Correlation Between High Frequency Ultrasound Combined With ^99mTc-MIBI Imaging And Serum Parathyroid Hormone In Hyperparathyroidism

Objective To analyze the imaging and laboratory quantitative and semi-quantitative indicators in patients with hyperparathyroidism,and to explore the correlation between serum parathyroid hormone and high-frequency ultrasound indicators and ^99mTc-MIBI SPECT/CT imaging semi-quantitative parameters in patients with hyperparathyroidism.The purpose of this study is to suggest the value of multiple imaging indexes combined to predict the degree of hyperparathyroidism.Methods Review in October 2020 to December 2022 were analyzed in Inner Mongolia medical university affiliated hospital on the basis of surgical pathology or guide the qualitative diagnosis of 70 cases of patients with parathyroid function already,record all of the patients age,gender,serum parathyroid hormone level and other clinical data and imaging features.All patients underwent high-frequency ultrasound and ^99mTc-MIBI SPECT/CT imaging.The total volume of pathological parathyroid tissue was determined by high-frequency ultrasound and the blood flow distribution grade was determined by color Doppler semi-quantitative method.The average radiation count ratio（T/NT）between diseased parathyroid tissue and adjacent normal thyroid tissue in delayed phase of^99mTc-MIBI SPECT/CT fusion imaging was measured and calculated using ROI technique.According to serum parathyroid hormone levels,they were divided into≤150pg/ml（mild group）,150～≤300pg/ml（moderate group）,300～≤600pg/ml（severe group）,>600pg/ml（extremely severe group）.To evaluate the correlation between high-frequency ultrasound features,^99mTc-MIBI SPECT/CT imaging semi-quantitative parameter T/NT and serum parathyroid hormone in patients with hyperparathyroidism.Serum PTH=300pg/ml was used as the cut-off value to judge the severity and non-severity of hyperparathyroidism,and ROC curve was established for the correlation indicators.To investigate the value of high-frequency ultrasound to predict the degree of hyperparathyroidism by the total volume and blood flow score of the lesion and the semi-quantitative parameter T/NT value of^99mTc-MIBI SPECT/CT imaging.Results（1）In the general clinical data of HPT patients,the incidence of pruritus in SHPT group was higher than that in PHPT group,and the difference was statistically significant（P<0.05）.There were no significant differences in T/NT value and semi-quantitative blood flow score between the two groups（P>0.05）.（2）The number of diseased parathyroid glands detected by high-frequency ultrasound was not consistent with serum PTH,and the correlation coefficients between serum PTH and the total volume of diseased glands,the semi-quantitative score of high-frequency ultrasound blood flow and T/NT value were 0.289,0.460 and 0.453,respectively,with statistical significance（all P<0.05）.（3）There was no correlation between T/NT value and total volume of diseased glands and semi-quantitative score of high-frequency ultrasound blood flow（all P>0.05）.（4）ROC curve:area under gland volume curve was 0.824,sensitivity was 92.3%,specificity was 65.9%;Area under the blood flow score curve was 0.831,sensitivity was 80.8%,specificity was 68.2%;The area under the T/NT value curve of ^99mTc-MIBI SPECT/CT imaging was 0.702,the sensitivity was 60.1%,and the specificity was 88.9%.The area under the combined diagnosis curve of the three indexes was 0.865,the sensitivity was 72.0%and the specificity was 91.1%.Conclusion（1）The serum PTH level in patients with HPT was positively correlated with the volume of the pathological parathyroid gland,the semi-quantitative score of high-frequency ultrasound blood flow,and the semi-quantitative parameter T/NT of ^99mTc-MIBI SPECT/CT imaging,while T/NT was not correlated with the volume of the pathological gland and the semi-quantitative score of blood flow.（2）Lesion parathyroid volume,blood flow semi-quantitative score,^99mTc-MIBI SPECT/CT imaging semi-quantitative parameter T/NT have better predictive value for serum PTH level increase,compared with high-frequency ultrasound or ^99mTc-MIBI imaging single index analysis,The combination of multiple indexes can more accurately reflect the degree of hyperparathyroidism,which can provide a beneficial supplement for the choice of treatment.