Koljević Marković Ana, Janković Milica M, Marković Ivan, Pupić Gordana, Džodić Radan, Delaloye Angelika Bischof
Department of Nuclear Medicine, National Cancer Research Center of Serbia, Pasterova 14, 11000, Belgrade, Serbia,
Ann Nucl Med. 2014 Oct;28(8):736-45. doi: 10.1007/s12149-014-0867-0. Epub 2014 Jun 20.
The aim was quantitative assessment of parathyroid adenoma (PTA) uptake in dual tracer dynamic scintigraphy.
In 78 patients, median age 58 (19-80) years, surgically treated for primary hyperparathyroidism (PHPT), with parathyroid hormone median 125 (70-658) pg/ml, we performed preoperative parathyroid scintigraphy, following EANM guidelines of subtraction and double-phase protocol (2009) using two tracers: Tc-99m pertechnetate and Tc-99m MIBI. In addition to standard subtraction processing and visual interpretation of delayed MIBI planar images of neck and mediastinum in oblique sections (positions according to ultrasound PTA localisation), we developed Submarine processing software that enables selecting custom regions grid sizes ≥6 mm (as this solution was not present in commercial software) to follow time activity curve changes in thyroid tissue and PTA. Histopathology in 53/78 patients revealed PHPT and in 25/78 patients thyroid nodular disease only, and thyroid malignancy occurred in total of 15/78 (19 %) patients. PHPT group included 44 solitary PTA, 8 patients with hyperplasia and one parathyroid carcinoma. The median macroscopic volume of PTA was 717.5 (15-6125) mm(3). Concomitant PHPT and thyroid nodular disease occurred in 24/53 patients and among them 8 patients had thyroid malignancies.
PTA showed typical pattern of late peak on time activity curves characterized by median start time on 15 (10-25) min, the peak amplitude mean 19 (±5) % above thyroid declining washout curve, and duration of peak 6 (4-10) min, allowing PTA to "emerge" like submarine, independent from thyroid tissue and lesions. The ratio of PTA-to-normal thyroid uptake at peak maximum was 1.35 (±0.21). The thyroid TACs results of normal 29/78 (37 %) patients, benign nodular 34/78 (44 %) patients, and malignancy in 15 (19 %) patients were all presented by declining exponential curves. The slope analysis of TACs in normal thyroid tissue, thyroid benign and malignant lesions (linear fitted logarithm of TAC) showed no difference (the same negative slope: -0.04). Submarine processing was sensitive in detection of small lesions, in hyperplasia, and concomitant thyroid nodular disease.
The novel Submarine processing confirmed specific PHPT pattern and was effective in the group with potential pitfalls of standard interpretation, increasing sensitivity and specificity of standard processing subtraction algorithm. Prolonged MIBI accumulation was present in malignant as well as benign thyroid nodules with identical TAC slope.
本研究旨在对双示踪剂动态闪烁显像中甲状旁腺腺瘤（PTA）摄取情况进行定量评估。
对78例年龄中位数为58岁（19 - 80岁）、因原发性甲状旁腺功能亢进症（PHPT）接受手术治疗、甲状旁腺激素中位数为125 pg/ml（70 - 658 pg/ml）的患者，按照欧洲核医学与分子影像协会（EANM）2009年减法和双时相方案指南，使用两种示踪剂：高锝[Tc-99m]酸盐和锝[Tc-99m]甲氧基异丁基异腈（MIBI）进行术前甲状旁腺闪烁显像。除了对颈部和纵隔的延迟MIBI平面图像进行标准减法处理和斜位（根据超声定位PTA的位置）视觉解读外，我们还开发了“潜艇”处理软件，该软件能够选择≥6 mm的自定义区域网格大小（因为商业软件中没有此解决方案），以跟踪甲状腺组织和PTA中的时间 - 活性曲线变化。78例患者中，53例经组织病理学检查确诊为PHPT，25例仅患有甲状腺结节性疾病，15例（19%）患者患有甲状腺恶性肿瘤。PHPT组包括44例孤立性PTA、8例增生患者和1例甲状旁腺癌。PTA的中位宏观体积为717.5 mm³（15 - 6125 mm³）。24/53例患者同时患有PHPT和甲状腺结节性疾病，其中8例患者患有甲状腺恶性肿瘤。
PTA在时间 - 活性曲线上呈现典型的晚期峰值模式，其特征为中位起始时间为15分钟（10 - 25分钟），峰值幅度比甲状腺下降洗脱曲线平均高19%（±5%），峰值持续时间为6分钟（4 - 10分钟），使得PTA能够像潜艇一样“浮现”，独立于甲状腺组织和病变。峰值时PTA与正常甲状腺摄取的比值为1.35（±0.21）。78例患者中，29例（37%）正常甲状腺、34例（44%）良性结节性甲状腺以及15例（19%）恶性甲状腺患者的甲状腺时间 - 活性曲线（TACs）结果均呈现指数下降曲线。正常甲状腺组织、甲状腺良性和恶性病变的TACs斜率分析（TAC的线性拟合对数）显示无差异（相同的负斜率：-0.04）。“潜艇”处理在检测小病变、增生以及合并甲状腺结节性疾病方面具有较高的敏感性。
新型“潜艇”处理方法证实了PHPT的特定模式，在标准解读存在潜在缺陷的人群中有效，提高了标准处理减法算法的敏感性和特异性。恶性和良性甲状腺结节中均存在MIBI长时间积聚，且TAC斜率相同。
