原发性甲状旁腺功能亢进症的术前123I/99mTc-司他比宁减影单光子发射计算机断层扫描及单光子发射计算机断层扫描/计算机断层扫描

Preoperative 123I/99mTc-sestamibi subtraction SPECT and SPECT/CT in primary hyperparathyroidism.

作者信息

Neumann Donald R, Obuchowski Nancy A, Difilippo Frank P

机构信息

Department of Nuclear Medicine, Cleveland Clinic Imaging Institute, Cleveland, Ohio, USA.

出版信息

J Nucl Med. 2008 Dec;49(12):2012-7. doi: 10.2967/jnumed.108.054858. Epub 2008 Nov 7.

DOI:10.2967/jnumed.108.054858

PMID:18997051

Abstract

UNLABELLED

The trend toward focused surgical parathyroidectomy requires precise preoperative localization of parathyroid lesions in patients with hyperparathyroidism. The purpose of this study was to directly compare the diagnostic accuracy of (99m)Tc-sestamibi/(123)I subtraction SPECT with SPECT/CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism.

METHODS

A total of 61 consecutive surgical patients with primary hyperparathyroidism underwent both (123)I/(99m)Tc-sestamibi subtraction SPECT and SPECT/CT scans preoperatively, using a hybrid SPECT/CT instrument that combined a dual-detector SPECT camera with a 6-slice multidetector spiral CT scanner. Four hours after being given (123)I-sodium iodide orally, each patient received (99m)Tc-sestamibi intravenously, followed immediately by a simultaneous, dual-isotope SPECT scan of the neck and upper chest. Then, without moving the patient, we performed a non-contrast-enhanced CT scan of the same body region. Normalization and subtraction of the (123)I SPECT images from the (99m)Tc SPECT images were performed. The subtraction SPECT and the coregistered fused SPECT/CT studies were interpreted separately, with images scored on a 5-point scale. Surgical and histopathologic findings were used as the standard of comparison.

RESULTS

Surgery was successful in 57 patients (solitary parathyroid adenoma in 48 patients, double parathyroid adenomas in 6 patients, and 10 hyperplastic parathyroid glands in 3 patients). The sensitivities of SPECT (50/70 = 71%) and SPECT/CT (49/70 = 70%) were similar (P = 0.779). The specificity of SPECT/CT (26/27 = 96%) was significantly greater than that of SPECT (13/27 = 48%; P = 0.006). The receiver-operating-characteristic area under the curve of SPECT/CT (0.833) was significantly greater than that of SPECT (0.632; P < 0.001).

CONCLUSION

SPECT/CT is significantly more specific than dual-isotope subtraction SPECT for the preoperative identification of parathyroid lesions in patients with primary hyperparathyroidism.

摘要

未标注

聚焦性甲状旁腺手术切除的趋势要求对甲状旁腺功能亢进患者的甲状旁腺病变进行精确的术前定位。本研究的目的是直接比较（99m）锝-甲氧基异丁基异腈/（123）碘减影单光子发射计算机断层扫描（SPECT）与SPECT/CT对原发性甲状旁腺功能亢进患者异常甲状旁腺的定位诊断准确性。

方法

共有61例连续接受手术的原发性甲状旁腺功能亢进患者术前均接受了（123）碘/（99m）锝-甲氧基异丁基异腈减影SPECT和SPECT/CT扫描，使用的是一台将双探测器SPECT相机与6层多探测器螺旋CT扫描仪相结合的SPECT/CT混合型仪器。口服（123）碘化钠4小时后，每位患者静脉注射（99m）锝-甲氧基异丁基异腈，随后立即对颈部和上胸部进行同步双同位素SPECT扫描。然后，在患者不移动的情况下，对同一身体区域进行非增强CT扫描。对（99m）锝SPECT图像进行归一化处理，并减去（123）碘SPECT图像。分别解读减影SPECT和配准融合的SPECT/CT图像，并按5分制对图像进行评分。手术和组织病理学结果用作比较标准。

结果

57例患者手术成功（48例为孤立性甲状旁腺腺瘤，6例为双发性甲状旁腺腺瘤，3例患者中有10个甲状旁腺增生）。SPECT（50/70 = 71%）和SPECT/CT（49/70 = 70%）的敏感性相似（P = 0.779）。SPECT/CT的特异性（26/27 = 96%）显著高于SPECT（13/27 = 48%；P = 0.006）。SPECT/CT的曲线下面积（0.833）显著大于SPECT（0.632；P < 0.001）。