Treglia Giorgio, Trimboli Pierpaolo, Huellner Martin, Giovanella Luca
Department of Nuclear Medicine and Thyroid Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland.
Minerva Endocrinol. 2018 Jun;43(2):133-143. doi: 10.23736/S0391-1977.17.02685-2. Epub 2017 Jun 23.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder usually due to hyperfunctioning parathyroid glands (HP). Surgical removal of HP is the main treatment in PHPT, particularly in symptomatic patients. The correct detection and localization of HP is challenging and crucial as it may guide surgical treatment in patients with PHPT. To date, different imaging methods have been used to detect and localize HP in patients with PHPT including radiology, nuclear medicine and hybrid techniques. This review was focused to describe the diagnostic performance of several imaging methods used in detecting HP in patients with PHPT.
We have summarized the diagnostic performance of different imaging methods used in detecting HP in patients with PHPT taking into account recent evidence-based articles published in the literature. To this regard, findings of recently published meta-analyses on the diagnostic accuracy of imaging methods in PHPT were reported. Furthermore, a suggested imaging strategy taking into account the diagnostic performance and further consideration has been described.
Cervical ultrasound (US) and parathyroid scintigraphy using 99mTc-MIBI are the most commonly employed first-line investigations in patients with PHPT, with many institutions using both methods in combination. The diagnostic performance of US and planar 99mTc-MIBI scintigraphy seems to be similar. The use of tomographic imaging (SPECT and SPECT/CT) increases the detection rate of HP compared to planar 99mTc-MIBI scintigraphy. Whereas traditional computed tomography (CT) has limited usefulness in PHPT, four dimensional CT (4D-CT) has similar diagnostic performance compared to tomographic parathyroid scintigraphy but a higher radiation dose. Although initial encouraging results, to date there is insufficient evidence to recommend the routine use of MRI or positron emission tomography (PET) with several radiopharmaceuticals in patients with PHPT. However, they could be useful alternatives in cases with negative or discordant findings at first-line imaging methods.
Patients with PHPT who are candidates for parathyroidectomy should be referred to an expert clinician to decide which imaging studies to perform based on regional imaging capabilities. The imaging techniques with higher diagnostic performance in detecting and localizing HP seems to be 99mTc-MIBI SPECT/CT and 4D-CT. Taking into account several data beyond the diagnostic performance, the combination of cervical US performed by an experienced parathyroid sonographer and 99mTc-MIBI SPECT or SPECT//CT seems to be an optimal first-line strategy in the preoperative planning of patients with PHPT.
原发性甲状旁腺功能亢进症（PHPT）是一种常见的内分泌疾病，通常由甲状旁腺功能亢进（HP）引起。手术切除甲状旁腺是PHPT的主要治疗方法，尤其是对有症状的患者。正确检测和定位甲状旁腺具有挑战性且至关重要，因为它可以指导PHPT患者的手术治疗。迄今为止，已使用不同的成像方法来检测和定位PHPT患者的甲状旁腺，包括放射学、核医学和混合技术。本综述旨在描述用于检测PHPT患者甲状旁腺的几种成像方法的诊断性能。
我们总结了用于检测PHPT患者甲状旁腺的不同成像方法的诊断性能，同时考虑了文献中最近发表的循证医学文章。就此而言，报告了最近发表的关于PHPT成像方法诊断准确性的荟萃分析结果。此外，还描述了一种考虑诊断性能及其他因素的建议成像策略。
颈部超声（US）和使用99mTc-MIBI的甲状旁腺闪烁扫描是PHPT患者最常用的一线检查方法，许多机构同时使用这两种方法。US和平面99mTc-MIBI闪烁扫描的诊断性能似乎相似。与平面99mTc-MIBI闪烁扫描相比，断层成像（SPECT和SPECT/CT）可提高甲状旁腺的检测率。传统计算机断层扫描（CT）在PHPT中的作用有限，四维CT（4D-CT）与断层甲状旁腺闪烁扫描的诊断性能相似，但辐射剂量更高。尽管初步结果令人鼓舞，但迄今为止，尚无足够证据推荐在PHPT患者中常规使用MRI或正电子发射断层扫描（PET）及几种放射性药物。然而，对于一线成像方法结果为阴性或不一致的病例，它们可能是有用的替代方法。
适合甲状旁腺切除术的PHPT患者应转诊给专业临床医生，以便根据当地的成像能力决定进行哪些成像检查。在检测和定位甲状旁腺方面诊断性能较高的成像技术似乎是99mTc-MIBI SPECT/CT和4D-CT。考虑到诊断性能之外 的一些数据，由经验丰富的甲状旁腺超声检查医师进行的颈部US与99mTc-MIBI SPECT或SPECT//CT的联合似乎是PHPT患者术前规划的最佳一线策略。
