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超声应变弹性成像在继发性甲状旁腺增生术前评估中的应用价值

Application value of ultrasound strain elastography in preoperative assessment for secondary parathyroid hyperplasia

    摘要
  • 摘要:
      目的  分析应变弹性成像技术在继发性甲状旁腺功能亢进症（SHPT）患者术前评估增生病灶的临床应用价值。
      方法  将南京医科大学第二附属医院肾脏病中心接受甲状旁腺手术的维持性血液透析患者50例纳入本研究，超声检查检测出增生病灶196枚。将病理检查证实为甲状旁腺增生的190枚病灶分为A组（n=147，单个增生腺体直径≥10 mm）与B组（n=43，单个增生腺体直径 < 10 mm）。患者均接受常规超声检查并采用弹性成像分析获得腺体的弹性应变率比值（SR）。分析病灶SR与病灶直径的相关性。比较不同回声、血流分级腺体SR的差异。
      结果  50例患者超声共检测出196枚甲状旁腺区异常病变，病理检查证实190枚为甲状旁腺增生，诊断符合率为96.94%（190/196）；另外6枚含其他组织成分，误诊率为3.06%（6/196）。50例患者术前腺体弹性成像分析显示，平均SR为（2.67±1.23），SR与腺体最大直径呈正相关（r=0.21，P < 0.05）。A组SR为（2.82±1.21），B组为（2.16±1.17），A组SR值高于B组，差异有统计学意义（P < 0.05）。低回声与等回声或高回声腺体SR比较，差异有统计学意义（P < 0.05）；增生的甲状旁腺直径与甲状旁腺激素（PTH）成正相关（r=0.21，P < 0.05），与血钙、血磷、碱性磷酸酶浓度均无显著相关性（P>0.05）。
      结论  应变弹性成像对SHPT患者甲状旁腺病灶检出率较高，可以用于筛查和术前定位，并可作为常规超声检查的有力补充。甲状旁腺直径在一定程度上反映了SPHT的严重程度。

     

    Abstract:
      Objective  To analyze the clinical value of ultrasound strain elastography in preoperative evaluation of hyperplasia lesions in patients with secondary hyperparathyroidism (SHPT).
      Methods  Fifty patients with maintenance hemodialysis who underwent parathyroid surgery in the Renal Disease Center of the Second Affiliated Hospital of Nanjing Medical University were enrolled in this study. A total of 196 hyperplasia lesions were detected by ultrasonography, among which 190 lesions confirmed by pathological examination as parathyroid hyperplasia were divided into group A (n=147, diameter of single hyperplasia gland ≥10 mm) and group B (n=43, diameter of single hyperplasia gland < 10 mm). The elastic strain rate ratio (SR) of the glands was obtained by routine ultrasound and elastography analysis. The correlation between SR and diameter was analyzed. The differences of SR in glands with different echo and blood flow grading were compared.
      Results  A total of 196 parathyroid glands were detected as abnormal lesions by ultrasound in 50 patients, and 190 parathyroid hyperplasia lesions were confirmed by pathological examination, with a consistent rate of 96.94%(190/196). Another 6 lesions contained other tissue components were misdiagnosed, with a misdiagnosis rate of 3.06%(6/196). Preoperative elastography of the glands in 50 patients revealed that mean SR was (2.67±1.23), and SR was positively correlated with the maximum diameter of the gland (r=0.21, P < 0.05). The mean SR in group A was (2.82±1.21), which was significantly higher than (2.16±1.17) of group B (P < 0.05). There was significant difference in SR between hypoechoic and isoechoic or hyperechoic glands (P < 0.05). The diameter of the parathyroid gland with hyperplasia had positive correlation with parathyroid hormone (PTH) (r=0.21, P < 0.05), and no correlation with serum calcium, phosphorus and alkaline phosphatase (P>0.05).
      Conclusion  Elastography has a high detection rate of parathyroid lesions in patients with SHPT, which can be used for preoperative localization and screening, and can be used as a powerful supplement to conventional ultrasound examination. The diameter of parathyroid gland reflects the severity of SPHT.

     

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