【摘要】：目的評(píng)價(jià)超聲在甲狀旁腺病變?cè)\斷中的價(jià)值，分析多種影像學(xué)技術(shù)在甲狀旁腺疾病診斷中的對(duì)比研究結(jié)果。 方法回顧性分析了從2009年2月至2013年12月于我院行甲狀旁腺手術(shù)切除患者94例，共104個(gè)病灶，術(shù)后病理結(jié)果為甲狀旁腺腺瘤(parathyroid adenoma,PTA)85例，增生(parathyroid hyperplasia,PHPT)4例，腺癌(parathyroid carcinoma,PTC)3例，囊腫2例。患者全部行超聲檢查，行核素顯像者84例，CT檢查者45例，MRI檢查者31例，本研究總結(jié)分析不同病變的聲像圖特征及血清甲狀旁腺激素（parathyroidhormone，PTH）水平，分析誤診及漏診原因，對(duì)多種影像學(xué)檢查進(jìn)行對(duì)比分析。 結(jié)果超聲可以清晰顯示甲狀旁腺病變的大小、形態(tài)、部位、邊界，內(nèi)部回聲、血流等情況,不同病變的聲像圖具有差異性，病變多發(fā)生于下極，多呈低回聲，多為血流豐富，，甲狀旁腺腺瘤隨著體積的不斷增大，易出現(xiàn)液化，甲狀旁腺癌常伴有鈣化，增生及腺癌患者血清甲狀旁腺素水平增高更明顯，超聲對(duì)下極的病變更易顯示。超聲誤診及漏診的原因主要有甲狀腺后突結(jié)節(jié)、轉(zhuǎn)移性淋巴結(jié)及異位的甲狀旁腺。超聲診斷的敏感性達(dá)82.7%，明顯高于CT、MRI檢查，對(duì)于直徑小于1cm的病變，超聲診斷的敏感性明顯高于其他影像學(xué)檢查單獨(dú)使用，而對(duì)于合并甲狀腺結(jié)節(jié)的病變，超聲的敏感性低于核素顯像及超聲聯(lián)合核素顯像檢查(P均0.05)。 結(jié)論超聲診斷甲狀旁腺病變的敏感性較高，可作為甲狀旁腺功能亢進(jìn)診斷的首選檢查方法。對(duì)于異位的甲狀旁腺病變及合并后凸甲狀腺結(jié)節(jié)的病變，超聲不容易發(fā)現(xiàn)及區(qū)分。聯(lián)合運(yùn)用多種影像學(xué)檢查，同時(shí)結(jié)合血清PTH值及臨床表現(xiàn)，可以提高病變?cè)\斷的敏感性，更好地進(jìn)行術(shù)前定位和診斷。
[Abstract]:Objective to evaluate the value of ultrasound in the diagnosis of parathyroidosis and to analyze the comparative results of various imaging techniques in the diagnosis of parathyroidosis. Methods 94 patients (104 lesions) underwent parathyroidectomy from February 2009 to December 2013 were analyzed retrospectively. the postoperative pathological results were parathyroadenoma (parathyroid adenoma,PTA) in 85 cases and hyperplasia (parathyroid hyperplasia,PHPT) in 4 cases. There were 3 cases of parathyroid carcinoma,PTC and 2 cases of cyst. All the patients were examined by ultrasound, 84 cases were examined by radionuclide imaging, 45 cases by CT and 31 cases by MRI. The sonographic features of different lesions and the level of serum parathyroid hormone (parathyroidhormone,PTH) were analyzed, and the causes of misdiagnosis and missed diagnosis were analyzed. A variety of imaging examinations were compared and analyzed. Results Ultrasound could clearly show the size, shape, location, boundary, internal echo, blood flow and so on of parathyroid lesions. The sonographic images of different lesions were different. Most of the lesions occurred in the lower pole, most of them were hypoechoic, and most of them were rich in blood flow. Parathyroid adenoma is prone to liquefaction with the increase of volume. Parathyroid carcinoma is often accompanied by calcification. The increase of serum parathyroxine level is more obvious in patients with hyperplasia and adenocarcinoma. Ultrasound is more easy to show the lesions of the lower pole. The main causes of misdiagnosis and missed diagnosis were posterior thyroid nodules, metastatic lymph nodes and ectopic parathyroid gland. The sensitivity of ultrasound in the diagnosis of thyroid nodules was 82.7%, which was significantly higher than that of CT,MRI. For lesions with diameters smaller than 1cm, the sensitivity of ultrasound was significantly higher than that of other imaging examinations alone, but for lesions complicated with thyroid nodules. The sensitivity of ultrasound was lower than that of radionuclide imaging and ultrasound combined radionuclide imaging (P 0.05). Conclusion Ultrasound is sensitive in the diagnosis of parathyroathyropathy and can be used as the first choice for the diagnosis of hyperparathyropathy. It is not easy to detect and distinguish ectopic parathyroidosis and kyphotic thyroid nodules. Combined with various imaging examinations, combined with serum PTH value and clinical manifestations, the sensitivity of pathological diagnosis can be improved, and preoperative localization and diagnosis can be better carried out.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.1;R582

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