Rubello Domenico, Fanti Stefano, Nanni Cristina, Farsad Mohsen, Castellucci Paolo, Boschi Stefano, Franchi Roberto, Mariani Giuliano, Fig Lorraine M, Gross Milton D
Nuclear Medicine Service, PET Unit, S. Maria della Misericordia Hospital, Insituto Oncologico Veneto, IOV, Viale Tre Martiri, 140, 45100 Rovigo, Italy.
Eur J Nucl Med Mol Imaging. 2006 Apr;33(4):453-9. doi: 10.1007/s00259-005-0008-z. Epub 2006 Jan 25.
Scintigraphic localisation of parathyroid glands is often unsuccessful in patients with renal failure on chronic haemodialysis who have secondary hyperparathyroidism (HPT). The purpose of this study was to investigate the use of (11)C-methionine PET/CT to detect hyperfunctioning parathyroid glands in patients with renal failure on chronic haemodialysis who had (99m)Tc-sestamibi-negative HPT.
(11)C-methionine PET/CT was performed in 18 patients (11 women and 7 men, aged 42-79 years; mean age 57.8 years) on haemodialysis for renal failure (2-14 years' duration), with normo-, hypo- or hypercalcaemia and HPT not localised by either dual-tracer (99m)Tc-pertechnetate/(99m)Tc-sestamibi subtraction scans or dual-phase (99m)Tc-sestamibi scans.
In three of ten patients with normo- or hypocalcaemic HPT there was increased (11)C-methionine accumulation in one gland. Seven of eight patients with hypercalcaemic HPT showed increased uptake: in five of these patients increased (11)C-methionine accumulation was present in one gland, while in two it was demonstrated in two glands. All patients also had high-resolution ultrasound of the neck and were treated with subtotal parathyroidectomy, leaving a remnant of the smallest of the four glands. Regardless of their size, all glands with abnormal (11)C-methionine parathyroid uptake were removed, and all demonstrated parathyroid hyperplasia. All patients developed post-parathyroidectomy hypoparathyroidism and one patient with normocalcaemic HPT relapsed 8 months after surgery.
These data suggest that (11)C-methionine PET/CT may be used to identify hyperfunctioning parathyroid glands in non-primary HPT, and especially hypercalcaemic HPT, when conventional (99m)Tc-sestamibi imaging is non-localising.
对于接受慢性血液透析且患有继发性甲状旁腺功能亢进（HPT）的肾衰竭患者，甲状旁腺闪烁显像定位常常不成功。本研究的目的是调查使用（11）C-蛋氨酸PET/CT来检测接受慢性血液透析且（99m）Tc-甲氧基异丁基异腈显像阴性的HPT患者中功能亢进的甲状旁腺。
对18例（11例女性和7例男性，年龄42 - 79岁；平均年龄57.8岁）因肾衰竭接受血液透析（病程2 - 14年）、伴有血钙正常、血钙过低或血钙过高且通过双示踪剂（99m）Tc-高锝酸盐/（99m）Tc-甲氧基异丁基异腈减影扫描或双相（99m）Tc-甲氧基异丁基异腈扫描未定位HPT的患者进行（11）C-蛋氨酸PET/CT检查。
在10例血钙正常或血钙过低性HPT患者中的3例，有一个腺体的（11）C-蛋氨酸积聚增加。8例血钙过高性HPT患者中的7例显示摄取增加：其中5例患者一个腺体出现（11）C-蛋氨酸积聚增加，而2例患者两个腺体出现这种情况。所有患者还接受了颈部高分辨率超声检查，并接受了甲状旁腺次全切除术，保留四个腺体中最小的一个作为残余。无论大小，所有（11）C-蛋氨酸甲状旁腺摄取异常的腺体均被切除，且均显示甲状旁腺增生。所有患者术后均发生甲状旁腺功能减退，1例血钙正常性HPT患者术后8个月复发。
这些数据表明，当传统的（99m）Tc-甲氧基异丁基异腈显像不能定位时，（11）C-蛋氨酸PET/CT可用于识别非原发性HPT，尤其是血钙过高性HPT中功能亢进的甲状旁腺。
