Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Eur J Radiol. 2017 Oct;95:82-88. doi: 10.1016/j.ejrad.2017.07.026. Epub 2017 Aug 1.
Our aim was to investigate the accuracy of available imaging modalities for parathyroid carcinoma (PC) in our institution and to identify which imaging modality, or combination thereof, is optimal in preoperative determination of precise tumor location.
All operated PC patients in our institution between 2000 and 2015 that had at least one of the following in-house preoperative scans: neck ultrasonography (US), neck 4D-Computed Tomography (4DCT) and 99mTc Sestamibi SPECT/CT (MIBI). Sensitivity, specificity and accuracy of PC tumor localization were assessed individually and in combination.
20 patients fulfilled the inclusion criteria and were analysed. There were 18 US, 18 CT and 9 MIBI scans. The sensitivity and accuracy for tumor localisation of US was 80% (CI 56-94%) and 73% respectively, of 4DCT was 79% (CI 58-93%) and 82%, and of MIBI was 81% (CI 54-96%) and 78%. The sensitivity and accuracy of the combination of CT and MIBI was 94% (CI 73-100%) and 95% and for the combination of US, CT and MIBI was 100% (CI 72-100%) and 100% respectively. The wash-out of the PC lesions, expressed as a percentage change in Hounsfield Units from the arterial phase to early delayed phase was -9.29% and to the late delayed phase was -16.88% (n=11).
The sensitivity of solitary preoperative imaging of PC patients, whether by US, CT or MIBI, is approximately 80%. Combinations of CT with MIBI and US increase the sensitivity to 95% or better. Combined preoperative imaging of patients with clinical possibility of PC is therefore recommended.
我们的目的是研究本机构内现有影像学方法对甲状旁腺癌（PC）的准确性，并确定哪种影像学方法或其组合在术前确定精确肿瘤位置方面最佳。
在我们的机构中，对 2000 年至 2015 年间接受过以下至少一种术前检查的所有手术治疗的 PC 患者进行研究：颈部超声（US）、颈部 4D 计算机断层扫描（4DCT）和 99mTc Sestamibi SPECT/CT（MIBI）。单独评估和组合评估 PC 肿瘤定位的敏感性、特异性和准确性。
20 名符合纳入标准的患者进行了分析。有 18 例 US、18 例 CT 和 9 例 MIBI 扫描。US 对肿瘤定位的敏感性和准确性分别为 80%（CI 56-94%）和 73%，4DCT 分别为 79%（CI 58-93%）和 82%，MIBI 分别为 81%（CI 54-96%）和 78%。CT 和 MIBI 联合的敏感性和准确性为 94%（CI 73-100%）和 95%，US、CT 和 MIBI 联合的敏感性和准确性为 100%（CI 72-100%）和 100%。11 例患者病变的洗脱率（用从动脉期到早期延迟期的 Hounsfield 单位百分比变化表示）为-9.29%，至晚期延迟期为-16.88%。
单独使用 US、CT 或 MIBI 对 PC 患者进行术前成像的敏感性约为 80%。CT 与 MIBI 和 US 的联合使用可将敏感性提高到 95%或更高。因此，建议对有临床可能的 PC 患者进行联合术前成像。
