Itoh Kazuo, Ishizuka Reiki
Department of Radiology, JR Sapporo General Hospital, Japan.
Ann Nucl Med. 2003 Jun;17(4):315-20. doi: 10.1007/BF02988528.
The aim of this study is to assess the sensitivity of Tc-99m-MIBI for the pre-operative localization of hyperfunctioning parathyroid glands in patients with persistent or recurrent hyperparathyroidism (HPT) after total parathyroidectomy (PTX) with autograft.
Tc-99m-MIBI scintigraphy was performed on 7 patients (3 men and 4 women; aged 32 to 62) on hemodialysis with persistent or recurrent HPT after PTX due to secondary hyperparathyroidism. Tc-99m-MIBI of 370 MBq was injected intravenously. Double-phase planar images were acquired at 15 min and 120 min-postinjection. SPECT images of the chest in an early phase were also obtained.
All patients underwent surgery after scintigraphy. The enlarged parathyroid grafts were removed in 4 patients. An unusual location of parathyroid hyperplasia was found in 2 patients. In one patient, the abnormal graft coexisted with an ectopic parathyroid in the mediastinal region. Tc-99m-MIBI was able to identify all hyperfunctioning parathyroids correctly (100% sensitivity). In one case, a focus of the increased uptake in SPECT was considered as a false positive. The remnant of ectopic parathyroid in the mediastinum was only detected by SPECT images.
Tc-99m-MIBI parathyroid scintigraphy is useful for the pre-operative localization of persistent or recurrent HPT following total PTX with autograft.
本研究的目的是评估锝-99m-甲氧基异丁基异腈（Tc-99m-MIBI）对甲状旁腺全切术（PTX）并自体移植后持续性或复发性甲状旁腺功能亢进症（HPT）患者术前定位功能亢进甲状旁腺的敏感性。
对7例因继发性甲状旁腺功能亢进症接受PTX后出现持续性或复发性HPT的血液透析患者（3例男性，4例女性；年龄32至62岁）进行了Tc-99m-MIBI闪烁扫描。静脉注射370MBq的Tc-99m-MIBI。在注射后15分钟和120分钟采集双时相平面图像。还获取了早期胸部的单光子发射计算机断层扫描（SPECT）图像。
所有患者在闪烁扫描后均接受了手术。4例患者切除了增大的甲状旁腺移植物。2例患者发现甲状旁腺增生位置异常。1例患者中，异常移植物与纵隔区域的异位甲状旁腺共存。Tc-99m-MIBI能够正确识别所有功能亢进的甲状旁腺（敏感性100%）。1例中，SPECT中摄取增加的一个病灶被认为是假阳性。纵隔中异位甲状旁腺的残余仅通过SPECT图像检测到。
Tc-99m-MIBI甲状旁腺闪烁扫描对甲状旁腺全切术并自体移植后持续性或复发性HPT的术前定位有用。
