Harris Luke, Yoo John, Driedger Albert, Fung Kevin, Franklin Jason, Gray Daryl, Holliday Ronald
Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Head Neck. 2008 Apr;30(4):509-17. doi: 10.1002/hed.20727.
This study evaluated the accuracy of single photon emission computed tomography (SPECT)-CT imaging for the preoperative localization of parathyroid adenomas.
This study included both a quantitative and qualitative accuracy measure. The quantitative measure was the distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively. Qualitatively, surgeons were asked whether or not the adenoma was in the exact location predicted by the SPECT-CT scan. The time from initial incision to identification of the parathyroid was recorded. Patients referred to London Health Sciences Centre for a suspected parathyroid adenoma were eligible for this study.
Twenty-three patients participated in this study. Eighteen (78.3%) had a single adenoma, 2 (8.7%) had double adenomas, and 3 (13.0%) had multiglandular hyperplasia. SPECT-CT correctly detected and localized 16 of 18 (88.9%) cases of single parathyroid adenomas. The mean distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively was 16.3 mm (95% < or = 19.0 mm). For single adenomas, the median time from skin incision to identification was 14 minutes (range, 8-40 minutes). The preoperative detection and localization of a single focus of sestamibi uptake yielded a parathyroid adenoma in the specified location in 80.0% of cases (95% CI, 97.4-66.5%).
SPECT-CT predicted the intraoperative location of a single parathyroid adenoma within 19.0 mm with 95% confidence. The correct detection and localization of multiglandular disease remains difficult.
本研究评估了单光子发射计算机断层扫描（SPECT）-CT成像在甲状旁腺腺瘤术前定位中的准确性。
本研究包括定量和定性准确性测量。定量测量是SPECT-CT扫描上腺瘤位置与术中腺瘤位置之间的距离。定性方面，询问外科医生腺瘤是否在SPECT-CT扫描预测的准确位置。记录从最初切口到识别甲状旁腺的时间。转诊至伦敦健康科学中心怀疑患有甲状旁腺腺瘤的患者符合本研究条件。
23名患者参与了本研究。18名（78.3%）有单个腺瘤，2名（8.7%）有两个腺瘤，3名（13.0%）有多发性腺体增生。SPECT-CT正确检测并定位了18例单个甲状旁腺腺瘤中的16例（88.9%）。SPECT-CT扫描上腺瘤位置与术中腺瘤位置之间的平均距离为16.3毫米（95%≤19.0毫米）。对于单个腺瘤，从皮肤切口到识别的中位时间为14分钟（范围8 - 40分钟）。术前检测并定位单个锝[99mTc]甲氧基异丁基异腈摄取灶在80.0%的病例中（95%CI，97.4 - 66.5%）产生了指定位置的甲状旁腺腺瘤。
SPECT-CT以95%的置信度预测单个甲状旁腺腺瘤的术中位置在19.0毫米范围内。对多腺体疾病的正确检测和定位仍然困难。
