Xue Jianjun, Liu Yan, Ji Ting, Zhao Aomei, Liang Yiqian, Deng Huixing, Wang Qi, Zhang Yuemin, Yang Lulu, Yang Aimin
Nucl Med Commun. 2018 Dec;39(12):1129-1137. doi: 10.1097/MNM.0000000000000921.
The aim of this study was to evaluate the value of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) imaging and ultrasound in preoperative localization of parathyroid adenoma (PA) and parathyroid hyperplasia (PH).
A retrospective study of Tc-MIBI double-phase scintigraphy (DPS) was performed in 187 hyperparathyroidism cases with pathologically diagnosed PA or PH. Of these patients, 167 cases underwent ultrasound, and 146 cases underwent Tc-MIBI single-photon emission computed tomography/computed tomography (SPECT/CT). The sensitivity and diagnostic accuracy of ultrasound, Tc-MIBI DPS, and SPECT/CT were compared between PA and PH. Differences in Tc-MIBI DPS, serum parathyroid hormone (PTH), serum calcium and phosphorus, as well as the weight and longest diameter of lesion between PA and PH were also compared.
As per patient-based analysis, the sensitivity of ultrasound, Tc-MIBI DPS, and SPECT/CT was 90.70% (39/43), 95.56% (43/45), and 100.00% (30/30), respectively, for PA, and 93.55% (116/124), 90.85% (129/142), and 93.10% (108/116), respectively, for PH. There were no significant differences in sensitivity of these three imaging methods between PA and PH. However, per lesion-based analysis, the accuracy of ultrasound, Tc-MIBI DPS, and SPECT/CT in detecting PA was 78.43% (40/51), 86.79% (46/53) and 96.88% (31/32), respectively, and the accuracy of Tc-MIBI DPS was higher than that of ultrasound (χ=6.507, P=0.011), and for PH, it was 49.69% (160/322), 40.71% (171/420), and 43.80% (152/347), respectively. The accuracy of ultrasound was higher than that of Tc-MIBI DPS (χ=5.940, P=0.015). The accuracy of a combination of all three examinations of ultrasound+Tc-MIBI DPS, ultrasound+Tc-MIBI SPECT/CT, Tc-MIBI DPS+SPECT/CT, and ultrasound+Tc-MIBI DPS+Tc-MIBI SPECT/CT was 51.51% (154/299), 53.85% (161/299), 50.17% (150/299), and 54.18% (162/299), respectively, which was higher than that of ultrasound (χ=5.273, P=0.022; χ=8.226, P=0.004; χ=3.880, P=0.049; χ=8.702, P=0.003, respectively). Serum levels of PTH and phosphorus were lower in patients with PA than in patients with PH (P<0.001), and serum calcium level, the weight, and the longest diameter of lesion and early uptake rate of Tc-MIBI DPS were higher in patients with PA than in patients with PH (P<0.01). Serum PTH level is often less than 1000 pg/ml in PA, but usually more than 1000 pg/ml in PH.
Ultrasound, Tc-MIBI DPS, and SPECT/CT all have a higher value in the diagnosis of PA than PH. Tc-MIBI SPECT/CT should be optimal for detecting PA, and early SPECT/CT scan might be better than delayed scan. Compared with Tc-MIBI DPS and SPECT/CT, ultrasound has a slight advantage in localization of PH lesions. The combination of ultrasound and Tc-MIBI DPS or SPECT/CT imaging could improve the accuracy in localization of PH lesions and should be considered as the first-line method for detecting PH.
本研究旨在评估锝-99m甲氧基异丁基异腈（Tc-MIBI）显像及超声检查在甲状旁腺腺瘤（PA）和甲状旁腺增生（PH）术前定位中的价值。
对187例经病理诊断为PA或PH的甲状旁腺功能亢进患者进行Tc-MIBI双时相闪烁显像（DPS）的回顾性研究。其中167例患者接受了超声检查，146例患者接受了Tc-MIBI单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）。比较了PA和PH患者中超声、Tc-MIBI DPS及SPECT/CT的敏感性和诊断准确性。还比较了PA和PH患者在Tc-MIBI DPS、血清甲状旁腺激素（PTH）、血清钙和磷水平，以及病变的重量和最长径之间的差异。
基于患者的分析，对于PA，超声、Tc-MIBI DPS及SPECT/CT的敏感性分别为90.70%（39/43）、95.56%（43/45）和100.00%（30/30）；对于PH，敏感性分别为93.55%（116/124）、90.85%（129/142）和93.10%（108/116）。PA和PH患者中这三种成像方法的敏感性无显著差异。然而，基于病灶的分析，超声、Tc-MIBI DPS及SPECT/CT检测PA的准确性分别为78.43%（40/51）、86.79%（46/53）和96.88%（31/32），Tc-MIBI DPS的准确性高于超声（χ=6.507，P=0.011）；对于PH，准确性分别为49.69%（160/322）、40.71%（171/??420）和43.80%（152/347），超声的准确性高于Tc-MIBI DPS（χ=5.940，P=0.015）。超声+Tc-MIBI DPS、超声+Tc-MIBI SPECT/CT、Tc-MIBI DPS+SPECT/CT及超声+Tc-MIBI DPS+Tc-MIBI SPECT/CT这四种联合检查的准确性分别为51.51%（154/299）、53.85%（161/299）、50.17%（150/299）和54.18%（162/299），均高于超声（χ值及P值分别为χ=5.273，P=0.022；χ=8.226，P=0.004；χ=3.880，P=0.049；χ=8.702，P=0.003）。PA患者的血清PTH和磷水平低于PH患者（P<0.001），PA患者的血清钙水平、病变重量、最长径及Tc-MIBI DPS的早期摄取率高于PH患者（P<0.01）。PA患者的血清PTH水平通常低于1000 pg/ml，而PH患者通常高于1000 pg/ml。
超声、Tc-MIBI DPS及SPECT/CT在PA诊断中的价值均高于PH。Tc-MIBI SPECT/CT应是检测PA的最佳方法，早期SPECT/CT扫描可能优于延迟扫描。与Tc-MIBI DPS和SPECT/CT相比，超声在PH病灶定位方面具有轻微优势。超声与Tc-MIBI DPS或SPECT/CT成像联合应用可提高PH病灶定位的准确性，应作为检测PH的一线方法。
