Raruenrom Yutapong, Theerakulpisut Daris, Wongsurawat Nantaporn, Somboonporn Charoonsak
Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Thailand, 123, Mittraparb road, 40000 Khon Kaen, Thailand.
Nucl Med Rev Cent East Eur. 2018;21(1):20-25. doi: 10.5603/NMR.a2018.0003. Epub 2018 Jan 10.
Several parathyroid scintigraphy protocols have been used for preoperative localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism. The aim of this study is to compare the diagnostic accuracy of various parathyroid scintigraphy protocols.
A retrospective diagnostic accuracy study with histopathology as the reference standard was done. Five imaging protocols were investigated including planar dual tracer Tc-99m pertechnetate/Tc-99m sestamibi (DT), planar dual phase Tc-99m sestamibi (DP), and combined dual tracer dual phase (DTDP) protocols, as well as add-on single photon emission computed tomography (SPECT), and single photon emission computed tomography/computed tomography (SPECT/CT).
A total of 63 patients underwent parathyroid scintigraphy and subsequent parathyroid surgery with a total of 106 excised lesions with histopathological diagnosis. On a lesion-based analysis, sensitivity and specificity (with 95% confidence interval) of protocols were as follows. DT protocol: 69.4% (53.1-82.0%) and 80.0% (49.0-94.3%); DP protocol: 78.6% (52.4-92.4%) and 33.3% (9.7-70.0%); DTDP protocol: 64.7% (47.9-78.5%) and 50.0% (18.8-81.2%); SPECT: 92.3% (66.7-98.6%) and 75.0% (30.1-95.4%); SPECT/CT: 80.0% (49.0-94.3%) and 75.0% (30.1-95.4%). All protocols had perfect sensitivity for detection of parathyroid adenoma whereas SPECT was the most sensitive method for detection of hyperplastic parathyroid glands.
Planar parathyroid scintigraphy using the DT protocol has a trend towards being more accurate than DP and DTDP protocols. Additional imaging with SPECT and SPECT/CT had a trend towards being more accurate than planar imaging.
几种甲状旁腺闪烁扫描方案已被用于甲状旁腺功能亢进患者功能亢进甲状旁腺的术前定位。本研究的目的是比较各种甲状旁腺闪烁扫描方案的诊断准确性。
进行了一项以组织病理学为参考标准的回顾性诊断准确性研究。研究了五种成像方案，包括平面双示踪剂锝-99m高锝酸盐/锝-99m甲氧基异丁基异腈（DT）、平面双相锝-99m甲氧基异丁基异腈（DP）和联合双示踪剂双相（DTDP）方案，以及附加单光子发射计算机断层扫描（SPECT）和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）。
共有63例患者接受了甲状旁腺闪烁扫描及随后的甲状旁腺手术，共切除106个病变并进行了组织病理学诊断。基于病变的分析中，各方案的敏感性和特异性（95%置信区间）如下。DT方案：69.4%（53.1-82.0%）和80.0%（49.0-94.3%）；DP方案：78.6%（52.4-92.4%）和33.3%（9.7-70.0%）；DTDP方案：64.7%（47.9-78.5%）和50.0%（18.8-81.2%）；SPECT：92.3%（66.7-98.6%）和75.0%（30.1-95.4%）；SPECT/CT：80.0%（49.0-94.3%）和75.0%（30.1-95.4%）。所有方案对甲状旁腺腺瘤的检测均具有完美的敏感性，而SPECT是检测增生性甲状旁腺最敏感的方法。
使用DT方案的平面甲状旁腺闪烁扫描比DP和DTDP方案更准确。SPECT和SPECT/CT的附加成像比平面成像更准确。
