Moka D, Eschner W, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H
Department of Nuclear Medicine, University of Cologne, Germany.
Eur J Nucl Med. 2000 May;27(5):485-9. doi: 10.1007/s002590050532.
The purpose of this study was to assess the value of technetium-99m methoxyisobutylisonitrile (MIBI) single-photon emission tomography (SPET) and an iterative reconstruction algorithm for the preoperative localisation of parathyroid adenomas (PTAs). Seventy-two patients (26 male, 46 female, mean age 58+/-16 years) with known primary hyperparathyroidism were examined preoperatively. First, a thyroid examination was performed to detect possible MIBI-accumulating thyroid lesions. Planar scans were then acquired 15 and 120 min and tomographic images 120 min after intravenous injection of 740 MBq 99mTc-MIBI, using a triple-head gamma camera (Picker Prism 3000). Additionally, 99mTc-MIBI/ 99mTc-pertechnetate subtraction scintigraphy of the early planar images was performed. The SPET data were evaluated using an iterative reconstruction (multiplicative iterative SPET reconstruction: MISR) as well as a standard algorithm (FBP: filtered back-projection with application of a 3-D low-pass postfilter). The weight of the resected PTAs ranged from 110 mg to 5 g. Using planar MIBI scans, correct localisation of the side of the PTA was possible in 81% of cases (58% for PTAs weighing less than 500 mg). Sensitivity increased to 94% using SPET and FBP, while with MISR it rose further, to 97%. Patients with PTAs weighing less than 500 mg showed a sensitivity of 88% with MISR and 81% with FBP. Furthermore, there was a clear improvement in image quality using MISR. None of the normal parathyroid glands were visualised. This study indicates that, in comparison with planar scintigraphy, 99mTc-MIBI SPET is a more sensitive and specific tool for topographical localisation of PTAs, especially those that are small. There is a further improvement in sensitivity and image quality when iterative reconstruction is used instead of FBP.
本研究的目的是评估锝-99m甲氧基异丁基异腈（MIBI）单光子发射断层扫描（SPET）及迭代重建算法在术前定位甲状旁腺腺瘤（PTA）中的价值。对72例已知原发性甲状旁腺功能亢进的患者（26例男性，46例女性，平均年龄58±16岁）进行了术前检查。首先，进行甲状腺检查以检测可能摄取MIBI的甲状腺病变。然后，在静脉注射740 MBq 99mTc-MIBI后15分钟和120分钟采集平面图像，并在120分钟采集断层图像，使用三头γ相机（Picker Prism 3000）。此外，还对早期平面图像进行了99mTc-MIBI/99mTc-高锝酸盐减影闪烁显像。使用迭代重建（乘法迭代SPET重建：MISR）以及标准算法（FBP：应用三维低通后置滤波器的滤波反投影）对SPET数据进行评估。切除的PTA重量范围为110 mg至5 g。使用平面MIBI扫描，81%的病例能够正确定位PTA所在侧（重量小于500 mg的PTA为58%）。使用SPET和FBP时，敏感性提高到94%，而使用MISR时进一步提高到97%。重量小于500 mg的PTA患者，MISR的敏感性为88%，FBP为81%。此外，使用MISR时图像质量有明显改善。未发现正常甲状旁腺显影。本研究表明，与平面闪烁显像相比，99mTc-MIBI SPET是一种更敏感、更特异的PTA地形定位工具，尤其是对于小的PTA。使用迭代重建代替FBP时，敏感性和图像质量有进一步提高。
