99mTc-司他米比SPECT/CT对甲状旁腺腺瘤的定位：一项荟萃分析

Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT: a meta-analysis.

作者信息

Wong Ka Kit, Fig Lorraine M, Gross Milton D, Dwamena Ben A

机构信息

aNuclear Medicine/Radiology Department, University of Michigan Hospital bNuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, Michigan, USA.

出版信息

Nucl Med Commun. 2015 Apr;36(4):363-75. doi: 10.1097/MNM.0000000000000262.

DOI:10.1097/MNM.0000000000000262

PMID:25642803

Abstract

PURPOSE

The aim of the study was to determine the diagnostic utility of parathyroid scintigraphy with technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) for localization of parathyroid adenoma.

MATERIALS AND METHODS

We performed a systematic search of medical databases PubMed and Medline/OVID for literature on 99mTc-sestamibi SPECT/CT parathyroid scintigraphy, using the search terms hyperparathyroidism, parathyroid adenoma/hyperplasia, SPECT/CT, and SPECT-CT. Citations for 981 articles and 128 abstracts of full articles were reviewed by two coauthors for relevance. Twenty-four peer-reviewed studies on SPECT/CT parathyroid scintigraphy qualified for inclusion. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. Meta-analytical techniques were used to obtain pooled estimates of the parathyroid adenoma localization rate using a random-effects model.

RESULTS

A total of 24 studies published between January 2003 and March 2014 with 1276 patients (334 men, 762 women, and 180 of unspecified sex) met the inclusion criteria. Data on the test performance of dual-phase 99mTc-sestamibi SPECT/CT showed an estimated pooled sensitivity (per-patient analysis) of 0.86 [confidence interval (CI) 0.81-0.90]. Sensitivity of SPECT/CT was superior to that of SPECT (0.74; CI 0.66-0.82) and planar (0.70; CI 0.61-0.80) techniques. Heterogeneity was present in the reported literature (I2=80.3%). The rate of ectopic parathyroid adenomas ranged between 4 and 20% and SPECT/CT was superior to SPECT and planar imaging for localization of ectopic sites.

CONCLUSION

Utilization of SPECT/CT fusion imaging for 99mTc-sestamibi parathyroid scintigraphy improves the test performance compared with planar and SPECT imaging; it assists preoperative planning for a minimally invasive surgical approach for the neck and is of value in subgroups with ectopic glands or coexisting nodular thyroid disease.

摘要

目的

本研究旨在确定锝-99m（99mTc）-甲氧基异丁基异腈单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）甲状旁腺闪烁显像对甲状旁腺腺瘤定位的诊断效用。

材料与方法

我们使用搜索词甲状旁腺功能亢进、甲状旁腺腺瘤/增生、SPECT/CT和SPECT-CT，在医学数据库PubMed和Medline/OVID中对有关99mTc-甲氧基异丁基异腈SPECT/CT甲状旁腺闪烁显像的文献进行了系统检索。两位共同作者对981篇文章的引用和128篇全文摘要进行了相关性审查。24项关于SPECT/CT甲状旁腺闪烁显像的同行评审研究符合纳入标准。使用诊断准确性研究质量评估-2工具评估研究质量。采用荟萃分析技术，使用随机效应模型获得甲状旁腺腺瘤定位率的汇总估计值。

结果

2003年1月至2014年3月期间发表的24项研究共纳入1276例患者（334例男性，762例女性，180例性别未明确），符合纳入标准。双期99mTc-甲氧基异丁基异腈SPECT/CT的检测性能数据显示，估计汇总敏感度（按患者分析）为0.86[置信区间（CI）0.81-0.90]。SPECT/CT的敏感度优于SPECT（0.74；CI 0.66-0.82）和平面显像（0.70；CI 0.61-0.80）技术。报告的文献存在异质性（I2=80.3%）。异位甲状旁腺腺瘤的发生率在4%至20%之间，SPECT/CT在异位部位定位方面优于SPECT和平面显像。