目的:比较11C-胆碱PET/CT的诊断效能,颈部超声检查,99mTc-MIBI双相平面闪烁显像,和99mTc-MIBISPECT/CT显像在原发性甲状旁腺功能亢进症(PHPT)诊断中的应用。方法:回顾性分析2019年1月至2022年12月在吉林大学中日友好医院核医学科就诊的32例PHPT患者。所有患者均行11C-胆碱PET/CT,颈部超声检查,99mTc-MIBI双相平面闪烁显像,术前2个月内行99mTc-MIBISPECT/CT检查。灵敏度,特异性,正预测值,使用术后病理和随访结果比较了每个影像学研究的阴性预测值。采用ROC曲线分析进一步分析诊断效能。还研究了影响99mTc-MIBI成像的因素。结果:32例患者共切除35个病灶。11C-胆碱PET/CT的诊断敏感性,颈部超声检查,99mTc-MIBI双相平面闪烁显像,99mTc-MIBISPECT/CT为88.2%,52.9%,58.8%,和67.6%,分别。特异性为96.8%,95.7%,96.8%,和95.7%,分别。阳性预测值为90.9%,81.8%,86.9%,85.2%,分别,阴性预测值为95.7%,84.9%,86.7%,和89.1%,分别。ROC曲线下面积(AUC)分别为0.925、0.743、0.778和0.817。其中,11C-胆碱PET/CT比其他影像学检查具有更高的灵敏度和AUC(p<0.05),而特异性,正预测值,阴性预测值相似(p>0.05)。99mTc-MIBISPECT/CT显像阳性组病灶直径明显大于阴性组(P<0.05),术前血钙和PTH差异无统计学意义(P>0.05)。结论:11C-胆碱PET/CT对PHPT的术前诊断效能优于颈部超声检查,99mTc-MIBI双相平面闪烁显像,和99mTc-MIBISPECT/CT。病变大小可能是影响99mTc-MIBI显像灵敏度的主要因素。
Objective: To compare the diagnostic efficacy of 11C-choline PET/CT, neck ultrasonography, 99mTc-MIBI dual-phase planar scintigraphy, and 99mTc-MIBI SPECT/CT imaging in the diagnosis of primary hyperparathyroidism (PHPT). Methods: We conducted a retrospective analysis of 32 patients with PHPT who visited the Nuclear Medicine Department of Jilin University
China-Japan Union Hospital between January 2019 and December 2022. All patients underwent 11C-choline PET/CT, neck ultrasonography, 99mTc-MIBI dual-phase planar scintigraphy, and 99mTc-MIBI SPECT/CT examinations within two months before surgery. Sensitivity, specificity, positive predictive value, and negative predictive value of each imaging study were compared using postoperative pathology and follow-up results. Diagnostic efficacy was further analyzed using ROC curve analysis. Factors influencing on 99mTc-MIBI imaging were also investigated. Results: A total of 35 lesions were resected in the 32 patients. The diagnostic sensitivity of 11C-choline PET/CT, neck ultrasonography, 99mTc-MIBI dual-phase planar scintigraphy, and 99mTc-MIBI SPECT/CT was 88.2%, 52.9%, 58.8%, and 67.6%, respectively. Specificity was 96.8%, 95.7%, 96.8%, and 95.7%, respectively. Positive predictive values were 90.9%, 81.8%, 86.9%, and 85.2%, respectively, and negative predictive values were 95.7%, 84.9%, 86.7%, and 89.1%, respectively. The areas under the ROC curve (AUC) were 0.925, 0.743, 0.778, and 0.817, respectively. Among them, 11C-choline PET/CT had higher sensitivity and AUC than other imaging studies (p<0.05), while specificity, positive predictive value, and negative predictive value were similar (p>0.05). The positive group in 99mTc-MIBI SPECT/CT imaging had significantly larger lesion diameters than the negative group (P<0.05), while preoperative blood calcium and PTH showed no statistical differences (P>0.05). Conclusion: 11C-choline PET/CT demonstrates superior preoperative diagnostic efficacy for PHPT compared to neck ultrasonography, 99mTc-MIBI dual-phase planar scintigraphy, and 99mTc-MIBI SPECT/CT. Lesion size may be the primary factor affecting the sensitivity of 99mTc-MIBI imaging.