Profanter Christoph, Prommegger Rupert, Gabriel Michael, Moncayo Roy, Wetscher Gerold J, Lang Thomas, Bale Reto
Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Am J Surg. 2004 Mar;187(3):383-7. doi: 10.1016/j.amjsurg.2003.12.012.
An imaging-guided unilateral surgical approach in patients with primary hyperparathyroidism (HPTH) requires reliable preoperative localization procedures. Using present imaging techniques, 60% to 80% of patients with primary HPTH can be treated successfully with limited surgery. Thus, further improvement of diagnostic accuracy is required. Computed axial tomography (CAT)-MIBI image fusion was introduced as a new technique for localizing enlarged parathyroid glands. We describe the new method and present its first results.
Six consecutive patients with primary HPTH underwent CAT-MIBI image fusion for preoperative parathyroid localization. CAT and technetium-99m-sestamibi scan were performed separately. The patient's head and neck were fixed with the noninvasive Vogele-Bale-Hohner Head Holder (VBH HeadFIX; Medical Intelligence, Schwabmünchen, Germany) and the BodyFIX (Medical Intelligence) vacuum cushion. Radiographic and scintigraphic markers were mounted at the head holder and the patient. CAT and MIBI images were fused by overlaying radiographic markers using a commercial software and workstation.
In 5 patients, localization and dimension of the solitary adenomas were exactly predicted. In 1 patient with multiglandular disease (3 enlarged glands), CAT-MIBI image fusion was not able to predict multiple gland involvement. However, in a retrospective analysis of the localization study, the other two enlarged parathyroid glands could be correctly identified regarding their site and size.
First results of CAT-MIBI image fusion are promising. The new technique provides a higher image resolution and better delimitation of enlarged parathyroid glands and adjacent anatomic structures than conventional scintigraphic methods.
对于原发性甲状旁腺功能亢进症（HPTH）患者，成像引导下的单侧手术方法需要可靠的术前定位程序。使用目前的成像技术，60%至80%的原发性HPTH患者可通过有限的手术成功治疗。因此，需要进一步提高诊断准确性。计算机轴向断层扫描（CAT）-甲氧基异丁基异腈（MIBI）图像融合作为一种定位增大甲状旁腺的新技术被引入。我们描述了这种新方法并展示了其初步结果。
连续6例原发性HPTH患者接受CAT-MIBI图像融合以进行术前甲状旁腺定位。分别进行CAT和锝-99m-甲氧基异丁基异腈扫描。患者的头部和颈部用无创的Vogele-Bale-Hohner头部固定器（VBH HeadFIX；德国施瓦布明兴市Medical Intelligence公司）和BodyFIX（Medical Intelligence）真空垫固定。在头部固定器和患者身上安装放射成像和闪烁成像标记物。使用商业软件和工作站通过叠加放射成像标记物将CAT和MIBI图像融合。
5例患者中，孤立性腺瘤的定位和大小被准确预测。1例多腺体疾病患者（3个腺体增大），CAT-MIBI图像融合未能预测多腺体受累情况。然而，在对定位研究的回顾性分析中，另外两个增大的甲状旁腺的位置和大小能够被正确识别。
CAT-MIBI图像融合的初步结果很有前景。与传统闪烁成像方法相比，这项新技术提供了更高的图像分辨率，能更好地界定增大的甲状旁腺和相邻解剖结构。
