Wimmer Gerd, Bale Reto, Kovacs Peter, Gabriel Michael, Putzer Daniel, Sauper Tonja, Sieb Michael, Profanter Christoph, Margreiter Raimund, Prommegger Rupert
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Anichstrasse 35, 6020, Innsbruck, Austria.
Langenbecks Arch Surg. 2008 Sep;393(5):687-92. doi: 10.1007/s00423-008-0359-6. Epub 2008 Jun 25.
In surgery for primary hyperparathyroidism, preoperative localization together with intraoperative parathyroid hormone assay is important when minimal invasive operations of the parathyroid glands are intended. In cases of reoperation, correct localization of the abnormal parathyroid glands is extremely instrumental. Computed tomography (CT)-(99m)Tc-sestamibi (MIBI)-single photon emission computed tomography (SPECT) image fusion allows for a virtual exploration of the neck by showing the suspected gland three-dimensionally with all the anatomic landmarks in correct position. The aim of this study was to evaluate whether CT-MIBI-SPECT image fusion is superior to MIBI-SPECT alone in detecting abnormal parathyroid glands in patients with previous neck surgery.
In a prospective study, CT-MIBI-SPECT image fusion for preoperative localization was performed in 28 patients with hyperparathyroidism and previous neck surgery. Twenty-one patients had thyroidectomy and seven patients had surgery for hyperparathyroidism. The results of MIBI-SPECT alone and CT-MIBI-SPECT image fusion were compared in these patients. The outcome and the exact predicted position, not just the predicted side, were correlated with intraoperative findings.
CT-MIBI-SPECT image fusion was able to predict the exact position of the abnormal gland in 24 of 28 patients (86%), whereas MIBI-SPECT alone was successful in 12 of 28 cases (43%, p < 0.004) only. CT-MIBI-SPECT image fusion detected all three pathologic glands in their ectopic position. With MIBI-SPECT alone, just one ectopic pathologic gland was found.
This study provides evidence that CT-MIBI-SPECT image fusion is superior to MIBI-SPECT alone in preoperative localization of enlarged parathyroid glands in patients with hyperparathyroidism and previous neck surgery. This should be kept in mind if the results are compared to earlier studies concerning CT-MIBI-SPECT image fusion.
在原发性甲状旁腺功能亢进症的手术中，若打算进行甲状旁腺的微创操作，术前定位以及术中甲状旁腺激素检测很重要。在再次手术的病例中，正确定位异常甲状旁腺极其关键。计算机断层扫描（CT）-（99m）锝-甲氧基异丁基异腈（MIBI）-单光子发射计算机断层扫描（SPECT）图像融合通过以正确位置显示所有解剖标志的三维方式，对颈部进行虚拟探查。本研究的目的是评估CT-MIBI-SPECT图像融合在检测既往有颈部手术史患者的异常甲状旁腺方面是否优于单独的MIBI-SPECT。
在一项前瞻性研究中，对28例患有甲状旁腺功能亢进症且既往有颈部手术史的患者进行了CT-MIBI-SPECT图像融合以进行术前定位。21例患者接受了甲状腺切除术，7例患者接受了甲状旁腺功能亢进症手术。对这些患者单独的MIBI-SPECT结果与CT-MIBI-SPECT图像融合结果进行了比较。结果以及确切的预测位置，而非仅仅是预测的一侧，与术中发现相关。
CT-MIBI-SPECT图像融合能够在28例患者中的24例（86%）中预测异常腺体的确切位置，而单独的MIBI-SPECT仅在28例中的12例（43%，p<0.004）中成功。CT-MIBI-SPECT图像融合检测到所有三个异位位置的病理性腺体。仅通过MIBI-SPECT，仅发现了一个异位病理性腺体。
本研究提供的证据表明，在既往有颈部手术史的甲状旁腺功能亢进症患者中，CT-MIBI-SPECT图像融合在术前定位增大的甲状旁腺方面优于单独的MIBI-SPECT。如果将结果与早期关于CT-MIBI-SPECT图像融合的研究进行比较，应牢记这一点。
