| Objective: Contrast parathyroid scintigraphy,ultrasonography and CT examination,to explore the sensitivity and specificity of three methods is examined individually and the joint inspection,to select the best method of examination;and three kinds of inspection methods for different types of parathyroid lesions detection capabilities,analyzing clinical diagnosis application value of parathyroid scintigraphy on secondary hyperparathyroidism(SHPT).Methods: Selected in our hospital suffering from chronic renal failure long-term hemodialysis of 41 patients with secondary hyperparathyroidism,respectively,41 cases 99mTc-MIBI/99 mTc O4-subtraction scintigraphy method and 99mTc-MIBI double phase scintigraphy,ultrasound was performed in 37 patients and 37 cases were examined by CT reduction.All patients were treated by surgical resection of parathyroid lesions and pathological examination,three different kinds of examination methods of imaging features and pathological results were analyzed and summarized.With the change of PTH content in all patients before and after surgery,analyzing the guiding role of radionuclide imaging in detection of hyperparathyroidism in surgery.Results: 41 patients with secondary hyperparathyroidism(40 cases of pathological diagnosis were parathyroid lesions and 1 case was normal parathyroid tissue);1 cases of multiple endocrine neoplasia(MEN).1,After surgical resection and pathological results confirmed parathyroid hyperplasia or adenoma were 140 pieces,the sensitivity and specificity of these three methods to detect lesions were 60%,83.3%;64.6%,72.2%;58.9%,62.5%.The sensitivity and specificity of Three methods of parathyroid radionuclide imaging,ultrasound and CT were compared,the difference was not significant(P>0.05).2,ECT imaging,ultrasound and CT,three methods each of the joint inspection sensitivity and specificity,ect imaging and ultrasound,SPECT imaging and CT,ultrasound and CT found lesions sensitivity and specificity were 84.7%,64.7%,69.2%,61.1%,69.6%,60.0%.ECT imaging and ultrasound examination method was more sensitive than the other two joint inspection method and separate inspection method,there was no significant difference in specificity.Three methods of joint inspection sensitivity was significantly higher than that of ECT imaging and CT,ultrasound and CT examination(P<0.05,P<0.05).3,Pathologically proven diagnosis of 40 patients with SHPT lesions,36 cases were detected the mean lesion size was(17.5 + 5.9)x(9.8 + 3.6),PTH ranged from 121pg/ml to 3497 pg/ml,median 1572 pg/ml.4 cases were not detected in lesion size is(15.8 + 6.9)x(7 + 1.4),PTH ranged from 611.8pg/ml to-2500+ pg/ml,median 1788+ pg/ml.No obvious relationship between ECT imaging detecting lesions ability and lesion size(P>0.05),all PTH increased in patients were decreased to normal range after surgical resection of the lesions.4,The detection of parathyroid lesions in pathologically was confirmed: parathyroid hyperplasia 120 pieces,parathyroid adenoma 17 pieces,3 pieces of parathyroid hyperplasia with adenoma.The difference of the detection ability of three kinds of examination methods for different types of lesions was not statistically significant(P>0.05).Conclusion:(1)ECT imaging,ultrasound and CT three methods of sensitivity and specificity between groups were compared,there was no significant difference.(2)ECT imaging and ultrasonography joint inspection for diagnosis of hyperparathyroidism is the best method.(3)Parathyroid scintigraphy for lesion detection ability and lesion size had no obvious relationship.All PTH increased in patients were decreased to normal range after surgical resection of the lesions,parathyroid scintigraphy can detect small and overactive lesions,guiding the surgical treatment.(4)The detection ability of hyperplasia,adenoma and hyperplasia with adenoma with three different types of lesions,there was no significant difference between the three methods.(5)Parathyroid scintigraphy can found ectopic parathyroid lesions better,especially mediastinal lesions. |
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