Chen Zejun, Fu Jingjing, Shao Qing, Zhou Bin, Wang Feng
Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing.
Department of Nuclear Medicine.
Medicine (Baltimore). 2018 Oct;97(40):e12578. doi: 10.1097/MD.0000000000012578.
This study aimed to evaluate the characteristics of parathyroid carcinoma and to validate the diagnostic value of Tc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography/x-ray computed tomography (SPECT/CT) for differentiating between parathyroid carcinoma and hyperparathyroidism. Four consecutive patients with suspected primary hyperparathyroidism were enrolled in this study and underwent Tc-MIBI SPECT/CT, ultrasonography, enhanced CT, and MRI. Serum parathyroid hormone (PTH) and calcium were measured. All primary and recurrent lesions showed high focal uptake on Tc-MIBI image, whereas metastatic lymph nodes gave false negative results. The serum PTH was 165.14 ± 90.26 pmol/L, which declined rapidly after surgery. One patient with a persistently high PTH (147.5 pmol/L) after surgery presented with multiple lymphadenopathy in the neck. Higher expression of chromogranin A (CgA) further confirmed parathyroid carcinoma as a rare endocrine tumor. Parathyroid carcinoma is thus usually diagnosed incidentally based on nonspecific multiorgan symptoms of hypercalcemia and hyperparathyroidism. Tc-MIBI SPECT/CT may help to localize the parathyroid carcinoma, while MRI is valuable for detecting metastasis. Serum PTH and CgA serve as circulating biomarkers in parathyroid carcinoma, and raised levels of PTH and CgA together with locoregional lymphadenopathy may indicate parathyroid carcinoma. Further studies are needed.
本研究旨在评估甲状旁腺癌的特征，并验证锝-甲氧基异丁基异腈（MIBI）单光子发射计算机断层扫描/ X射线计算机断层扫描（SPECT/CT）在鉴别甲状旁腺癌和甲状旁腺功能亢进症方面的诊断价值。本研究连续纳入了4例疑似原发性甲状旁腺功能亢进症的患者，他们均接受了锝- MIBI SPECT/CT、超声检查、增强CT和MRI检查。检测了血清甲状旁腺激素（PTH）和钙水平。所有原发性和复发性病变在锝- MIBI图像上均显示高灶性摄取，而转移性淋巴结则给出假阴性结果。血清PTH为165.14±90.26 pmol/L，术后迅速下降。1例术后PTH持续升高（147.5 pmol/L）的患者出现颈部多发淋巴结病。嗜铬粒蛋白A（CgA）的高表达进一步证实甲状旁腺癌是一种罕见的内分泌肿瘤。因此，甲状旁腺癌通常是基于高钙血症和甲状旁腺功能亢进症的非特异性多器官症状而偶然诊断出来的。锝- MIBI SPECT/CT可能有助于甲状旁腺癌的定位，而MRI对于检测转移有价值。血清PTH和CgA可作为甲状旁腺癌的循环生物标志物，PTH和CgA水平升高以及局部淋巴结病可能提示甲状旁腺癌。还需要进一步的研究。
