影像学检查在SHPT术前定位诊断中的临床价值

发布时间：2018-03-24 21:34

本文选题：继发性甲状旁腺功能亢进症　切入点：影像学检查　出处：《皖南医学院》2017年硕士论文

【摘要】：目的:探讨超声、CT、MIBI三种影像学检查方法在继发性甲状旁腺功能亢进症术前定位诊断中的价值,以及继发性甲状旁腺功能亢进症的手术治疗意义。方法:回顾性分析我院2012年1月-2016年12月期间在甲乳外科住院的继发性甲状旁腺功能亢进症患者的影像学检查资料,结合手术后的病理,分别计算三种影像学检查及任意两种检查方法联合后的灵敏度和特异度。分析三种检查方法在术前定位诊断中的价值。结果:本组研究共48例患者接受了高频超声检查,检测出138枚增大腺体,经术中病理检查证实其中3枚增生腺体为假阳性,为2枚肿大淋巴结和1枚甲状腺结节;2例未检出腺体患者经病理证实有7枚增生甲状旁腺,即漏诊7枚;经统计学计算,高频超声的敏感度为77.97%,特异度为97.82%。49例患者接受了CT平扫+增强的检查,共检测出121枚增大腺体,经术中病理检查证实其中2枚增生腺体为假阳性,为1枚肿大淋巴结和1枚甲状腺结节;1例未检出腺体患者经病理证实有4枚增生甲状旁腺,即漏诊4枚;经统计学计算,CT检查的敏感度为66.85%,特异度为98.35%。36例患者接受了99mTc-MIBI检查,共检测出72枚增大腺体,经术中病理检查证实所有检出腺体均为甲状旁腺增生组织,无假阳性。1例未检出腺体患者经病理证实有4枚增生甲状旁腺,即漏诊4枚;经统计学计算,99mTc-MIBI检查的敏感度为52.56%,特异度为100%。经统计学分析,高频超声敏感度优于CT(χ2=5.526,P=0.019)和99mTc-MIBI(χ2=6.172,P=0.013);CT敏感度高于99mTc-MIBI(χ2=4.889,P=0.027);各种联合检查的敏感度均高于单独检查,差异有统计学意义,特异度无统计学差异;两两联合检查中,高频超声+CT的敏感度优于高频超声+99mTc-MIBI(χ2=4.601,P=0.032)和高频超声(χ2=18.524,P0.001),有统计学差异,三种联合检查方法的特异度无差异。36例患者同时接受三种检查方法,共检出130枚增生腺体,敏感度为94.89%,特异度为100%;其敏感度和特异度与高频超声+CT检查比较,均无统计学差异。结论:1.推荐高频超声+CT检查作为SHPT患者术前定位诊断的首选检查方案;2.单独采用三种检查方法时,超声检查的敏感性最高,99mTc-MIBI检查的特异度最高;
[Abstract]:Objective: to investigate the value of three imaging methods of CT and MIBI in the diagnosis of secondary hyperparathyroidism before operation. The significance of surgical treatment of secondary hyperparathyroidism methods: the imaging data of secondary hyperparathyroidism hospitalized in our hospital from January 2012 to December 2016 were analyzed retrospectively. Combined with post-operative pathology, The sensitivity and specificity of the three imaging examinations and any two examination methods were calculated respectively. The value of the three methods in preoperative localization diagnosis was analyzed. Results: 48 patients in this study received high frequency ultrasound examination. 138 enlarged glands were detected, 3 of which were proved to be false positive by intraoperative pathological examination, 2 enlarged lymph nodes and 1 thyroid nodule were found in 2 patients with undetectable glands, 7 hyperplastic parathyroid glands were confirmed by pathology. The sensitivity of high frequency ultrasound was 77.97, the specificity was 97.82%. 49 patients underwent plain CT enhanced CT examination, 121 enlarged glands were detected, and 2 of them were confirmed to be false positive by intraoperative pathological examination. Four hyperplastic parathyroid glands were confirmed by pathology in one enlarged lymph node and one thyroid nodule. The sensitivity of CT examination was 66.85 and the specificity was 98.35.36 patients underwent 99mTc-MIBI examination. A total of 72 enlarged glands were detected, all of which were confirmed to be parathyroid hyperplasia by intraoperative pathological examination. There were 4 hyperplastic parathyroid glands (4 hyperplastic parathyroid glands, 4 missed diagnosis) in no false positive cases. The sensitivity of 99mTc-MIBI was 52.56 and the specificity was 100. By statistical analysis, the sensitivity of high-frequency ultrasound was superior to that of CT( 蠂 ~ 2 ~ 2 ~ (5.526) P ~ (0.019)) and ~ ~ (99m) Tc-MIBI (蠂 ~ (2) ~ (2) ~ (6.172U)) ~ (0.013) ~ (1) (蠂 ~ (2)) Tc-MIBI (蠂 ~ (2) 2.889) (蠂 ~ (2)), and the sensitivity of all kinds of combined examination was higher than that of single examination, the difference was statistically significant. The sensitivity of high-frequency ultrasound CT was better than that of high-frequency ultrasound 99mTc-MIBI (蠂 ~ 2 + 4.601) and high-frequency ultrasound (蠂 ~ 2 ~ 2 ~ (18.524) P _ (0.001) P _ (0.001)), the sensitivity of high-frequency ultrasound CT was better than that of high-frequency ultrasound 99mTc-MIBI (蠂 ~ 2 ~ 2 ~ 2 ~ (4.601)). There was no difference in the specificity of the three combined examination methods. 36 patients were examined by three methods at the same time, 130 hyperplasia glands were detected, the sensitivity was 94.89 and the specificity was 100. The sensitivity and specificity of the three methods were compared with that of high-frequency ultrasound CT. Conclusion 1. High frequency ultrasound CT examination is recommended as the first choice for preoperative localization diagnosis in SHPT patients. The sensitivity of ultrasound examination is the highest when using the three methods alone, and the specificity of 99mTc-MIBI examination is the highest.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R653;R692.5

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