Shafiei Babak, Hoseinzadeh Samaneh, Fotouhi Fereidoun, Malek Hadi, Azizi Fereidoun, Jahed Adel, Hadaegh Farzad, Salehian Mohammadtaghi, Parsa Hossein, Javadi Hamid, Assadi Majid
Department of Nuclear Medicine, Erfan Hospital, Iran.
Nucl Med Commun. 2012 Oct;33(10):1070-6. doi: 10.1097/MNM.0b013e32835710b6.
Investigations using a hybrid single photon emission computed tomography/computed tomography (SPECT-CT) scanning technique have been carried out in limited studies and have shown mixed results. However, the assessment of this technique for the detection of parathyroid adenoma in patients with a nodular goiter was performed in only one study with a small sample size. The aim of this prospective study was to assess the role of 99mTc-sestamibi parathyroid SPECT-CT scans for localization of parathyroid adenomas with a concomitant nodular goiter using 99mTc-methoxyisobutyl isonitrile (MIBI) scintigraphy and to compare it with SPECT and planar imaging.
This study was conducted on 48 patients with primary hyperparathyroidism and nodular goiter, who were candidates for parathyroid surgery and had been referred for parathyroid scintigraphy. The patients underwent an early set of planar 99mTc-MIBI scanning procedures first, followed by SPECT and CT scannings, and finally a delayed set of planar 99mTc-MIBI scannings. Sensitivity, specificity, negative and positive predictive values, and accuracy were determined on a per-parathyroid-gland basis for each scanning method, as defined by histology and follow-up.
The surgery was successful in 48 out of 50 patients with primary hyperparathyroidism concomitant with thyroid nodularity, and data were completed for 80 sites in 48 patients. The accuracy of SPECT-CT in correctly identifying a parathyroid adenoma was 85.00, versus 75.00% for SPECT (P=0.01, significant). The sensitivity and specificity for SPECT-CT were 77.55 and 96.77%, respectively, versus 67.34 and 87.09%, respectively, for SPECT (P=0.12 and 0.12, not significant). There were nine sites that showed better localization on SPECT-CT scans relative to SPECT images, of which five sites were located in the ectopic regions.
The results of our study indicate that SPECT-CT is more accurate than sestamibi planar imaging and SPECT for the preoperative identification of parathyroid lesions in patients with primary hyperparathyroidism concomitant with thyroid nodularity. Also, we would recommend the use of SPECT-CT for a workup of all patients with ectopic glands who are scheduled for minimally invasive parathyroid surgery.
使用混合单光子发射计算机断层扫描/计算机断层扫描（SPECT-CT）扫描技术的研究开展有限，结果不一。然而，仅在一项小样本研究中对该技术在结节性甲状腺肿患者中检测甲状旁腺腺瘤进行了评估。这项前瞻性研究的目的是使用99m锝-甲氧基异丁基异腈（MIBI）闪烁显像评估99m锝-司他米比甲状旁腺SPECT-CT扫描在伴有结节性甲状腺肿的甲状旁腺腺瘤定位中的作用，并将其与SPECT和平面显像进行比较。
本研究对48例原发性甲状旁腺功能亢进合并结节性甲状腺肿的患者进行，这些患者均为甲状旁腺手术候选者且已被转诊进行甲状旁腺闪烁显像。患者首先接受一组早期的平面99m锝-MIBI扫描程序，随后进行SPECT和CT扫描，最后进行一组延迟的平面99m锝-MIBI扫描。根据组织学和随访结果，对每种扫描方法按每个甲状旁腺进行敏感性、特异性、阴性和阳性预测值以及准确性的测定。
50例原发性甲状旁腺功能亢进合并甲状腺结节的患者中有48例手术成功，48例患者的80个部位的数据完整。SPECT-CT正确识别甲状旁腺腺瘤的准确性为85.00%，而SPECT为75.00%（P=0.01，具有显著性）。SPECT-CT的敏感性和特异性分别为77.55%和96.77%，而SPECT分别为67.34%和87.09%（P=0.12和0.12，无显著性）。有9个部位在SPECT-CT扫描上的定位相对于SPECT图像更好，其中5个部位位于异位区域。
我们的研究结果表明，对于原发性甲状旁腺功能亢进合并甲状腺结节的患者，SPECT-CT在术前识别甲状旁腺病变方面比司他米比平面显像和SPECT更准确。此外，我们建议对所有计划进行微创甲状旁腺手术的异位腺体患者使用SPECT-CT进行检查。
