Preoperative Diagnostic Significance Of 3D-reconstructed CT And Biochemical Correlation Study Of Parathyroid In Refractoiy Secondary Hyperparathyroidism

BackgroundWith the development of renal replacement therapy and hemodialysis Technology, patients with chronic renal failure prolong the survival time, at the same time, The complications increase affecting survival quality and threatening life. secondary hyperparathyroidism(SHPT) which combined with bone joint, cardiovascular, nervous system diseases is one of the most common and serious complications. a considerable number of patients failed to internal medicine and need surgical operation. before operation, it is important to diagnose the size, number of the hyperplasia gland as well as the Surrounding anatomic structures. Multislice CT and three dimensional reconstruction technology provides a new method for preoperative diagnosis and postoperativefollow-up. using three dimensional reconstruction technology can detect the size, number of the hyperplasia gland accurately which is very important for preoperative diagnosis of the degree of progression of SHPT.The first part Image analysis of CT three dimensional reconstruction of parathyroid glands and comparative study among CT, ultrasound and 99mTc-MIBI dual phase examinationObjecstive To investigate the sensitivity and specificity of CT, ultrasound and 99 m Tc-MIBI dual phase examination on patients with SHPT, analyze the image characteristics of CT three dimensional reconstruction of parathyroid glands, explore the application value of CT three dimensional reconstruction on preoperative diagnosis of SHPT.Method 48 patients with SHPT underwent CT three dimensional reconstruction examination before operation. 35 of them also underwent ultrasound examination, 15 of them underwent 99 m Tc-MIBI dual phase examination 7d after CT examination. The results of imaging examination were compared with the postoperative pathology, the sensitivity and specificity of CT, ultrasound, 99 m Tc-MIBI dual phase examination were compared, the image characteristics of CT three dimensional reconstruction were analyzed.Results sensitivity and specificity of CT were 92.97% and 28.57%, the sensitivity and specificity of ultrasound were 78.03% and 37.50%, the sensitivity and specificity of 99 m Tc-MIBI dual phase examination were 74.07% and 66.66%, the sensitivity of CT was higher than those of ultrasound and 99 m Tc-MIBI dual phase examination, thespecificity of CT was lower than that of 99 m Tc-MIBI dual phase examination(P<0.05). there was no difference on detection rate between bilateral side of parathyroid glands.Conclusion CT three dimensional reconstruction has high detection rate of parathyroid glands in SHPT patients, can clearly fix position of anatomic location of the lesion, and exhibit the surrounding anatomic structures. The CT images has the characteristics of high resolution observation density, clear and intuitive, multi angle. Which is most instructive on the clinical diagnosis of parathyroid glands before operation.The second part The accordance on the size of parathyroid glands between CT images and postoperative pathology and the correlation between CT and biochemical examinationObjective To evaluate the accordance on the size of parathyroid glands between three dimensional reconstruction images and the postoperative pathology results, analyze the accuracy of CT examination, investigate the correlation between the size of parathyroid glands detected by three dimensional reconstruction and preoperative serum phosphorus and PTH level.Method The maximum cross-sectional area of parathyroid glands of 48 SHPT patients were detected using Advanced Workstation 4.4 before operation, and compared with the postoperative pathology results, the correlation between three dimensional reconstruction images and preoperative serum phosphorus and PTH level were analyzed.Results there was no significant difference between the maximum cross-sectional area of parathyroid glands detected by CT and the postoperative pathology results; There was a significant positive correlation between the size of parathyroid glands and preoperative serum phosphorus and PTH level.Conclusion CT three dimensional reconstruction examination is reasonably accurate and has high coincidence with postoperative pathology results, the increasing of serum phosphorus and PTH level in SHPT patients can stimulate the parathyroid glands, it is more accurate to diagnose the severity and progression stages of SHPT patients using CT three dimensional reconstruction examination combined with biochemical examination.