van der Vorst Joost R, Schaafsma Boudewijn E, Verbeek Floris P R, Swijnenburg Rutger-Jan, Tummers Quirijn R J G, Hutteman Merlijn, Hamming Jaap F, Kievit Job, Frangioni John V, van de Velde Cornelis J H, Vahrmeijer Alexander L
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Head Neck. 2014 Jun;36(6):853-8. doi: 10.1002/hed.23384. Epub 2013 Oct 4.
Intraoperative identification of parathyroid adenomas can be challenging. We hypothesized that low-doses methylene blue (MB) and near-infrared fluorescence (NIRF) imaging could be used to identify parathyroid adenomas intraoperatively.
MB was injected intravenously after exploration at a dose of 0.5 mg/kg into 12 patients who underwent parathyroid surgery. NIRF imaging was performed using the Mini-FLARE imaging system.
In 10 of 12 patients, histology confirmed a parathyroid adenoma. In 9 of these patients, NIRF could clearly identify the parathyroid adenoma during surgery. Seven of these 9 patients had a positive preoperative (99m) Tc-sestamibi single photon emission CT (SPECT) scan. Importantly, in 2 patients, parathyroid adenomas could be identified only using NIRF.
This is the first study to show that low-dose MB can be used as NIRF tracer for identification of parathyroid adenomas, and suggests a correlation with preoperative (99m) Tc-sestamibi SPECT scanning.
术中识别甲状旁腺腺瘤具有挑战性。我们推测低剂量亚甲蓝（MB）和近红外荧光（NIRF）成像可用于术中识别甲状旁腺腺瘤。
在12例接受甲状旁腺手术的患者探查后，以0.5mg/kg的剂量静脉注射MB。使用Mini-FLARE成像系统进行NIRF成像。
12例患者中有10例经组织学证实为甲状旁腺腺瘤。其中9例患者在手术期间NIRF能够清晰识别甲状旁腺腺瘤。这9例患者中有7例术前（99m）锝-司他比单光子发射计算机断层扫描（SPECT）扫描呈阳性。重要的是，有2例患者仅使用NIRF就能识别甲状旁腺腺瘤。
这是第一项表明低剂量MB可作为NIRF示踪剂用于识别甲状旁腺腺瘤的研究，并提示其与术前（99m）锝-司他比SPECT扫描存在相关性。
