虚拟颈部探查：一种定位异常甲状旁腺的新方法。

Virtual neck exploration: a new method for localizing abnormal parathyroid glands.

作者信息

Prommegger Rupert, Wimmer Gerd, Profanter Christoph, Sauper Tonja, Sieb Michael, Kovacs Peter, Bale Reto, Putzer Daniel, Gabriel Michael, Margreiter Raimund

机构信息

Department of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.

出版信息

Ann Surg. 2009 Nov;250(5):761-5. doi: 10.1097/SLA.0b013e3181bd906b.

DOI:10.1097/SLA.0b013e3181bd906b

PMID:19806053

Abstract

BACKGROUND DATA

Computed tomography (CT) together with 99mTc-sestamibi single photon emission computed tomography (MIBI-SPECT) image fusion (CT-MIBI-SPECT image fusion) allows virtual exploration of the neck. The aim of this study was to evaluate whether CT-MIBI-SPECT image fusion is superior to MIBI-SPECT and CT in detecting abnormal parathyroid glands in patients with primary hyperparathyroidism.

METHODS

CT-MIBI-SPECT image fusion for preoperative localization was performed in 116 patients with primary hyperparathyroidism (pHPT). Both investigations were performed with reproducible fixation of the patient on a vacuum mattress. At a special work station the neck was virtually explored by viewing the CT images in all 3 dimensions. The MIBI-SPECT images were superimposed on underlying CT images. Only patients with single-gland disease were evaluated (pHPT: 112, persistent pHPT: 1, recurrent pHPT: 1, persistent secondary hyperparathyroidism: 1, tertiary HPT after kidney transplantation: 1). CT-MIBI-SPECT image fusion results were compared with those obtained with CT alone and MIBI-SPECT alone. The predicted positions were correlated with the intraoperative findings.

RESULTS

CT-MIBI-SPECT image fusion was able to predict the exact position of the abnormal gland in 102 (88%) of the 116 patients, whereas CT alone showed in 75 (65%) patients and MIBI-SPECT alone in 64 (55%) patients the exact position of the abnormal gland. Sixty-two patients underwent minimally invasive surgery, namely in 21 patients with a unilaterally focused approach and in 33 patients with a bilateral approach (27 of these underwent simultaneous thyroid resection). Sensitivity for CT-MIBI-SPECT image fusion was 88%, for CT alone 70%, and for MIBI-SPECT alone 59%. Specificity for CT-MIBI-SPECT image fusion was 99%, for MIBI-SPECT alone 95%, for CT alone 94%. Overall accuracy for CT-MIBI-SPECT image fusion was 97%, for CT alone 89%, for MIBI-SPECT 87%.

CONCLUSIONS

This study provides evidence that CT-MIBI-SPECT image fusion is superior to CT or MIBI-SPECT alone for preoperative localization of enlarged parathyroid glands in patients with single-gland primary hyperparathyroidism.

摘要

背景资料

计算机断层扫描（CT）与99mTc-甲氧基异丁基异腈单光子发射计算机断层扫描（MIBI-SPECT）图像融合（CT-MIBI-SPECT图像融合）可实现对颈部的虚拟探查。本研究的目的是评估CT-MIBI-SPECT图像融合在检测原发性甲状旁腺功能亢进患者异常甲状旁腺方面是否优于MIBI-SPECT和CT。

方法

对116例原发性甲状旁腺功能亢进（pHPT）患者进行CT-MIBI-SPECT图像融合以进行术前定位。两项检查均在患者可重复固定于真空床垫上的情况下进行。在一个特殊的工作站，通过在所有三个维度查看CT图像对颈部进行虚拟探查。将MIBI-SPECT图像叠加在基础CT图像上。仅对单腺疾病患者进行评估（pHPT：112例，持续性pHPT：1例，复发性pHPT：1例，持续性继发性甲状旁腺功能亢进：1例，肾移植后三发性甲状旁腺功能亢进：1例）。将CT-MIBI-SPECT图像融合结果与单独使用CT和单独使用MIBI-SPECT获得的结果进行比较。预测位置与术中发现相关。

结果

CT-MIBI-SPECT图像融合能够在116例患者中的102例（88%）中预测异常腺体的准确位置，而单独使用CT在75例（65%）患者中显示异常腺体的准确位置，单独使用MIBI-SPECT在64例（55%）患者中显示异常腺体的准确位置。62例患者接受了微创手术，其中21例采用单侧聚焦方法，33例采用双侧方法（其中27例同时进行了甲状腺切除术）。CT-MIBI-SPECT图像融合的敏感性为88%，单独使用CT为70%，单独使用MIBI-SPECT为59%。CT-MIBI-SPECT图像融合的特异性为99%，单独使用MIBI-SPECT为95%，单独使用CT为94%。CT-MIBI-SPECT图像融合的总体准确率为97%，单独使用CT为89%，MIBI-SPECT为87%。