Torregrosa J V, Fernández-Cruz L, Canalejo A, Vidal S, Astudillo E, Almaden Y, Pons F, Rodriguez M
Renal Transplant Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
World J Surg. 2000 Nov;24(11):1386-90. doi: 10.1007/s002680010229.
Double-phase parathyroid MIBI ((99m)Tc-sestamibi) was performed in 27 patients with secondary hyperparathyroidism (SPT). Focal areas of increased uptake were scored for intensity on a three-point scale. All patients underwent subtotal parathyroidectomy (SPTx), and a total of 78 glands were removed at operation. Blood was obtained from the jugular vein before and after SPTx to measure the parathyroid hormone (PTH) levels. The volume and weight of the glands were calculated. The tissue was divided, with one aliquot being used for cell cycle analysis. The nuclei were acquired by flow cytometry and analyzed using CELLEIT software. Cell viability was assessed by flow cytometry and analyzed with LYSIS II software. Positive MIBI uptake was observed in 88.8% of patients. Focal MIBI uptake of one, two, or three glands was observed in 6, 11, and 8 patients, respectively. All patients experienced an 86% decrease in PTH blood level after SPTx compared to that before excision. A correlation was found between the volume of glands and the blood levels of intact PTH (iPTH) (r = 0.5, p < 0.05). A positive correlation was observed between MIBI uptake and the iPTH levels before SPTx (p < 0.01) and between the uptake of MIBI in the parathyroid glands and the cell cycle phases; low-grade uptake correlated with the G(0) phase and higher uptake with G(2)+S phase (r = 7, p < 0.01). No correlation was observed between MIBI uptake and the weight of the glands. MIBI scintigraphy accurately reflects the functional status of the hyperplastic parathyroid glands: Higher uptake grades correlated with the active growth phase. MIBI uptake does not reveal parathyroid enlargement; rather, it identifies the presence of hyperfunctioning autonomous glands. SPTx and total parathyroidectomy with autografting (TPTx+A) are the most widely accepted surgical approaches for patients with SPT. Reoperation for recurrence is necessary in 6% to 15% of cases. MIBI is now considered to be the radionuclide of reference for parathyroid gland scanning, although it is widely accepted that it produces poor results when trying to detect hyperplastic glands.
对27例继发性甲状旁腺功能亢进（SPT）患者进行了双期甲状旁腺MIBI（（99m）Tc-甲氧基异丁基异腈）检查。对摄取增加的局灶性区域按三分制对强度进行评分。所有患者均接受了甲状旁腺次全切除术（SPTx），术中共切除78个腺体。在SPTx前后从颈静脉取血以测量甲状旁腺激素（PTH）水平。计算腺体的体积和重量。将组织分开，其中一份用于细胞周期分析。通过流式细胞术获取细胞核并使用CELLEIT软件进行分析。通过流式细胞术评估细胞活力并用LYSIS II软件进行分析。88.8%的患者观察到MIBI摄取阳性。分别在6例、11例和8例患者中观察到1个、2个或3个腺体的局灶性MIBI摄取。与切除前相比，所有患者在SPTx后PTH血水平下降了86%。发现腺体体积与完整PTH（iPTH）血水平之间存在相关性（r = 0.5，p < 0.05）。在SPTx前观察到MIBI摄取与iPTH水平之间存在正相关（p < 0.01），并且在甲状旁腺腺体中MIBI摄取与细胞周期阶段之间存在正相关；低级别摄取与G(0)期相关，较高摄取与G(2)+S期相关（r = 7，p < 0.01）。未观察到MIBI摄取与腺体重量之间的相关性。MIBI闪烁显像准确反映了增生性甲状旁腺的功能状态：较高的摄取等级与活跃生长阶段相关。MIBI摄取并不能显示甲状旁腺肿大；相反，它可识别功能亢进的自主性腺体的存在。SPTx和甲状旁腺全切除术加自体移植（TPTx + A）是SPT患者最广泛接受的手术方法。6%至15%的病例需要再次手术治疗复发。MIBI现在被认为是甲状旁腺扫描的参考放射性核素，尽管人们普遍认为在试图检测增生性腺体时它的效果不佳。
