏感度分别为72.70%、47.52%、44.33%、82.27%;特异度分别为78.16%、91.75%、95.14%、67.96%;3种影像学联用的敏感度大于各自的敏感度,均差异有统计学意义,而3种影像学联用的特异度均小于各自的特异度,差异有统计学意义。结论:MRI、99mTc-MIBI核素显像及彩色多普勒超声等3种影像学检查联用对病变甲状旁腺术前定位的诊断价值较高,可有效辅助SHPT的手术治疗。
-
关键词:
- 甲状旁腺功能亢进症 /
- 核磁共振 /
- 彩色多普勒超声 /
- 99m锝-甲氧基异丁基异腈核素显像
Abstract: Objective: To investigatethe diagnostic value of three combined imaging studies' preoperative localization for secondary hyperparathyroidism.Method: This study lies on the retrospective analysis about 72 patients with secondary hyperparathyroidism who had parathyroid gland resection in our hospital from 2010 to 2017. All of 72 cases are examined by color doppler ultrasound, 99mTC-MIBI nuclide imaging and magnetic resonance imaging. According to the gold standard——pathological diagnosis after surgery, we compute the sensitivity and the specificity of various imaging examination and analyse these statistics by rate card square test with SPSS 19.0 software.Result: The parathyroid gland number of pathological diagnosis is 282. The sensitivities of magnetic resonance imaging, 99mTC-MIBI nuclide imaging, color doppler ultrasound and three combined imaging are 72.70%, 47.52%, 44.33% and 82.27%, respectively. The specificities of the examinations are 78.16%, 91.75%, 95.14% and 67.96%, respectively. The sensitivity of the combined three imaging studies is greater than the sensitivity of each single imaging studies, and there is a statistical significance between them. The specificity of the combined three imaging studies is smaller than the sensitivity of single imaging studies. There is a statistical significance,either.Conclusion: Three combined imaging studies' preoperative localization for secondary hyperparathyroidism has higher diagnostic value for the preoperative localization about secondary hyperparathyroidism. It can be a effective way to SHPT's surgery. -
[1] TAIEB D, URENA-TORRES P, ZANOTTI-FREG-ONARA P.Parathyroid scintigraphy in renal hyperparathyroidism:the added diagnostic value of SPECTand SPECT/CT[J].Clin Nucl Med, 2013, 38:630-635.
[2] BRUNKHORST R.Mineral and bone disorder in chronic kidney disease.Critical appraisal of pharmacotherapy[J].Internist, 2014, 55:334-339.
[3] YUAN C M, NEE R, NARAYAN R, et al.Treatment of secondaryhyperparathyroidism with parathyroidectomy instead of cinacalcet:time to pick the low-hanging fruit[J]?Am J Kidney Dis, 2012, 60:179-181.
[4] MADORIN C, OWEN R P, FRASER W D, et al.The surgical management of renal hyperparathyroidism[J].Eur Arch Otorhinolaryngol, 2012, 269:1565-1576.
[5] CONZO G, PERNA A, AVENIA N, et al.Evaluation of the ‘putative’ role of intraoperative intact parathyroid hormone assay during parathyroidectomy for secondary hyperparathyroidism.A retrospective study on 35consecutive patients:intraoperative iPTH assay during parathyroidectomy[J].Endocrine, 2012, 42:606-611.
[6] ROY M, MAZEH H, CHEN H, et al.Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients[J].World J Surg, 2013, 37:102-102.
[7] ALKHALILI E, TASCI Y, AKSOY E, et al.The utility of neck ultrasound and sestamibiscans in patients with secondary and tertiary hyperparathyroidism[J].World J Surg, 2015, 39:701-705.
[8] 刘洁, 徐海波.MRI在血透患者继发性甲状旁腺功能亢进术前定位诊断中的价值[J].华中科技大学学报(医学版), 2013, 42(1):33-37.
[9] HIRAMITSU T, TOMINAGA Y, OKADA M, et al.Retrospective study of the impact of intraoperative intact parathyroid hormone monitoring during total parathyroidectomy for secondary hyperparathyroidism:STARD study[J].Medicine (Baltimore), 2015, 94:e1213-e1213.
[10] MADORIN C, OWEN R P, FRASER W D, et al.The surgical management of renal hyperparathyroidism[J].Eur Arch Otorhinolaryngol, 2012, 269:1565-1576.
[11] 葛平江, 刘双信, 程秋惠.甲状旁腺切除术治疗肾衰继发甲状旁腺功能亢进的临床观察[J].临床耳鼻咽喉头颈外科杂志, 2014, 28(24):1987-1989.
[12] KESTENBAUM B, ANDRESS D L, SCHWARTZ SM, et al.Survival following parathyroidectomy among United States dialysis patients[J].Kidney Int, 2004, 66:2010-2016.
[13] MADORIN C, OWEN R P, FRASER W D, et al.The surgical management of renal hyperparathyroidism[J].Eur Arch Otorhinolaryngol, 2012, 269:1565-1576.
[14] RICHARDS M L, WORMUTH J, BINGENER J, et al.Parathyroidectomy in secondary hyperparathyroidism:is there an optimal operative management[J]?Surgery, 2016, 139:174-180.
[15] SHARMA J, RAGGI P, KUTNER N, et al.Improved long-term survival of dialysis patients after near-total parathyroidectomy[J].J Am Coll Surg, 2012, 214:400-408.
[16] KOMABA H, TANIGUCHI M, WADA A, et al.Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism[J].Kidney Int, 2015, 88:350-359.
[17] RICHARDS M L, WORMUTH J, BINGENER J, et al.Parathyroidectomy in secondary hyperparathyroidism:is there an optimal operative management[J]?Surgery, 2016, 139:174-180.
[18] SCHNEIDER R, SLATER E P, KARAKAS E, et al.Initial parathyroid surgery in 606patients with renal hyperparathyroidism[J].World J Surg, 2012, 36:318-326.
[19] CONZO G, PERNA A F, SINISI A A, et al.Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease[J].J Endocrinol Invest, 2012, 35:8-13.
[20] 刘洁, 徐海波, 孔祥泉, 等.MRI在血透患者继发性甲状旁腺功能亢进术前定位诊断中的价值[J].华中科技大学学报(医学版), 2013, 42(1):33-36.
计量
- 文章访问数: 103
- PDF下载数: 75
- 施引文献: 0