基于多模态影像与生化指标的甲状旁腺病变术前诊断价值研究：单中心回顾性分析

A Study of the Preoperative Diagnostic Value of Multimodal Imaging and Biochemical Markers for Parathyroid Lesions: A Single-Center Retrospective Analysis

摘要: 目的：探讨超声、^99mTc-MIBI SPECT/CT显像及生化指标在甲状旁腺病变术前诊断中的应用价值。方法：回顾性分析81例疑似甲状旁腺疾病患者的临床资料。在全组患者中评价超声与SPECT/CT检查结果的一致性，比较SPECT/CT阳性组与阴性组的生化指标，并对两项影像检查结果不一致的病例进行描述性分析。将其中31例具有完整术后病理结果的患者纳入病理验证亚组，以术后病理结果为金标准，比较超声、SPECT/CT以及“任一阳性”和“同时阳性”两种联合策略的诊断效能。采用受试者工作特征曲线评价血钙、甲状旁腺激素(PTH)及二者联合对病理阳性的鉴别效能，并构建多模态联合模型。结果：全组81例患者中，超声与SPECT/CT检查结果仅呈轻度一致(κ = 0.138)。SPECT/CT阳性组的血钙、PTH、碱性磷酸酶及肌酐水平均高于阴性组(均P < 0.05)。两项影像检查结果不一致者35例(43.2%)，其中超声阳性而SPECT/CT阴性21例，SPECT/CT阳性而超声阴性14例。在31例病理验证亚组中，超声与SPECT/CT的灵敏度均为73.1%，SPECT/CT的特异度高于超声(100.0%比80.0%)。“任一阳性”策略的灵敏度最高(92.3%)，“同时阳性”策略的特异度和阳性预测值均为100.0%。病理阳性组的血钙和PTH水平均高于病理阴性组(P = 0.039、0.001)。ROC曲线分析显示，PTH、血钙及二者联合诊断的曲线下面积分别为0.923、0.800和0.915；超声、SPECT/CT、血钙及PTH构成的多模态联合模型曲线下面积为0.977，但因病理阴性病例数较少，该结果仍需谨慎解释。结论：超声与^99mTc-MIBI SPECT/CT在甲状旁腺病变术前诊断中具有互补价值。PTH具有较好的鉴别效能，血钙可提供辅助诊断信息。联合影像检查及生化指标的多模态评估可能提高术前诊断效能，但仍需在更大样本中进一步验证。

Abstract: Objective: To investigate the value of ultrasonography, ^99mTc-MIBI SPECT/CT, and biochemical markers in the preoperative diagnosis of parathyroid lesions. Methods: The clinical data of 81 patients with suspected parathyroid disease were retrospectively analyzed. In the entire cohort, agreement between ultrasonography and SPECT/CT was evaluated, biochemical markers were compared between patients with positive and negative SPECT/CT findings, and cases with discordant imaging findings were descriptively analyzed. Thirty-one patients with complete postoperative pathological results were included in a pathological validation subgroup. Using postoperative pathology as the reference standard, the diagnostic performance of ultrasonography, SPECT/CT, and two combined strategies—“any-positive” and “both-positive”—was compared. Receiver operating characteristic curves were used to evaluate the ability of serum calcium, parathyroid hormone (PTH), and their combination to discriminate pathology-positive lesions, and a multimodal model was constructed. Results: In the entire cohort of 81 patients, ultrasonography and SPECT/CT showed only slight agreement (κ = 0.138). Serum calcium, PTH, alkaline phosphatase, and creatinine levels were higher in the SPECT/CT-positive group than in the SPECT/CT-negative group (all P < 0.05). Discordant ultrasonography and SPECT/CT findings were observed in 35 patients (43.2%), including 21 with positive ultrasonography and negative SPECT/CT findings and 14 with negative ultrasonography and positive SPECT/CT findings. In the pathological validation subgroup of 31 patients, ultrasonography and SPECT/CT both had a sensitivity of 73.1%, whereas SPECT/CT had higher specificity than ultrasonography (100.0% vs. 80.0%). The any-positive strategy achieved the highest sensitivity (92.3%), while the both-positive strategy achieved a specificity and positive predictive value of 100.0%. Serum calcium and PTH levels were higher in the pathology-positive group than in the pathology-negative group (P = 0.039 and P = 0.001, respectively). Receiver operating characteristic curve analysis showed that the areas under the curve for PTH, serum calcium, and their combination were 0.923, 0.800, and 0.915, respectively. The multimodal model incorporating ultrasonography, SPECT/CT, serum calcium, and PTH achieved an area under the curve of 0.977; however, this finding should be interpreted cautiously because of the small number of pathology-negative cases. Conclusion: Ultrasonography and ^99mTc-MIBI SPECT/CT have complementary value in the preoperative diagnosis of parathyroid lesions. PTH demonstrates good discriminatory ability, while serum calcium provides supplementary diagnostic information. Multimodal assessment combining imaging findings and biochemical markers may improve preoperative diagnostic performance, although further validation in larger cohorts is required.