Clinical Value And Influencing Factors Of The^99mTc-MIBI SPECT/CT In The Diagnosis Of Hyperparathyroidism

Objective:To evaluate the clinical value and related influencing factors of 99mTc-sestamibi(MIBI)single photon emission computed tomography/computerized tomography(SPECT/CT)imaging in qualitative and localized diagnosis of hyperparathyroidism,and to investigate the diagnostic value of different phase tomographic imaging and to study the optimizing method of 99mTc-MIBI SPECT/CT tomographic fusion imaging.Methods:Clinical data of 54 hyperparathyroidism patients who clinically diagnosed at the First People's Hospital of Kunshan from February 2017 to June 2018.There were 15 cases of primary hyperparathyroidism,35 cases of secondary hyperparathyroidism,and 3 cases of post-parathyroidectomy,1 cases of post-parathyroidectomy with thyroid double lobes resection..Among them,17 patients underwent surgical resection surgically and confirmed by pathology.All patients underwent 99mTc-MIBI dual-phase planar imaging,99mTc-MIBI SPECT/CT early tomographic fusion imaging,delayed tomographic fusion imaging,and ultrasonography.According to the clinical diagnostic criteria,the sensitivity of dual-phase planar imaging,early-stage tomography,and delayed-slice imaging for diagnosis of hyperparathyroidism and lesions was analyzed.Combined with the patient's serum PTH value,whether accompanied with thyroid nodules,the maximum cross-sectional diameter of the lesion d,and parathyroid tissue weight parameters of surgical patients,the factors were studied for dual-phase planar imaging,early tomographic imaging and delayed tomographic imaging sensitivities.SPSS 17 software was used for statistical analysis,and ttest and ?2 test were used to analyze the relevant data.The difference was statistically significant with p<0.05.Results:(1)The diagnostic sensitivity of the 99mTc-MIBI dual-phase planar imaging was 75.93%(41/54 cases).The diagnostic sensitivity of the 99mTc-MIBI SPECT/CT early tomographic fusion imaging was 88.89%(48/54 cases),99mTc-MIBI SPECT.The diagnostic sensitivity of 99mTc-MIBI SPECT/CT delayed tomographic fusion imaging was 77.78%(42/54 cases),and the diagnostic sensitivity of ultrasonography was 75.93%(41/54 cases).(2)A total of 74 lesions were diagnosed by 99mTc-MIBI dual-phase planar imaging,95 lesions were diagnosed by 99mTc-MIBI SPECT/CT early tomography fusion imaging,and 78 lesions were diagnosed by 99mTc-MIBI SPECT/CT delayed tomography tomographic fusion imaging.The detection rate of positive lesions in early stage tomography was the highest.(3)In 17 surgical cases,a total of 51 lesions were removed,and 44 were true positives.With 1.00 g as the limit,all lesions were divided into A and B groups.The lesion quality of group A was<1 g(24,as small quality groups).In group B,the lesion mass was>1g(27,as large quality group),and the diagnostic sensitivity in group B was higher than that in group A,which was 80.00%(20/25)and 47.37%(9/19)respectively.The difference between the two groups was statistically significant(?2=5.11,P=0.024).There was no statistically significant difference in diagnostic sensitivity between 99mTc-MIBI SPECT/CT early tomography fusion imaging,delayed tomography fusion imaging,and ultrasound between the two groups(P>0.05).(4)There was no significant difference in the maximum cross-sectional diameters of positive lesions between the dual-phase planar imaging and delayed phase tomography imaging with those of the early stage tomography imaging(t=0.81,P>0.05;t=0.89,P>0.05).All cases were divided into two groups according to whether there were thyroid nodules,with thyroid nodule group,the sensitivity of dual-phase planar imaging,early tomography fusion imaging and delayed tomography fusion imaging was 78.95%,89.47%,and 78.95%,respectively.No thyroid nodules group,the sensitivity of dual-phase planar imaging,early and delayed fusion imaging was 73.53%,88.23%and 76.47%,respectively.The diagnostic sensitivity of the three imaging groups was no statistically significant difference(P>0.05).All cases were divided into two groups according to PTH value reference,group A PTH<18.60 pmol/L,group B PTH>18.60 pmol/L.The sensitivity of 99mTc-MIBI planar imaging between the two groups was 70.00%(7/10)and 77.27%(34/44)respectively,and there was no significant difference in the sensitivity of the 99mTc-MIBI planar imaging between the two groups(?2=0.23,P=0.63).The sensitivity of 99mTc-MIBI SPECT/CT tomography between the two groups was 80.00%(8/10)and 90.91%(40/44),respectively.There was no significant difference in sensitivity between the two groups(X2=0.98,P=0.32).(5)In all cases,4 cases of ectopic parathyroid lesions were diagnosed by early tomography fusion imaging,and 3 case,3 case,and 0 case were diagnosed by dual-phase planar imaging,delayed-slice imaging,and ultrasound,respectively.Conclusion:(1)The 99mTc-MIBI parathyroid imaging has unique advantages in the diagnosis of hyperparathyroidism and can be complemented by ultrasound.99mTc-MIBI SPECT/CT tomographic imaging in the diagnosis of hyperparathyroidism lesions,especially for the diagnosis and localization of heterotopic parathyroid lesions,has a high clinical value,CT scan has a gain effect in the diagnosis of localization.(2)The size of the parathyroid gland(with a boundary of 1.00 g)has an effect on the dual-phase planar imaging.When the parathyroid gland is small,the sensitivity decreases.The size of the parathyroid gland has no effect on the sensitivity of the early tomographic imaging.The remaining indicators,including PTH values(with a boundary of 18.60 pmol/L),whether or not thyroid nodules were merged,had no clear effect on 99mTc-MIBI parathyroid imaging.(3)There is high sensitivity of 99mTc-MIBI SPECT/CT early tomographic fusion imaging in the diagnosis of hyperparathyroidism,and early tomographic fusion imaging has important clinical diagnostic value,synergistic serum PTH and dual phase plane imaging can improve the diagnostic efficiency and diagnostic confidence.