| Objectives:This study aimed to evaluate the value of technetium-99m methoxyisobutylisonitrile(99mTc-MIBI)single photon emission computed tomography/computed tomography(SPECT/CT),99mTc-MIBI double-phase scintigraphy(DPS)and ultrasound in preoperative localization of hyperparathyroidism.The influence factors of the imaging results were discussed by combining the blood biochemical and immunohistochemical data of the included patients,and the value and influence factors of semi-quantitative analysis in the tomography fusion imaging in preoperative positioning diagnosis were preliminarily discussed.Materials and methods:According to the inclusion criteria,this study selected 104 patients with hyperparathyroidism who underwent surgery in the Department of General surgery,Nanfang Hospital of Southern Medical University from January 2015 to July 2019,and the relevant clinical data were recorded.99mTc-MIBI imaging were performed within three months before operation of all patients in the department of nuclear medicine of our hospital,and pathological analysis was performed after operation,and the number and location of abnormal parathyroid glands in each patient were recorded.Some patients also underwent cervical ultrasound examination.Taking postoperative pathology as the gold standard,the diagnostic sensitivities of the three methods(99mTc-MIBI SPECT/CT、99mTc-MIBI DPS and ultrasound)were calculated respectively.And,ROI technique was used to draw the T/NT ratio of the lesions on the basis of tomographic fusion imaging,and the correlations between imaging results and pathological types,laboratory indexes and immunohistochemical results were analyzed retrospectively.In addition,the correlation between T/NT ratio and the above factors was also studied.Results:1.As per patient-based HPT analysis with three imaging methods,the sensitivity of 99mTc-MIBI SPECT/CT imaging was higher than that of neck ultrasound(P<0.05).On a per lesion-based analysis,the detection rate of 99mTc-MIBI SPECT/CT,99mTc-MIBI DPS and ultrasound in detecting PH were 70.4%,62.6%and 52.2%,respectively,and the detection rate of 99mTc-MIBI SPECT/CT was higher than that of the other two imaging methods(P<0.05).However,the sensitivity of these three imaging methods in PA lesions detection had no obviously differences(P>0.05).2.The detection rate of 99mTc-MIBI DPS in PA lesions was higher than that of PH lesions(86.4%vs 62.6%,P=0.036).The size of glands in patients with PA were(6.39±12.22)cm3 which was significantly larger than that of PH(2.20±2.30)cm3(P<0.05).Serum levels of PTH,phosphorus and VitD were lower in patients with PA than in patients with PH,and serum calcium level showed the opposite trend in the two groups of patients.(P<0.05).3.In 99mTc-MIBI SPECT/CT imaging,the average level of blood PTH and the average volume of lesions in the true positive group were higher than those in the false negative group(P<0.05).The sensitivity of 99mTc-MIBI SPECT/CT in different positions of hyperplastic lesions were not exactly the same,which was 67.9%,85.4%,51.9%and 80.5%,respectively.The sensitivity of left inferior lesions was higher than that of double upper lesions(85.4%vs 67.9%、51.9%,P=0.008、0.00).And the sensitivity of right upper pole lesions were lower than that of right lower pole lesions(51.9%vs 80.5%,P=0.00).4.Although there was no difference in T/NT of lesions with different pathological types,such as adenoma and hyperplasia.A positive correlation of T/NT with the corresponding volume was observed,and there was significant differences(r=0.404,P=0.013).5.As per lesion-based analysis,the expression of Bcl-2 in true positive lesions of PA were higher than that in false negative lesions(P=0.046),but there were no difference in the expression of Cox-2 between the two groups(P>0.05).On per PH lesion-based analysis,there was no significant difference in the expression of Bcl-2 and Cox-2 between true positive group and false negative group(P>0.05).But the T/NT of hyperplastic glands with fat tissue was lower than that of hyperplastic glands without fat tissue,which were(1.23±0.78),(2.21±1.06),respectively(P=0.009).Conclusions:Although the three imaging methods all have certain value in preoperative localization diagnosis of HPT patients,99mTc-MIBI SPECT/CT imaging is the most effective among these three methods,especially in patients with hyperplastic glands.The preoperative diagnostic results of 99mTc-MIBI SPECT/CT were positively correlated with the volume of lesions and the serum level of PTH before operation,and also correlated with the location of hyperplastic lesions.The increased expression of Bcl-2 in PA glands has a certain effect on the detection of lesions.Semi-quantitative analysis of 99mTc-MIBI SPECT/CT showed that T/NT ratio was positively correlated with lesion volume,and the fat content in PH glands can also affect the T/NT results.The semi-quantitative analysis of 99mTc-MIBI SPECT/CT is of little value in distinguishing the different pathological types of PA and PH glands. |
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