Fuster David, Ybarra Juan, Ortin Jaime, Torregrosa José-Vicente, Gilabert Rosa, Setoain Xavier, Paredes Pilar, Duch Joan, Pons Francesca
Nuclear Medicine Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
Eur J Nucl Med Mol Imaging. 2006 Apr;33(4):467-73. doi: 10.1007/s00259-005-0021-2. Epub 2006 Jan 11.
The purpose of this study was to assess whether pre-operative (99m)Tc-methoxyisobutylisonitrile (MIBI) scintigraphy and neck ultrasound (US) are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidism.
Forty-eight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent "blinded" subtotal parathyroid surgery, with 1-year follow-up to establish cure or relapse of their secondary hyperparathyroidism. Double-phase (99m)Tc-MIBI scintigraphy and neck US were performed pre-operatively in all patients. When the preserved gland showed (99m)Tc-MIBI uptake or an abnormal size on US, it was considered that "(99m)Tc-MIBI advice" and "US advice", respectively, had not been followed. Pre-operative and follow-up parathyroid hormone (PTH) levels were obtained in all patients. All data were evaluated on a patient by patient basis.
Four parathyroid glands were identified in each patient at primary surgery, resulting in an operative success rate of 100%. Their weight ranged from 15 to 7,300 mg (mean 1,120+/-900 mg). Nine of the 48 patients (19%) showed a recurrence of their secondary hyperparathyroidism. The recurrence rate was 2% (1/48) and 10% (5/48), respectively, when (99m)Tc-MIBI and US advice was followed. The sensitivity, specificity, NPV and PPV for pre-operative imaging were 72%, 95%, 97% and 80% respectively for (99m)Tc-MIBI, and 55%, 67%, 87% and 28% for US.
(99m)Tc-MIBI scintigraphy is a reliable non-invasive exploratory tool and its preoperative use results in a significant reduction in the number of recurrences in haemodialysis patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. The use of neck US did not significantly improve the results obtained with (99m)Tc-MIBI alone.
本研究旨在评估术前（99m）锝-甲氧基异丁基异腈（MIBI）闪烁扫描和颈部超声（US）对改善继发性甲状旁腺功能亢进患者甲状旁腺次全切除术预后是否有价值。
48例连续性重度继发性甲状旁腺功能亢进的血液透析患者前瞻性地接受了“盲法”甲状旁腺次全手术，并进行了1年的随访以确定继发性甲状旁腺功能亢进的治愈或复发情况。所有患者术前均进行了双期（99m）Tc-MIBI闪烁扫描和颈部超声检查。当保留的甲状旁腺显示有（99m）Tc-MIBI摄取或超声检查发现大小异常时，分别认为未遵循“（99m）Tc-MIBI建议”和“超声建议”。所有患者均获得了术前和随访时的甲状旁腺激素（PTH）水平。所有数据均逐例进行评估。
初次手术时每位患者均发现4个甲状旁腺，手术成功率为100%。其重量范围为15至7300毫克（平均1120±900毫克）。48例患者中有9例（19%）出现继发性甲状旁腺功能亢进复发。遵循（99m）Tc-MIBI和超声建议时，复发率分别为2%（1/48）和10%（5/48）。术前成像的敏感性、特异性、阴性预测值和阳性预测值，（99m）Tc-MIBI分别为72%、95%、97%和80%，超声分别为55%、67%、87%和28%。
（99m）Tc-MIBI闪烁扫描是一种可靠的非侵入性探测工具，术前使用可显著降低适合甲状旁腺次全切除术的继发性甲状旁腺功能亢进血液透析患者的复发率。单独使用颈部超声并未显著改善仅使用（99m）Tc-MIBI所获得的结果。
