Haber Richard S, Kim Chun K, Inabnet William B
Departments of Medicine, Mount Sinai School of Medicine, New York 10029, USA.
Clin Endocrinol (Oxf). 2002 Aug;57(2):241-9. doi: 10.1046/j.1365-2265.2002.01583.x.
To determine the utility of ultrasonography for the preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism, and to compare this method with (99m)technetium sestamibi scintigraphy.
The results of ultrasonography for localization of enlarged parathyroid glands were determined in 120 consecutive patients with primary hyperparathyroidism and compared with findings at surgery (n = 86) and with the results of (99m)technetium sestamibi scintigraphy (n = 99).
All patients had biochemically documented primary hyperparathyroidism based on elevated serum calcium and 'intact' parathyroid hormone measured by immunoassay. Patients with prior parathyroid surgery or secondary hyperparathyroidism were excluded.
High-resolution ultrasonography was performed by a single observer. (99m)Technetium sestamibi scintigraphy was performed using early and delayed (2-h) views, and correlated with simultaneous thyroidal 123I uptake in most patients.
Ultrasonography detected putative enlarged parathyroid glands in 92 of 120 unselected patients (77%). It correctly predicted surgical findings in 64 of 86 patients undergoing surgery (74%), including 61 of 72 patients with solitary eutopic parathyroid adenomas (84%), but only two of eight patients with solitary ectopic adenomas, and only one of six patients with multigland parathyroid disease. Sestamibi scintigraphy was positive in 87 of 99 unselected patients (88%), a higher proportion than ultrasonography (P < 0.05), reflecting superior sensitivity for the detection of ectopic parathyroid adenomas. For 74 patients undergoing parathyroid surgery who underwent both imaging tests there was no statistically significant difference between ultrasonography and sestamibi scintigraphy in ability to correctly predict surgical findings (74%vs. 82%, respectively) or in positive predictive value (93%vs. 90%, respectively). However, sestamibi scintigraphy was clearly more sensitive for ectopic parathyroid adenomas, providing correct localization in 8/8 cases. When one test was negative, testing with the second method was usually positive, improving the likelihood of a positive result to 98% when both tests were employed.
Ultrasonography can be a sensitive and accurate method for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism, comparable in overall utility to sestamibi scintigraphy. These results suggest that a strategy of initial testing with one or the other method, followed by the alternate imaging test if the first test is negative, would provide correct parathyroid imaging in most patients without prior parathyroid surgery.
确定超声检查在原发性甲状旁腺功能亢进症中对增大甲状旁腺进行术前定位的效用，并将该方法与锝-99m 甲氧基异丁基异腈闪烁扫描术进行比较。
对 120 例连续性原发性甲状旁腺功能亢进症患者进行超声检查以定位增大的甲状旁腺，并将结果与手术结果（n = 86）以及锝-99m 甲氧基异丁基异腈闪烁扫描术结果（n = 99）进行比较。
所有患者均根据血清钙升高及免疫测定法测得的“完整”甲状旁腺激素水平，经生化检查确诊为原发性甲状旁腺功能亢进症。排除既往有甲状旁腺手术史或继发性甲状旁腺功能亢进症的患者。
由一名观察者进行高分辨率超声检查。采用早期和延迟（2 小时）图像进行锝-99m 甲氧基异丁基异腈闪烁扫描术，大多数患者同时进行甲状腺碘-123 摄取情况的对比。
在 120 例未经筛选的患者中，超声检查发现 92 例（77%）有疑似增大的甲状旁腺。在 86 例接受手术的患者中，超声检查正确预测手术结果的有 64 例（74%），其中包括 72 例单发正常位置甲状旁腺腺瘤患者中的 61 例（84%），但 8 例单发异位腺瘤患者中仅 2 例，6 例多腺体甲状旁腺疾病患者中仅 1 例。在 99 例未经筛选的患者中，甲氧基异丁基异腈闪烁扫描术阳性的有 87 例（88%），比例高于超声检查（P < 0.05），这反映出其对异位甲状旁腺腺瘤的检测敏感性更高。对于 74 例接受甲状旁腺手术且两项影像学检查都做了的患者，超声检查和甲氧基异丁基异腈闪烁扫描术在正确预测手术结果的能力方面（分别为 74%和 82%）以及阳性预测值方面（分别为 93%和 90%）均无统计学显著差异。然而，甲氧基异丁基异腈闪烁扫描术对异位甲状旁腺腺瘤明显更敏感，在 8/8 例中提供了正确定位。当一项检查为阴性时，用第二种方法检查通常为阳性，两项检查都采用时阳性结果的可能性提高到 98%。
超声检查可为原发性甲状旁腺功能亢进症中增大甲状旁腺的术前定位提供一种敏感且准确的方法，总体效用与甲氧基异丁基异腈闪烁扫描术相当。这些结果表明，对于大多数既往无甲状旁腺手术史的患者，先采用其中一种方法进行初步检查，若首次检查为阴性则采用另一种影像学检查的策略，可提供正确的甲状旁腺成像。
