1 Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, 95 Yong An Rd, XiCheng District, Beijing 100050, PR China.
AJR Am J Roentgenol. 2014 Jan;202(1):180-4. doi: 10.2214/AJR.13.11053.
Surgical intervention in the form of parathyroidectomy is generally considered only for severe secondary hyperparathyroidism (sHPT). However, correct location of the parathyroid glands before parathyroidectomy is a challenge. The purpose of this study was to compare the diagnostic value of early and delayed phase (99m)Tc-sestamibi SPECT/CT in the detection of parathyroid tissue to guide operative treatment of patients with sHPT.
Eighty patients with sHPT who were undergoing hemodialysis were evaluated preoperatively with dual-phase (99m)Tc-sestamibi SPECT/CT parathyroid scintigraphy to locate parathyroid tissue before parathyroidectomy. The scintigraphic results were classified as positive or negative. The accuracy of (99m)Tc sestamibi early and delayed phase SPECT/CT scintigraphy was determined.
Early phase (99m)Tc-sestamibi SPECT/CT depicted 3.57 parathyroid glands (PTGs) and delayed phase (99m)Tc-sestamibi SPECT/CT depicted 3.55 PTGs per study. The specificity of both early and delayed phase (99m)Tc-sestamibi SPECT/CT in detecting PTGs was 100%. The (99m)Tc-sestamibi SPECT/CT images of 7 of 80 patients showed positive findings in the delayed phase and negative findings in the early phase. The (99m)Tc-sestamibi SPECT/CT images of 6 of 80 patients showed positive findings in the early phase and negative findings in the delayed phase.
The results of our study indicate that both early and delayed phase (99m)Tc-sestamibi SPECT/CT should be performed in the preoperative evaluation of hemodialysis patients with sHPT due to chronic kidney disease. Performance of both early and delayed phase (99m)Tc-sestamibi SPECT/CT did not increase the radiation dose compared with the use of only the early or the delayed phase.
甲状旁腺切除术形式的手术干预通常仅被认为适用于严重的继发性甲状旁腺功能亢进症（sHPT）。然而，甲状旁腺在甲状旁腺切除术之前的正确定位是一个挑战。本研究的目的是比较早期和延迟期（99m）Tc-甲氧基异丁基异腈 SPECT/CT 在检测甲状旁腺组织以指导 sHPT 患者手术治疗中的诊断价值。
80 名接受血液透析的 sHPT 患者在手术前接受双期（99m）Tc-甲氧基异丁基异腈 SPECT/CT 甲状旁腺闪烁显像术以定位甲状旁腺组织。将闪烁显像结果分类为阳性或阴性。确定（99m）Tc 甲氧基异丁基异腈早期和延迟期 SPECT/CT 闪烁显像的准确性。
早期（99m）Tc-甲氧基异丁基异腈 SPECT/CT 描绘了 3.57 个甲状旁腺（PTG），延迟期（99m）Tc-甲氧基异丁基异腈 SPECT/CT 描绘了每个研究中的 3.55 个 PTG。早期和延迟期（99m）Tc-甲氧基异丁基异腈 SPECT/CT 检测 PTG 的特异性均为 100%。80 名患者中的 7 名患者的（99m）Tc-甲氧基异丁基异腈 SPECT/CT 图像在延迟期呈阳性，而在早期呈阴性。80 名患者中的 6 名患者的（99m）Tc-甲氧基异丁基异腈 SPECT/CT 图像在早期呈阳性，而在延迟期呈阴性。
我们的研究结果表明，由于慢性肾脏病，接受血液透析的 sHPT 患者在术前评估中应同时进行早期和延迟期（99m）Tc-甲氧基异丁基异腈 SPECT/CT。与仅使用早期或延迟期相比，进行早期和延迟期（99m）Tc-甲氧基异丁基异腈 SPECT/CT 不会增加辐射剂量。
