术中99mTc-MIBI引导检测继发性甲状旁腺功能亢进中的异位腺体

Intraoperative 99mTc-MIBI-guided detection of ectopic glands in secondary hyperparathyroidism.

作者信息

Takeyama Hiroshi, Shioya Hisashi, Ogi Shigeyuki, Yokoyama Keitaro, Yamamoto Hiroyasu, Odaka Makoto, Sato Shuji, Kinoshita Satoki, Uchida Ken, Morikawa Toshiaki

机构信息

Department of Surgery, The Jikei University School of Medicine, Nishi-sinbashi, Tokyo, Japan.

出版信息

Int Surg. 2009 Apr-Jun;94(2):154-63.

PMID:20108620

Abstract

99mTc-MIBI-guided detection of abnormal parathyroid glands in primary hyperparathyroidism (1-HPT) has become a popular and effective technique, but its efficacy for detecting the ectopic glands of secondary hyperparathyroidism (2-HPT) is still controversial. Of the 2-HPT cases from 2000 to 2004, 14 ectopic parathyroid glands in 11 patients were resected using intraoperative 99mTc-MIBI scintigraphy. We evaluated and compared the results of radioguided surgery with the preoperative findings from ultrasonography (US), computed tomography (CT), and scintigraphy. The overall results for intraoperative 99mTc-MIBI-guided detection of ectopic parathyroid glands were sensitivity of 100% (14/14) and accuracy of 84.2% (16/19) compared with 42.9% (6/14) and 31.6% (6/19), respectively, for preoperative US and 50.0% (6/12) and 42.9% (6/14), respectively, for preoperative 99mTc-MIBI scintigraphy. Using intraoperative 99mTc-MIBI-guided surgery in cases of 2-HPT will ensure all ectopic parathyroid glands are detected, making the surgery easier to perform and the outcome more successful.

摘要

99mTc-MIBI引导下检测原发性甲状旁腺功能亢进症（1-HPT）中异常甲状旁腺已成为一种流行且有效的技术，但其检测继发性甲状旁腺功能亢进症（2-HPT）异位甲状旁腺的功效仍存在争议。在2000年至2004年的2-HPT病例中，对11例患者的14个异位甲状旁腺进行了术中99mTc-MIBI闪烁扫描切除。我们评估并比较了放射性引导手术的结果与术前超声（US）、计算机断层扫描（CT）和闪烁扫描的结果。术中99mTc-MIBI引导检测异位甲状旁腺的总体结果为敏感性100%（14/14）、准确性84.2%（16/19），相比之下，术前US的敏感性和准确性分别为42.9%（6/14）和31.6%（6/19），术前99mTc-MIBI闪烁扫描的敏感性和准确性分别为50.0%（6/12）和42.9%（6/14）。在2-HPT病例中使用术中99mTc-MIBI引导手术将确保检测到所有异位甲状旁腺，使手术更易于实施且结果更成功。