【摘要】目的探讨^99m锝-甲氧基异丁基异腈(99mTc-methoxyisobutylisonitrile,^99mTc-MIBI)和单光子发射型计算机断层显像/计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)联合高频超声对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism, SHPT)甲状旁腺的定位诊断价值。方法回顾性分析2010 年1 月～2020 年12 月就诊于解放军第九六〇医院(原济南军区总医院)甲状腺乳腺外科的442 例SHPT 患者，男264 例，女178 例，年龄16～71 岁(平均45.87±11.16 岁)。手术前对SHPT 患者行颈部高频超声和^99mTc-MIBI SPECT/CT 检查确定甲状旁腺位置，以手术后病理诊断为标准，比较^99mTc-MIBI SPECT/CT 和超声及两者联合应用对于继发性甲状旁腺功能亢进症甲状旁腺的定位诊断价值。结果442 例患者共切除1703 枚甲状旁腺，其中6 例患者初次手术切除5 枚甲状旁腺，32 例患者接受2 次手术，3 例患者接受3 次手术，1 例患者接受4 次手术。应用^99mTc-MIBI SPECT/CT 融合显像和超声对初次手术甲状旁腺的检出率分别为87.25%、60.24%；对再次手术患者的检出率分别为91.67%、64.58%，初次手术和再次手术前应用99mTc-MIBI SPECT/CT 和超声两者联合检查的灵敏度为90.15%、91.67%，均高于单独应用^99mTc-MIBI SPECT/CT 融合显像或超声的灵敏度(χ2值分别为311.785、5.143，P 值分别为＜0.001、0.023)。结论SHPT 患者术前应用^99mTc-MIBI SPECT/CT 融合显像联合高频超声可以精确定位甲状旁腺，且优于单一检查；二者联合检查尤其对于持续性或复发性继发性甲旁亢术前定位甲状旁腺价值更高。

【Abstract】Objective To evaluate the value of 99m technetium-methoxyisobutyl isonitrile (^99mTc-MIBI) and single photon emission computed tomography (SPECT/CT) combined with color Doppler ultrasound in the localization of parathyroid glands in secondary hyperparathyroidism (SHPT). Methods A retrospective analysis was conducted on 442 SHPT patients (264 males and 178 females; 16～71 years old, average 45.87± 1.16 years old) from January 2010 to December 2020 treated in the Department of Thyroid and Breast Surgery, The 960th Hospital of PLA Joint Logistics Support Force (General Hospital of Jinan Military Region).
Preoperative high-frequency ultrasonography and ^99mTc-MIBI SPECT/CT were performed in SHPT patients to localize the parathyroid glands. With postoperative pathological diagnosis as the standard, the localization value of parathyroid glands in SHPT using ^99mTc-MIBI SPECT/CT, ultrasonography and their combination was evaluated. Results A total of 1,703 parathyroid glands were removed in 442 patients, in which 6 patients underwent the first operation to remove 5 parathyroid glands, 32 patients underwent the second operation, 3 patients underwent the third operation, and one patient underwent the fourth operation. The detection rates by ^99mTc-MIBI SPECT/CT fusion imaging and ultrasonography were 87.25% and 60.24%, respectively, in primary parathyroidectomy, and were 91.67% and 64.58% , respectively, in reoperation parathyroidectomy (χ2=311.785, P=0.000). The localization ability was higher by 99mTc-MIBI SPECT/CT fusion imaging than by ultrasonography. The localization rates of ^99mTc-MIBI SPECT/CT combined with ultrasonography before primary parathyroidectomy and reoperation parathyroidectomy were 90.15% and 91.67%, respectively(χ2=5.143, P=0.023), higher than those of ^99mTc-MIBI SPECT/CT fusion imaging or ultrasonography alone. Conclusion Preoperative ^99mTc-MIBI SPECT/CT fusion imaging combined with high frequency ultrasonography can accurately localize the parathyroid glands in SHPT patients. Combined use of the two methods was better than use of one method, especially for preoperative localization of the parathyroid glands in persistent and recurrent SHT.