Influential factors of 99m Tc⁃MIBI imaging in renal secondary hyperparathyroidism
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摘要:
目的：探究肾性继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)99m 锝-甲氧基异丁基异腈(99m Tc-MIBI) 显像的相关影响因素。方法：回顾性分析在南京医科大学第一附属医院接受手术治疗的482例肾性SHPT患者的临床资料，以术后病理为对照，比较不同显像方案(A组：仅行99m Tc-MIBI双时相法平面显像；B组：在A组显像基础上加做早期相SPECT/CT) 对SHPT诊断效能的差异。根据影像与病理结果是否一致，再将B组患者分为完全诊断组(MIBI诊断结果与病理结果完全一致)与部分诊断组(MIBI诊断的腺体数目少于病理结果)，进一步分析临床特征和生化指标对MIBI显像的影响。结果：在SHPT 诊断效能分析中，B组的灵敏度、特异度、准确度和阳性预测值均高于A组(81.9% vs. 70.3%；97.1% vs. 60.0%；82.2% vs. 69.9%； 99.9% vs. 97.9%，P ＜ 0.01)，但两组阴性预测值差异无统计学意义(6.8% vs. 10.2%，P ＞ 0.05)。多因素Logistic回归分析示，血清磷离子水平是预测MIBI显像假阴性的独立危险因素(OR=0.57，95%CI：0.372~0.866，P = 0.007)。ROC曲线显示，当血清磷离子水平 ＜ 1.97 mmol/L时，99m Tc-MIBI 双时相法平面显像加早期相SPECT/CT诊断SHPT发生漏诊的风险增加。结论：99m Tc-MIBI 双时相法平面显像加做早期相SPECT/CT可提高SHPT患者功能亢进甲状旁腺腺体的检出灵敏度及准确度。影像结果的判断应当结合血清磷离子水平，当血清磷离子水平较低时，MIBI显像存在漏诊的可能，影像医生和临床医生都须予以关注。
Abstract:
Objective：To investigate what factors could affect the accuracy of preoperative 99m Tc-methoxy isobutylisonitrile(99m Tc-MIBI) imaging in patients with secondary hyperparathyroidism(SHPT). Methods：The clinical characteristics of 482 renal SHPT patients undergoing surgical treatment in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Postoperative pathology was used as control，different imaging schemes(Group A：only 99m Tc-MIBI dual-phase plane imaging；Group B： group A plus early phase SPECT/CT)were compared. In addition，patients in group B were divided into completely identified group and partly identified group，and the effects of clinical characteristics on MIBI imaging were analyzed. Results：In general，the sensitivity，specificity and diagnostic consistency of group B were higher than that of group A(81.9% vs. 70.3%；97.1% vs. 60.0%； 82.2% vs. 69.9%；99.9% vs. 97.9%，P ＜ 0.01 respectively). However，there was no significant difference in negative predictive value (6.8% vs. 10.2%，P ＞ 0.05). Serum phosphorus ion level was an independent risk factor for predicting false negative MIBI imaging (OR=0.57，95% CI：0.372~0.866，P=0.007). The risk of misdiagnosing on 99m Tc - MIBI dual - phase plane imaging plus early phase SPECT/CT was increased when the level of serum phosphorus ion was lower than 1.97 mmol/L. Conclusion：99m Tc -MIBI dual -phase plane imaging plus early phase SPECT/CT can improve the sensitivity and accuracy of hyperfunctional parathyroid tissue detection in SHPT patients. The judgment of imaging results should be combined with the level of serum phosphorus ion. When the level of serum phosphorus ion is lower than 1.97 mmol/L，imaging doctors and clinicians should concentrate on the possibility of misdiagnosing hyperfunctional parathyroid.
