Schweighofer-Zwink Gregor, Hehenwarter Lukas, Rendl Gundula, Rettenbacher Lukas, Langsteger Werner, Beheshti Mohsen, Pirich Christian
UK für Nuklearmedizin und Endokrinologie, Universitätsklinikum Salzburg der Paracelus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
Abteilung für Nuklearmedizin und Endokrinologie, Ordensklinikum Linz, Seilerstätte 4, 4010, Linz, Österreich.
Wien Med Wochenschr. 2019 Feb;169(1-2):15-24. doi: 10.1007/s10354-018-0660-0. Epub 2018 Sep 27.
Ultrasound and sestamibi scintigraphy are the recommended standard procedures for initial diagnosis in primary hyperparathyroidism (pHPT). Recently, F‑18 choline positron emission tomography computed tomography (choline PET/CT) has been shown promising results for the diagnostic work up of primary hyperparathyroidism (pHPT) suggesting superiority over conventional scintigraphy using Tc99m sestamibi based protocols using planar dual-phase imaging, SPECT or SPECT/CT.
This review presents the results of F‑18 choline PET/CT on the basis of a literature search using the keywords "primary hyperparathyroidism and choline", "primary hyperparathyroidism and PET", "parathyroid adenoma and choline" und "parathyroid adenoma and PET".
6 studies were identified dealing with the diagnostic impact of choline PET/CT. The studies included 5 to 151 patients. Localization of single gland adenomas can be achieved with choline PET/CT in 80 up to 96% of cases. A high sensitivity and accuracy of choline PET/CT imaging is documented even in cases of repeated surgery for recurrent pHPT, in coexistant nodular goiter or in the detection of adenoma in atypical localization.
Using choline PET/CT parathyroid adenoma and probably parathyroid hyperplasia can be exactly localized in most patients with pHPT. Thus, a minimal-invasive surgical procedure is feasible with decreased risk of complications but high success rate in terms of biochemical cure. The diagnostic accuracy in multiglandular disease remains to be established.
超声检查和锝-99m 甲氧基异丁基异腈闪烁扫描术是原发性甲状旁腺功能亢进症（pHPT）初始诊断的推荐标准程序。最近，F-18 胆碱正电子发射断层扫描计算机断层扫描（胆碱 PET/CT）在原发性甲状旁腺功能亢进症（pHPT）的诊断检查中显示出有前景的结果，表明其优于使用基于锝-99m 甲氧基异丁基异腈的平面双期成像、单光子发射计算机断层扫描（SPECT）或 SPECT/CT 的传统闪烁扫描术。
本综述基于文献检索结果呈现 F-18 胆碱 PET/CT 的情况，检索关键词为“原发性甲状旁腺功能亢进症和胆碱”、“原发性甲状旁腺功能亢进症和 PET”、“甲状旁腺腺瘤和胆碱”以及“甲状旁腺腺瘤和 PET”。
确定了 6 项关于胆碱 PET/CT 诊断影响的研究。这些研究纳入了 5 至 151 名患者。胆碱 PET/CT 在 80%至 96%的病例中可实现单发性腺体腺瘤的定位。即使在复发性 pHPT 再次手术、并存结节性甲状腺肿或非典型部位腺瘤检测的情况下，胆碱 PET/CT 成像也具有高敏感性和准确性。
使用胆碱 PET/CT，大多数 pHPT 患者的甲状旁腺腺瘤以及可能的甲状旁腺增生能够被精确定位。因此，可行微创外科手术，并发症风险降低，但生化治愈成功率高。多腺体疾病的诊断准确性仍有待确定。
