术前甲状旁腺闪烁显像的最佳解释策略。

From the *Department of Radiology, University of California, San Diego, CA; †Department of Radiology, Baylor University Medical Center, Dallas, TX; and ‡Center for Clinical Excellence, BJC HealthCare, St Louis, MO.

Clin Nucl Med. 2015 Feb;40(2):116-22. doi: 10.1097/RLU.0000000000000626.

PURPOSE

Our objective was to retrospectively compare various scintigraphic methods to determine their relative accuracies and interobserver variabilities in preoperative localization of single-gland disease in patients with primary hyperparathyroidism.

PATIENTS AND METHODS

We studied 292 patients who underwent preoperative parathyroid scintigraphy and surgical resection between June 2002 and September 2008. Imaging included early and delayed pinhole Tc-MIBI imaging (including anterior oblique images), similar I imaging, and MIBI SPECT. Seven different imaging combinations were assessed as follows: early MIBI only, delayed MIBI only, comparison of dual-phase early and delayed MIBI, visual subtraction of early MIBI and I images, all planar images, SPECT only, and all planar and SPECT images (ALL). Each data set was reviewed by 2 of 4 experienced nuclear physicians without knowledge of clinical information or final diagnosis. Imaging results were compared with surgical outcomes.

RESULTS

The accuracy of ALL imaging for delineating abnormal/normal parathyroid glands by quadrant was 96%, 93%, 95%, and 95% for the 4 readers. The accuracies of visual subtraction of early MIBI and I images and all planar images were not significantly different from ALL for all 4 readers. All planar and SPECT images were significantly more accurate than early MIBI only, delayed MIBI only, or SPECT only for all 4 readers and better than comparison of dual-phase early and delayed MIBI for 3 of 4 readers.

CONCLUSIONS

A rigorous combination of multiple imaging approaches yielded high accuracies across multiple readers for localization of a single offending parathyroid gland, but a more limited technique using MIBI/I subtraction imaging with anterior and anterior oblique pinhole images provided similarly high accuracy and limited interobserver variation of accuracy.

目的

本研究旨在回顾性比较各种闪烁显像方法，以确定它们在术前定位原发性甲状旁腺功能亢进患者单发性腺体疾病中的相对准确性和观察者间变异性。

方法

我们研究了 292 例于 2002 年 6 月至 2008 年 9 月期间接受术前甲状旁腺闪烁显像和手术切除的患者。成像包括早期和延迟针孔 Tc-MIBI 成像（包括前斜位图像）、相似 I 成像和 MIBI SPECT。评估了七种不同的成像组合如下：早期 MIBI 仅、延迟 MIBI 仅、双时相早期和延迟 MIBI 比较、早期 MIBI 与 I 图像的视觉减影、所有平面图像、SPECT 仅、所有平面和 SPECT 图像（ALL）。每个数据集由 4 位经验丰富的核医学医师中的 2 位进行评估，他们不知道临床信息或最终诊断。将成像结果与手术结果进行比较。

结果

ALL 成像在通过象限划定异常/正常甲状旁腺方面的准确性为 96%、93%、95%和 95%，4 位读者的准确率相似。早期 MIBI 和 I 图像的视觉减影以及所有平面图像的准确性与 ALL 相比在所有 4 位读者中均无显著差异。所有平面和 SPECT 图像均显著优于早期 MIBI 仅、延迟 MIBI 仅或 SPECT 仅，在 4 位读者中均优于双时相早期和延迟 MIBI 比较，在 3 位读者中优于双时相早期和延迟 MIBI 比较。