甲状旁腺核素 SPECT/CT 减影在原发性甲状旁腺功能亢进症中引导微创甲状旁腺切除术的价值。

Value of I/Tc-sestamibi parathyroid scintigraphy with subtraction SPECT/CT in primary hyperparathyroidism for directing minimally invasive parathyroidectomy.

机构信息

Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, France.

Department of General Endocrine and Metabolic Surgery, La Conception University Hospital, Aix-Marseille University, France.

出版信息

Am J Surg. 2019 Jan;217(1):108-113. doi: 10.1016/j.amjsurg.2018.06.027. Epub 2018 Jun 30.

DOI:10.1016/j.amjsurg.2018.06.027

PMID:29980283

Abstract

BACKGROUND

Primary hyperparathyroidism/(PHPT) is one of the most common endocrinological conditions. Surgery remains the only curative option. We have evaluated the performance of double isotope I/Tc-sestamibi parathyroid scintigraphy/(PS) with subtraction SPECT/CT in PHP for identifying uniglandular disease.

METHODS

Ninety PHPT patients undergoing parathyroidectomy (December 2015-August 2016) were included. All patients were evaluated with neck ultrasound/(US), PS and SPECT/CT with a new protocol. Outcomes from imaging modalities were reported as: uniglandular disease/(UGD), multiglandular disease/(MGD), or negative, and were compared to post-operative diagnoses.

RESULTS

Post-operatively, 72 and 18 patients had true UGD and MGD, respectively. Sensitivities and specificities of US, pinhole scintigraphy with subtraction, pinhole and SPECT/CT with subtraction, and all modalities combined were 91.7%/38.9%, 88.9%/72.2%, 93%/66.7% and 84.72%/77.78%, respectively: specificity of US + PS superior to US alone, p = 0.074. SPECT/CT enables reclassification of doubtful uptake foci.

CONCLUSIONS

Combination of neck US and PS with subtraction SPECT/CT offers a higher specificity for guiding towards minimally invasive parathyroidectomy.

摘要

背景

原发性甲状旁腺功能亢进症（PHPT）是最常见的内分泌疾病之一。手术仍然是唯一的治愈选择。我们评估了双同位素 I/Tc- sestamibi 甲状旁腺闪烁显像术（PS）与减影 SPECT/CT 在 PHPT 中单发性疾病中的应用。

方法

纳入 90 例接受甲状旁腺切除术的 PHPT 患者（2015 年 12 月至 2016 年 8 月）。所有患者均采用新方案进行颈部超声（US）、PS 和 SPECT/CT 评估。影像学结果报告为单发性疾病（UGD）、多发性疾病（MGD）或阴性，并与术后诊断进行比较。

结果

术后，72 例和 18 例患者分别为真性 UGD 和 MGD。US、针孔减影闪烁显像术、针孔和减影 SPECT/CT 以及所有联合模式的灵敏度和特异性分别为 91.7%/38.9%、88.9%/72.2%、93%/66.7%和 84.72%/77.78%：US+PS 的特异性优于单独使用 US，p=0.074。SPECT/CT 可重新分类可疑摄取灶。