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目的探讨甲状旁腺增生(PH)的多层螺旋CT(MSCT)表现,提高诊断正确率,减少漏诊。方法回顾性分析47例经手术及病理证实的PH患者的MSCT资料,并纳入实验组,对PH的发生部位、形态学特征、强化特点及周围毗邻关系进行分析,同期8例甲状旁腺腺瘤(PA)患者设为对照组,比较两组MSCT表现的异同。结果 47例PH患者中,CT检出病灶158个,与手术结果(n=175)的符合率为90.3%。CT测量PH病灶的面积在0.21~6.72 cm~2之间。原发性甲状旁腺功能亢进(PHPT)与继发性甲状旁腺功能亢进(SHPT)患者在PH病灶的面积(t=-0.918,P=0.360>0.05)上进行比较,差异无统计学意义,但二者在血清磷的浓度(t=4.693,P=0.000<0.05)上进行比较,差异有统计学意义。47例PH单侧或双侧均可发生,双侧发生多见,且形态不对称。病灶形态呈类圆形或椭圆形,平扫呈软组织密度,无出血、囊变或坏死。PHPT患者的PH无钙化;SHPT患者的PH钙化发生率为60.5%;PH造成骨骼改变表现为多发囊性改变和/或毛玻璃片样改变。PH的动态增强扫描时间-密度曲线为缓慢上升型和速升缓降型。病理上PH与PA在病灶最大径(t=-3.792,P=0.000<0.05)上进行比较,差异有统计学意义,其他鉴别在平扫及增强图像上差异不大。结论 PH发生特定的解剖区域,单发或双侧不对称发生,SHPT患者的PH的钙化率及骨骼改变发生率较高,CT增强扫描有助于PH的识别。
Objective To explore the performance of multi-slice spiral CT (MSCT) of hyperparathyroidism (PH) to improve the diagnostic accuracy and reduce the missed diagnosis. Methods A retrospective analysis of 47 cases of pathologically confirmed PH patients with MSCT data and included in the experimental group, the PH site, morphological features, enhanced features and the surrounding adjacent to the analysis of the same period, 8 cases of parathyroid adenoma (PA) patients as control group, comparing the two groups of MSCT performance similarities and differences. Results Among the 47 patients with PH, 158 lesions were detected by CT, and the coincidence rate with the result of surgery (n = 175) was 90.3%. The area of PH lesions measured by CT ranged from 0.21 to 6.72 cm ~ 2. There was no significant difference in the area of PH lesions between patients with primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) (t = -0.918, P = 0.360> 0.05) , But the difference was statistically significant at the level of serum phosphorus (t = 4.693, P = 0.000 <0.05). 47 cases of PH can occur unilateral or bilateral, bilateral more common, and the shape is not symmetrical. Lesion was round or oval-shaped lesions, soft tissue density showed plain, no bleeding, cystic degeneration or necrosis. Phosphatidylinositol in PHPT patients; PH calcification in SHPT patients was 60.5%; PH caused skeletal changes in patients with multiple cystic changes and / or ground glass changes. Dynamic Enhanced Scanning Times for PH - The density curves are slowly ascending and descending. Pathological PH and PA lesions in the largest diameter (t = -3.792, P = 0.000 <0.05), the difference was statistically significant, other differences in the plain scan and enhanced images was not significant. CONCLUSIONS: Specific anatomical regions of PH occur singly or bilaterally. The PH calcification rate and skeletal change rate of SHPT patients are higher. CT enhanced scan is helpful for the identification of PH.