Pham Tuan H, Sterioff Sylvester, Mullan Brian P, Wiseman Gregory A, Sebo Thomas J, Grant Clive S
Department of Surgery, Mayo Clinic, 200 Second Street SW, Rochester, Minnesota 55901, USA.
World J Surg. 2006 Mar;30(3):327-32. doi: 10.1007/s00268-005-0279-3.
Parathyroid scintigraphy (PS) may be used to localize hyperactive parathyroid glands preoperatively. Performance of PS in the setting of secondary and tertiary hyperparathyroidism (HPT) is not well quantified. The performance of PS in secondary/tertiary HPT versus primary HPT may reflect physiologic as well as radiopharmaceutical kinetic differences between multigland hyperplasia versus adenoma. The aim of this study was to review the performance of PS in secondary/tertiary HPT with a comparison to that for primary HPT. Moreover, we evaluated (1) the sensitivity of PS in detecting enlarged glands, and (2) PS detectability as a function of gland weight.
We performed a retrospective review of the Mayo Clinic database from 2000 to 2004. We identified 40 patients with secondary or tertiary HPT as well as a matched control group of 40 patients with primary HPT who had had preoperative PS and underwent parathyroid surgery.
Parathyroid scintigraphy correctly localized all enlarged glands in 88% of patients in the primary HPT group. PS correctly identified both the number and locations of all hyperplastic glands in only 28% of the secondary/tertiary HPT patients. PS failed to identify one enlarged gland in 23% of the patients and two or more enlarged glands in 40% of the patients. PS correctly detects the largest gland in 88% of the patients with secondary and tertiary HPT. The mean gland weight detectable by PS was 612 +/- 120 mg for primary HPT. In secondary/tertiary HPT, glands detected by PS had a mean weight of 950 +/- 109 mg, whereas the mean weight was 276 +/- 34 mg for undetected glands (P < 0.002).
Parathyroid scintigraphy is a sensitive study for localizing parathyroid glands preoperatively in primary HPT patients. Its sensitivity is low in secondary and tertiary HPT patients. Thus PS has limited value as a preoperative localization study in secondary/tertiary HPT patients.
甲状旁腺闪烁显像（PS）可用于术前定位功能亢进的甲状旁腺。PS在继发性和三发性甲状旁腺功能亢进（HPT）中的表现尚未得到充分量化。PS在继发性/三发性HPT与原发性HPT中的表现可能反映了多腺体增生与腺瘤之间的生理以及放射性药物动力学差异。本研究的目的是回顾PS在继发性/三发性HPT中的表现，并与原发性HPT进行比较。此外，我们评估了（1）PS检测增大腺体的敏感性，以及（2）PS检测能力与腺体重量的关系。
我们对梅奥诊所2000年至2004年的数据库进行了回顾性研究。我们确定了40例继发性或三发性HPT患者以及40例原发性HPT患者的匹配对照组，这些患者均接受了术前PS检查并接受了甲状旁腺手术。
甲状旁腺闪烁显像在原发性HPT组88%的患者中正确定位了所有增大的腺体。PS仅在28%的继发性/三发性HPT患者中正确识别了所有增生腺体的数量和位置。PS在23%的患者中未能识别出一个增大的腺体，在40%的患者中未能识别出两个或更多增大的腺体。PS在88%的继发性和三发性HPT患者中正确检测出最大的腺体。PS可检测到的原发性HPT腺体平均重量为612±120毫克。在继发性/三发性HPT中，PS检测到的腺体平均重量为950±109毫克，而未检测到的腺体平均重量为276±34毫克（P<0.002）。
甲状旁腺闪烁显像对于原发性HPT患者术前甲状旁腺定位是一项敏感的检查。其在继发性和三发性HPT患者中的敏感性较低。因此，PS作为继发性/三发性HPT患者术前定位检查的价值有限。
