Casáns-Tormo I, Prado-Wohlwend S, Díaz-Expósito R, Cassinello-Fernández N, Ortega-Serrano J
Servicio de Medicina Nuclear, Hospital Clínico Universitario, Valencia. España.
Servicio de Medicina Nuclear, Hospital Clínico Universitario, Valencia. España.
Rev Esp Med Nucl Imagen Mol. 2015 Mar-Apr;34(2):116-9. doi: 10.1016/j.remn.2014.11.005. Epub 2015 Jan 7.
Initial experience is presented by using freehand SPECT in the intraoperative radiolocalization of a parathyroid adenoma in 2 patients, one which was mediastinal. There is only one previous publication including 3 patients with parathyroid adenomas in usual parathyroid localizations. We also report for the first time a comparative assessment of results with portable gammacamera during the same surgery. In the operating room, we obtained images with portable gamma-camera and 3 D reconstruction with freehand SPECT from 15 min after iv injection of 5 mCi of (99m)Tc-MIBI. Both devices enabled the 2 adenomas to be detected intraoperatively, as well as checking activity of the excised gland and absence of significant uptake in surgical bed, with confirmation by intraoperative pre-postsurgical PTH levels, pathology and clinical follow-up for 10 months. Both devices accurately located the parathyroid adenomas intraoperatively, as well as confirmation of their extirpation, but freehand SPECT provided additional information of adenoma depth (mm) from the skin border, very useful for minimally invasive radio-guided surgery.
本文介绍了在2例患者中使用徒手单光子发射计算机断层扫描（SPECT）对甲状旁腺腺瘤进行术中放射性定位的初步经验，其中1例腺瘤位于纵隔。此前仅有一篇文献报道了3例位于甲状旁腺常见位置的甲状旁腺腺瘤患者。我们还首次报告了在同一手术过程中使用便携式伽马相机对结果进行的比较评估。在手术室中，静脉注射5毫居里（99m）锝-甲氧基异丁基异腈（Tc-MIBI）15分钟后，我们使用便携式伽马相机获取图像，并通过徒手SPECT进行三维重建。两种设备均能在术中检测到2个腺瘤，同时检查切除腺体的活性以及手术床有无明显摄取，并通过术中术后甲状旁腺激素（PTH）水平、病理检查及10个月的临床随访得以证实。两种设备均能在术中准确定位甲状旁腺腺瘤，并确认其已被切除，但徒手SPECT还提供了腺瘤距皮肤边缘深度（毫米）的额外信息，这对微创放射性引导手术非常有用。
