Rodríguez-Carranza Sandra, Cáceres Mario, Aguilar-Salinas Carlos A, Gómez-Pérez Francisco J, Herrera Miguel F, Pantoja Juan Pablo, Rull Juan A
Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias, Médicas y Nutrición, Salvador Zubirán, Mexico.
Endocr Pract. 2004 Nov-Dec;10(6):472-7. doi: 10.4158/EP.10.6.472.
To assess the diagnostic properties of (99m)Tc-sestamibi scanning (dual-phase technique) in patients with primary hyperparathyroidism and to establish the overall efficacy of this imaging technique for localization of an adenoma.
The medical records of all 131 patients who underwent parathyroid scanning in a tertiary care center between January 1997 and December 2002 were reviewed. The surgical findings were used as the "gold standard" for the diagnosis of parathyroid pathologic conditions.
Primary hyperparathyroidism was diagnosed in 87 of the 131 patients (66.4%); of these, 76 underwent surgical treatment. In 44 patients, sestamibi scanning was also done for conditions other than primary hyperparathyroidism. (99m)Tc-sestamibi scanning had a sensitivity of 79.1%, a specificity of 86.7%, a positive predictive value of 88.3%, a false-positive rate of 11.6%, and a false-negative rate of 23.3% for the diagnosis of parathyroid adenoma. Despite the apparent high sensitivity of this scanning technique, only 58.2% of the adenomas were found intra-operatively at the location predicted by the scan. Lesions in the upper neck area were missed more frequently by sestamibi scanning than were those in the lower neck area (13 of 32 versus 1 of 35, respectively) (P<0.05).
Preoperative localization of parathyroid adenomas with use of (99m)Tc-sestamibi scanning showed a limited capacity to reveal their precise location. Thus, such scans must be complemented with other studies, such as intraoperative ultrasonography and rapid parathyroid hormone assay, to ensure a successful excision if a limited surgical procedure is planned.
评估（99m）锝-甲氧基异丁基异腈扫描（双期技术）在原发性甲状旁腺功能亢进患者中的诊断特性，并确定该成像技术对腺瘤定位的总体效能。
回顾了1997年1月至2002年12月在一家三级医疗中心接受甲状旁腺扫描的所有131例患者的病历。手术结果被用作甲状旁腺病理状况诊断的“金标准”。
131例患者中有87例（66.4%）被诊断为原发性甲状旁腺功能亢进；其中76例接受了手术治疗。44例患者因原发性甲状旁腺功能亢进以外的疾病也进行了甲氧基异丁基异腈扫描。（99m）锝-甲氧基异丁基异腈扫描对甲状旁腺腺瘤诊断的敏感性为79.1%，特异性为86.7%，阳性预测值为88.3%，假阳性率为11.6%，假阴性率为23.3%。尽管该扫描技术具有明显较高的敏感性，但术中仅在扫描预测的位置发现了58.2%的腺瘤。甲氧基异丁基异腈扫描漏诊上颈部区域病变的频率高于下颈部区域（分别为32例中的13例和35例中的1例）（P<0.05）。
使用（99m）锝-甲氧基异丁基异腈扫描对甲状旁腺腺瘤进行术前定位显示出揭示其精确位置的能力有限。因此，如果计划进行有限的手术，此类扫描必须辅以其他检查，如术中超声检查和快速甲状旁腺激素测定，以确保成功切除。
