The Accuracy of Ultrasonography and ?Tl- [fee6]Tc Subtraction Scan in Localization of Parathyroid Lesions

　　　　　本文係針對副甲狀腺機能亢進病人術前定位檢查經常使狦之副甲狀腺超音波及雙光子鉈201-塔-99m副甲狀腺掃描二種檢查準確性之比較。自民國75年3月至85年6月，林口長庚醫院回顧了27名經病理診斷為副甲狀腺機能亢進病人。其平均年齡51.3歲，男與女之比較17：10，所有病人分原發性副甲狀腺機能亢進及續發性副甲狀腺機能亢進二組；原發性副甲狀腺機能亢進病患共有16位；其中12位為良性副甲狀腺瘤；4位為副甲狀腺癌。腎衰辦引起之續發性副甲狀腺機亢進病患有11位；所有病人均經病理診斷為副甲狀腺增生。 研究結果顯示：(1)對於原發或智甲狀機能亢進之術前定位，超音波之敏感性及特異性75.0%和95.8%，雙光子副甲狀腺掃描敏感性及特異性為87.5%和100.0%。(2)對於續發或副甲狀腺機能亢進之術前定位，超音波和雙光子副甲狀腺掃描之敏感性均為32.4%，而特異性各為85.7%和100.0%。(3)結合二種檢查作為術前定位，可有效提高診斷之準確性。
　　　　　We reviewed 27 patients who received preoperative localization using both parathyroid ultrasongography and parathriod 201TI-99mTc subtraction (TTS) scan from March 1986 to July 1993 in Chang Gung Memorial Hospital, Linkou. These 27 patients were diagnosed hyperparathyroidism by the pathological reports. There were 16 patients with primary hyperparathyroidism [PHPT; 9 males, 7 females; (mean age: 56.3±4.6 yrs)] and 11 patients with secondary hyperparathyroidism [SHPT; 8 males, 3 females; (mean age: 38.3±2.5 yrs)] due to end stage renal disease. The diagnostic accuracy was compared, and the results were as follow: (1) in localization of PHPT, the sensitiveity and specificity of ultrasonography were 75.0% and 95.8% respectively, whereas the sensitivity and specificity of TTS were 87.5% and 100% respectively. The differences were not statistically significant; (2) the sensitivity and specificity of ultrasonography and TTS for patients with SHPT were 32.4% and 85.7%vs. 32.4% and 100.0%; and (3) higher sensitiveity and specificity were achieved when both methods were chosen for localizing either PHPT or SHPT.