间碘苄胍闪烁扫描术在嗜铬细胞瘤诊断中的临床应用和价值。

Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Endocr Pract. 2010 May-Jun;16(3):398-407. doi: 10.4158/EP09302.OR.

OBJECTIVE

To examine the indications for metaiodobenzylguanidine (MIBG) scintigraphy and to assess its performance in localizing pheochromocytoma in the post-computed tomography and magnetic resonance imaging era.

METHODS

In this retrospective study, electronic and paper medical records of patients who underwent MIBG scintigraphy at a large academic hospital in Los Angeles, California, between January 1995 and July 2009 were reviewed for indications for MIBG scintigraphy, clinical history, biochemical test results, findings from imaging studies, and pathologic diagnoses. MIBG score was defined as follows: 3 (or intensive uptake) meant MIBG uptake of adrenal gland or other locus was higher than that of the liver; 2 (or moderate uptake) meant uptake was similar to that of the liver; 1 (or borderline uptake) meant uptake was lower than that of liver; and 0 (or negative uptake) meant background signal.

RESULTS

Ninety-eight patients underwent MIBG scintigraphy during the study period; the indication was suspected pheochromocytoma in 75 cases. Pheochromocytoma diagnosis was excluded in 48 and confirmed in 15. The remaining 12 patients had insufficient information in the medical records to render a diagnosis. Among the 63 patients, 47 received 131I-MIBG and 16 received 123I-MIBG. Sensitivity was 73% and specificity was 69% if any adrenal uptake was considered positive, but increased to 90% if borderline uptake was considered negative. False results were more common in younger patients, but not correlated with biochemical test results. In patients with pheochromocytoma either excluded or confirmed, the MIBG scintigraphy results were confirmatory in 63%, but misleading in 37%. MIBG scintigraphy results did not provide additional diagnostic value to any case and contributed to pheochromocytoma overdiagnosis and even unnecessary adrenalectomy.

CONCLUSIONS

MIBG scintigraphy results are either confirmatory or misleading, and this imaging modality is not necessary for most patients in modern practice.

目的

探讨间碘苄胍（MIBG）闪烁扫描的适应证，并评价其在 CT 和 MRI 后时代定位嗜铬细胞瘤的作用。

方法

本回顾性研究分析了 1995 年 1 月至 2009 年 7 月在加利福尼亚州洛杉矶一家大型学术医院行 MIBG 闪烁扫描的患者的电子和纸质病历，内容包括 MIBG 闪烁扫描的适应证、临床病史、生化检查结果、影像学检查结果和病理诊断。MIBG 评分定义如下：3 分（或浓聚）表示肾上腺或其他部位摄取 MIBG 高于肝脏；2 分（或中度摄取）表示摄取与肝脏相似；1 分（或边界摄取）表示摄取低于肝脏；0 分（或无摄取）表示背景信号。

结果

研究期间共有 98 例患者行 MIBG 闪烁扫描，75 例的适应证为疑似嗜铬细胞瘤。48 例排除嗜铬细胞瘤诊断，15 例得到证实。其余 12 例的病历中缺乏诊断信息。在 63 例患者中，47 例接受 131I-MIBG 治疗，16 例接受 123I-MIBG 治疗。如果任何肾上腺摄取被认为是阳性，则敏感性为 73%，特异性为 69%；但如果边界摄取被认为是阴性，则敏感性增加至 90%。年轻患者中假阳性结果更为常见，但与生化检查结果无关。在排除或确诊的嗜铬细胞瘤患者中，MIBG 闪烁扫描结果有 63%为证实性，但有 37%为误导性。MIBG 闪烁扫描结果对任何病例均无额外诊断价值，导致嗜铬细胞瘤过度诊断甚至不必要的肾上腺切除术。