目的评价^99mTc-MIBI双时相显像对继发性甲状旁腺功能亢进症(secondaryhyperparathyroidism,SHPD)的应用价值。方法58例临床确诊或疑诊的SHPD患者,行^99mTc-MIBI20min和2h双时相显像,同期行甲状旁腺B超检查。最后诊断方法为术后病理或血清IPTH水平与临床随访综合分析。确诊为SHPD52例,排除诊断6例。其中25例手术后病理诊断为:甲状旁腺增生10例,甲状旁腺增生伴腺瘤9例,甲状旁腺腺瘤6例。结果58例患者^99mTc-MIBI双时相显像阳性50例,阴性8例。其中真阳性49例,假阳性1例,真阴性5例,假阴性3例。^99mTc-MIBI双时相显像诊断SHPD的敏感性、特异性和准确率分别为94.2%、83.3%和93.1%。对于49例真阳性,^99mTc-MIBI双时相显像共发现SHPD病灶114个,其中1个病灶为14例,2个病灶为21例,3个以上病灶14例。同组资料B超诊断SHPD的敏感性、特异性和准确率分别为88.5%、50%和84.4%。结论^99mTc-MIBI双时相显像对SHPD的定性、定位诊断均有很高的价值,应作为术前的常规检查。

Objective To evaluate the clinical value of ^99mTc-MIBI double-phase imaging in the secondary hyperparathyroidism. Methods On 58 patients with diagnostic or suspicious secondary hyperparathyroidism, the ^99mTc-MIBI double-phase imaging was performed at early (20 min) and late (2 hours) phase, and all of them underwent neck ultrasonography. Final diagnosis was obtained by pathological result, serum IPTH test, and clinical follow-up. 52 cases were confirmed as having hyperparathyroidism and 6 were excepted. Among them 25 cases obtained pathological results (10 with hyperplasia, 9 with hyperplasia and adenoma, and 6 with adenoma). Results 49 true positive cases, 1 false positive case, 5 true negative cases and 3 false negative cases were validated. The sensitivity, specificity and accuracy of ^99mTc-MIBI double-phase imaging in the diagnosis of secondary hyperparathyroidism were 94.2%, 83.3%, 93.1%, respectively. 114 foci of hyperparathyroidism were detected by ^99mTc-MIBI double-phase imaging, of them 14 cases with 1focus, 21 with 2 foci, 14 with 3 foci or more. The sensitivity, specificity and accuracy of neck ultrasonography in the diagnosis of secondary hyperparathyroidism were 88.5%, 50%, 84.4%, respectively. Conclusion ^99mTc-MIBI double-phase imaging is useful in the diagnosis and localization of secondary hyperparathyroidism and should be taken as routine before operation.