The Value Of 99mTc-MIBI Spect/ct On Preoperative Diagnosis And Localization Of Primary Hyperparathyroidism

[Objectives]To investigate the value of 99mTc-MIBI spect/ct on preoperative diagnosis and localization of PHPT,and to compare this examination with 99mTc-MIBI dual-time imaging and color Doppler ultrasonography,and to study the effect of preoperative blood calcium levels on 99mTc-MIBI imaging.[Methods]Retrospective analysis of 60 PHPT patients treated by surgery from 2012.01 to 2016.12.All patients were followed up by high frequency color Doppler ultrasonography,99mTc-MIBI double time imaging and 99mTc-MIBI spect/ct examination.The preoperative blood calcium levels were also determinated.The pathological results were used as the gold standard.The correlation between the delayed phase T/NT and preoperative blood calcium was also analyzed by using the ROI technology.[Results]1.Surgical and pathological results The lesions of 60 patients were successfully removed by surgery,most patients have no obvious postoperative complications.A total of 73 parathyroid lesions were removed,including 70 cases of lesions in situ,3 cases of ectopic lesions;49 cases of single glandular lesions,24 cases of multiple glandular lesions;13 cases of parathyroid hyperplasia,60 cases of parathyroid adenoma,no cancer case was included.2.99mTc-MIBI spect/ct locating value The sensitivity,specificity and accuracy of 99mTc-MIBI spect/ct were 90.4%,92.3%and 90.7%,respectively.The sensitivities of paraneoplastic lesions(upper left,lower left,right upper,lower right,ectopic)were 81.8%,90.6%,75.0%,100%and 100%respectively,the differences were statistically significant(P<0.05).Comparing with high frequency color Doppler ultrasound,the differences of sensitivity,specificity and accuracy of 99mTc-MIBI spect/ct were not statistically significant(P>0.05).Comparing with 99mTc-MIBI double-time imaging,the differences of sensitivity and accuracy of 99mTc-MIBI spect/ct were statistically significant(P<0.05).3.99mTc-MIBI imaging combined with color Doppler ultrasound positioning results The sensitivity,specificity and accuracy of 99mTc-MIBI spect/ct combined with high frequency color Doppler ultrasonography were 95.6%,69.2%and 91.9%respectively.Comparing with 99mTc-MIBI spect/ct,the differences of sensitivity,specificity and accuracy of the combined examination were not statistically significant(P>0.05).Comparing with high frequency color Doppler ultrasound,the difference of sensitivity of the combined examination was statistically significant(P<0.05).4.Correlation between T/NT and preoperative Ca A positive correlation of T/NT and preoperative Ca level was observered with a statistically significant(r = 0.614,P<0.05).[Conclusions]1.99mTc-MIBI spect/ct is an important method for preoperative positioning of PHPT,and it has a high diagnostic value for the detection of the lower and ectopic parathyroid gland.Our study find that for some cases of ectopic parathyroid,reoperation of parathyroid and the parathyroid lesion with a unclear margin with thyroid,99mTc-MIBI spect/ct plays a greater role because of its particular advantage of combining metabolic imaging and anatomical structures.2.The combined examination can improve the detection rate of lesions and surgical effect.3.T/NT and preoperative Ca were positively correlated,preoperative blood calcium level has a certain impact on 99mTc-MIBI spect/ct imaging.The low level of serum calcium may lead to a false negative results.