Медицинская литература. Новинки

 

 

 

 

 

 

Методы топической диагностики при первичном гиперпаратиреозе. Сравнительная характеристика

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Топическая диагностика околощитовидных желез (ОЩЖ) – важный этап в предоперационном обследовании больных с первичным гиперпаратиреозом (ПГПТ). Существующий на сегодняшний день алгоритм диагностики не всегда требует использования всех методов для каждого пациента. Задачей исследования явилось изучение диагностической ценности каждого из методов исследования в отдельности и их сочетания. Полученные данные свидетельствуют о высокой чувствительности и специфичности каждого из методов дооперационной топической диагностики патологии ОЩЖ у больных с ПГПТ. Чувствительность УЗИ, сцинтиграфии, УЗИ+сцинтиграфия и мультиспиральной компьютерной томографии (МСКТ) составила 96,8; 91,8; 99,2 и 95,2% соответственно. Специфичность УЗИ, сцинтиграфии, УЗИ+сцинтиграфия и МСКТ составила 91,9; 84,2; 94,1 и 94,1% соответственно. Результаты исследования свидетельствуют об отсутствии статистически значимых различий в параметрах чувствительности и специфичности между УЗИ и “золотым стандартом” диагностики патологии ОЩЖ, что позволяет рекомендовать УЗИ, в качестве единственного метода первичной топической диагностики патологии ОЩЖ при ПГПТ. Однако любые сомнения в диагностической точности УЗИ требуют развертывания всего комплекса диагностических мероприятий – сцинтиграфического исследования, включая однофотонную эмиссионную компьютерную томографию, а также МСКТ, особенно в случае атипичного расположении ОЩЖ. На основании результатов исследования разработан оптимальный диагностический алгоритм при ПГПТ.

Ключевые слова:
первичный гиперпаратиреоз, парааденома, паратгормон, УЗИ, сцинтиграфия, паратиреоидэктомия

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Topical diagnostics methods in primary hyperparathyroidism. Comparative features

Topical diagnostics of parathyroids an important stage in preoperative inspection of patients with a primary hyperparathyreosis. Methods of diagnostics existing for today not always demand use of all methods for each patient. A research problem was studying of diagnostic value of each of research methods separately and their combinations. The obtained data testifies to high sensitivity and specificity of each of methods of preoperative topical diagnostics of a pathology of parathyroids at patients with a primary hyperparathyreosis. Sensitivity of US, the Scintigraphy, US + Scintigraphy and the Multispiral computer tomography (MSCT) has compounded – 96,8 %, 91,8 %, 99,2 % and 95,2 % accordingly. Specificity of US, the Scintigraphy, US + Scintigraphy and a MSCT has compounded – 91,9 %, 84,2 %, 94,1 % and 94,1 % accordingly. Findings of investigation have taped absence of statistically significant differences in sensitivity and specificity parametres between US and «the gold standard» diagnostics of a pathology of parathyroids that allows to recommend US, as a unique method of primary topical diagnostics of a pathology of parathyroids at a primary hyperparathyreosis. However any doubts in diagnostic accuracy of US demand expansion of all complex of diagnostic actions - scintigraphy, including an SPECT, and also MSCT, especially in case of atypical a locating of parathyroids. On the basis of findings of investigation the optimum diagnostic algorithm is developed at a primary hyperparathyreosis

Keywords:
spontaneous remission acromegaly, pituitary adenoma.