• 中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院普通外科（遼寧沈陽(yáng) 110004）;

目的 　探討超聲、CT與99Tcm-甲氧基異丁基異腈（MIBI）核素掃描在原發(fā)性甲狀旁腺功能亢進(jìn)癥（PHPT）中的診斷價(jià)值及其漏診原因。
方法 　回顧性分析中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院普外科2003年1月至2012年8月期間行手術(shù)治療的69例PHPT患者的臨床資料。
結(jié)果 　術(shù)后經(jīng)病理學(xué)檢查證實(shí)，69例患者共76個(gè)病灶，其中甲狀旁腺腺瘤58例（60個(gè)病灶），甲狀旁腺增生7例（11個(gè)病灶），甲狀旁腺腺癌4例（5個(gè)病灶）。超聲、CT與99Tcm-MIBI核素掃描的靈敏度分別為81.94% （59/72）、61.76% （21/34）及69.57% （16/23），準(zhǔn)確性分別為78.67%（59/75）、61.76% （21/34）及66.67% （16/24）；陽(yáng)性預(yù)測(cè)值分別為95.16% （59/62）、100% （21/21）及94.12% （16/17）。僅超聲與CT靈敏度的差異有統(tǒng)計(jì)學(xué)意義（P=0.03），3種檢查的其他相應(yīng)指標(biāo)比較差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）。
結(jié)論 　超聲與99Tcm-MIBI核素掃描互補(bǔ)，而CT對(duì)診斷甲狀旁腺病灶的幫助不大，推薦術(shù)前常規(guī)行超聲與99Tcm-MIBI
核素掃描兩項(xiàng)檢查。

引用本文： 趙海鷹,楊福全,田忠,張春菊,劉金鋼. 超聲、CT與99Tcm-MIBI核素掃描在原發(fā)性甲狀旁腺功能亢進(jìn)癥中的診斷價(jià)值比較及其漏診原因分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(9): 1038-1044. doi: 復(fù)制

1. Fraser WD. Hyperparathyroidism[J]. Lancet， 2009， 374(9684)：.
2. Levy JM， Kandil E， Yau LC， et al. Can ultrasound be used as the primary screening modality for the localization of parathyroiddisease prior to surgery for primary hyperparathyroidism? A review of 440 cases[J]. ORL J Otorhinolaryngol Relat Spec， 2011， 73(2)：116-120.
3. 董建宇， 管珩， 朱預(yù). 甲狀旁腺功能亢進(jìn)癥455例臨床癥狀分析[J]. 中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào)， 2011， 33(3)：330-333.
4. 周建平， 田雨霖. 中國(guó)人原發(fā)性甲狀旁腺功能亢進(jìn)10年文獻(xiàn)回顧(1995～2004年)[J]. 中國(guó)普通外科雜志， 2007， 16(1)：.
5. Udelsman R， Lin Z， Donovan P. The superiority of minimally invasive parathyroidectomy based on 1 650 consecutive patients with primary hyperparathyroidism[J]. Ann Surg， 2011， 253(3)：585-591.
6. Arciero CA， Shiue ZS， Gates JD， et al. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism[J]. J Cancer， 2012， 3：1-6.
7. Wilson SD， Doffek KM， Wang TS， et al. Primary hyperparath-yroidism with a history of head and neck irradiation：the conseq-uences of associated thyroid tumors[J]. Surgery， 2011， 150(4)：.
8. Akbaba G， Berker D， Isik S， et al. A comparative study of pre-operative imaging methods in patients with primary hyperparath-yroidism：ultrasonography， 99Tcm sestamibi， single photon emission computed tomography， and magnetic resonance imaging[J]. J Endocrinol Invest， 2012， 35(4)：359-364.
9. Ruda JM， Hollenbeak CS， Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003[J]. Otolaryngol Head Neck Surg， 2005， 132(3)：359-372.
10. Untch BR， Adam MA， Scheri RP， et al. Surgeon-performedultrasound is superior to 99Tc-sestamibi scanning to localize para-thyroid adenomas in patients with primary hyperparathyroidism：results in 516 patients over 10 years[J]. J Am Coll Surg， 2011， 212(4)：522-529.
11. Chandramohan A， Sathyakumar K， Irodi A， et al. Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism[J]. Eur J Radiol， 2012， 81(12)：3956-3964.
12. Lane MJ， Desser TS， Weigel RJ， et al. Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas[J]. AJR Am J Roentgenol， 1998， 171(3)：819-823.
13. Heller MT， Yip L， Tublin ME. Sonography of intrathyroid parathyroid adenomas：are there distinctive features that allow for preoperative identification?[J]. Eur J Radiol， 2013， 82(1)：22-27.
14. Johnson NA， Yip L， Tublin ME. Cystic parathyroid adenoma：sonographic features and correlation with 99Tcm-sestamibi SPECT findings[J]. AJR Am J Roentgenol， 2010， 195(6)：1385-1390.
15. Cating-Cabral MT， Cabungcal AC， Villafuerte CV 3rd， et al. Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis[J]. BMJ Case Rep， 2012， 2012.
16. Witteveen JE， Kievit J， Stokkel MP， et al. Limitations of 99Tcm-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism[J]. World J Surg， 2011， 35(1)：128-139.
17. Kwon JH， Kim EK， Lee HS， et al. Neck ultrasonography as preoperative localization of primary hyperparathyroidism with an additional role of detecting thyroid malignancy[J]. Eur J Radiol， 2013， 82(1)：e17-e21.
18. Krausz Y， Shiloni E， Bocher M， et al. Diagnostic dilemmas in parathyroid scintigraphy[J]. Clin Nucl Med， 2001， 26(12)：997-1001.
19. Mihai R， Gleeson F， Buley ID， et al. Negative imaging studies for primary hyperparathyroidism are unavoidable：correlation of sestamibi and high-resolution ultrasound scanning with histologicalanalysis in 150 patients[J]. World J Surg， 2006， 30(5)：697-704.
20. Kim YI， Jung YH， Hwang KT， et al. Efficacy of 99Tcm-sestamibi SPECT/CT for minimally invasive parathyroidectomy：comparative study with 99Tcm-sestamibi scintigraphy， SPECT， US and CT[J]. Ann Nucl Med， 2012， 26(10)：804-810.
21. Shafiei B， Hoseinzadeh S， Fotouhi F， et al. Preoperative 99Tcm-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter：comparison of SPECT-CT， SPECT， and planar imaging[J]. Nucl Med Commun， 2012， 33(10)：1070-1076.
22. Iervolino L， Scalisse NM， Maeda SS. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?[J]. Arq Bras Endocrinol Metabol， 2012， 56(4)：265-269.
23. Adler JT， Chen H， Schaefer S， et al. Does routine use of ultras-ound result in additional thyroid procedures in patients with primaryhyperparathyroidism?[J]. J Am Coll Surg， 2010， 211(4)：536-.
24. Harris R， Ryu H， Vu T， et al. Modern approach to surgical intervention of the thyroid and parathyroid glands[J]. Semin Ultrasound CT MR， 2012， 33(2)：115-122.
25. Ogawa T， Kammori M， Tsuji E， et al. Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism[J]. Thyroid， 2007， 17(1)：59-62.
26. -80.
27. -158.
28. .
29. -877.
  1. 1. Fraser WD. Hyperparathyroidism[J]. Lancet， 2009， 374(9684)：.
  2. 2. Levy JM， Kandil E， Yau LC， et al. Can ultrasound be used as the primary screening modality for the localization of parathyroiddisease prior to surgery for primary hyperparathyroidism? A review of 440 cases[J]. ORL J Otorhinolaryngol Relat Spec， 2011， 73(2)：116-120.
  3. 3. 董建宇， 管珩， 朱預(yù). 甲狀旁腺功能亢進(jìn)癥455例臨床癥狀分析[J]. 中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào)， 2011， 33(3)：330-333.
  4. 4. 周建平， 田雨霖. 中國(guó)人原發(fā)性甲狀旁腺功能亢進(jìn)10年文獻(xiàn)回顧(1995～2004年)[J]. 中國(guó)普通外科雜志， 2007， 16(1)：.
  5. 5. Udelsman R， Lin Z， Donovan P. The superiority of minimally invasive parathyroidectomy based on 1 650 consecutive patients with primary hyperparathyroidism[J]. Ann Surg， 2011， 253(3)：585-591.
  6. 6. Arciero CA， Shiue ZS， Gates JD， et al. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism[J]. J Cancer， 2012， 3：1-6.
  7. 7. Wilson SD， Doffek KM， Wang TS， et al. Primary hyperparath-yroidism with a history of head and neck irradiation：the conseq-uences of associated thyroid tumors[J]. Surgery， 2011， 150(4)：.
  8. 8. Akbaba G， Berker D， Isik S， et al. A comparative study of pre-operative imaging methods in patients with primary hyperparath-yroidism：ultrasonography， 99Tcm sestamibi， single photon emission computed tomography， and magnetic resonance imaging[J]. J Endocrinol Invest， 2012， 35(4)：359-364.
  9. 9. Ruda JM， Hollenbeak CS， Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003[J]. Otolaryngol Head Neck Surg， 2005， 132(3)：359-372.
  10. 10. Untch BR， Adam MA， Scheri RP， et al. Surgeon-performedultrasound is superior to 99Tc-sestamibi scanning to localize para-thyroid adenomas in patients with primary hyperparathyroidism：results in 516 patients over 10 years[J]. J Am Coll Surg， 2011， 212(4)：522-529.
  11. 11. Chandramohan A， Sathyakumar K， Irodi A， et al. Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism[J]. Eur J Radiol， 2012， 81(12)：3956-3964.
  12. 12. Lane MJ， Desser TS， Weigel RJ， et al. Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas[J]. AJR Am J Roentgenol， 1998， 171(3)：819-823.
  13. 13. Heller MT， Yip L， Tublin ME. Sonography of intrathyroid parathyroid adenomas：are there distinctive features that allow for preoperative identification?[J]. Eur J Radiol， 2013， 82(1)：22-27.
  14. 14. Johnson NA， Yip L， Tublin ME. Cystic parathyroid adenoma：sonographic features and correlation with 99Tcm-sestamibi SPECT findings[J]. AJR Am J Roentgenol， 2010， 195(6)：1385-1390.
  15. 15. Cating-Cabral MT， Cabungcal AC， Villafuerte CV 3rd， et al. Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis[J]. BMJ Case Rep， 2012， 2012.
  16. 16. Witteveen JE， Kievit J， Stokkel MP， et al. Limitations of 99Tcm-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism[J]. World J Surg， 2011， 35(1)：128-139.
  17. 17. Kwon JH， Kim EK， Lee HS， et al. Neck ultrasonography as preoperative localization of primary hyperparathyroidism with an additional role of detecting thyroid malignancy[J]. Eur J Radiol， 2013， 82(1)：e17-e21.
  18. 18. Krausz Y， Shiloni E， Bocher M， et al. Diagnostic dilemmas in parathyroid scintigraphy[J]. Clin Nucl Med， 2001， 26(12)：997-1001.
  19. 19. Mihai R， Gleeson F， Buley ID， et al. Negative imaging studies for primary hyperparathyroidism are unavoidable：correlation of sestamibi and high-resolution ultrasound scanning with histologicalanalysis in 150 patients[J]. World J Surg， 2006， 30(5)：697-704.
  20. 20. Kim YI， Jung YH， Hwang KT， et al. Efficacy of 99Tcm-sestamibi SPECT/CT for minimally invasive parathyroidectomy：comparative study with 99Tcm-sestamibi scintigraphy， SPECT， US and CT[J]. Ann Nucl Med， 2012， 26(10)：804-810.
  21. 21. Shafiei B， Hoseinzadeh S， Fotouhi F， et al. Preoperative 99Tcm-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter：comparison of SPECT-CT， SPECT， and planar imaging[J]. Nucl Med Commun， 2012， 33(10)：1070-1076.
  22. 22. Iervolino L， Scalisse NM， Maeda SS. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?[J]. Arq Bras Endocrinol Metabol， 2012， 56(4)：265-269.
  23. 23. Adler JT， Chen H， Schaefer S， et al. Does routine use of ultras-ound result in additional thyroid procedures in patients with primaryhyperparathyroidism?[J]. J Am Coll Surg， 2010， 211(4)：536-.
  24. 24. Harris R， Ryu H， Vu T， et al. Modern approach to surgical intervention of the thyroid and parathyroid glands[J]. Semin Ultrasound CT MR， 2012， 33(2)：115-122.
  25. 25. Ogawa T， Kammori M， Tsuji E， et al. Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism[J]. Thyroid， 2007， 17(1)：59-62.
  26. 26. -80.
  27. 27. -158.
  28. 28. .
  29. 29. -877.

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