Prabhu Meghana, Kumari Garima, Damle Nishikant A, Arora Geetanjali, Kumar Praveen, Kumar Rajeev, Tripathi Madhavi, Bal Chandrasekhar, Khadgawat Rajesh, Kumar Chitresh, Agarwal Shipra
Departments of Nuclear Medicine.
Endocrinology.
Nucl Med Commun. 2018 Dec;39(12):1190-1196. doi: 10.1097/MNM.0000000000000924.
The aim of the present study was to assess the utility of early dynamic PET/computed tomography with fluorine-18-fluorocholine (F-FCH) in detecting parathyroid lesions and in differentiating parathyroid lesions from cervical lymph nodes (LNs).
A prospective study was conducted on 14 patients with clinical and biochemical evidence of primary hyperparathyroidism by having a positive Tc-sestaMIBI scan. Patients underwent early dynamic F-FCH PET/computed tomography scan, after the administration of 5-8 mCi (185-296 MBq) at 1 min per frame for 15 min. Delayed static images of 2-3 min per bed position were taken between 45 and 60 min. 3D-VOI's were plotted on parathyroid adenoma, cervical LN and thyroid. Dynamic and static images were interpreted by two expert nuclear medicine physicians independently and the following parameters were calculated for parathyroid adenoma and cervical LN: maximum standardized uptake value (SUVmax), time activity curve for SUVmax, t-peak. Adenoma to thyroid ratio (A/T) and cervical LN to thyroid ratio were calculated for each dynamic and static image.
Fourteen (eight females and six males) patients were included in the study. All patients showed a higher SUVmax in the adenoma and the cervical LN in the early dynamic images as compared with delayed static images. A/T ratio obtained in the dynamic and static images were compared and found to have insignificant difference (P=0.2255). The difference between mean A/T and LN to thyroid ratio was found to be significant (P=0.0117) during the dynamic study.
A possible explanation of higher SUVmax in the dynamic images in adenomas may be due to the increased vascularity/early F-FCH uptake. Results indicate early dynamic imaging could suffice, without the need for a delayed image after 45 min, and this technique could adequately differentiate a parathyroid adenoma from a cervical LN.
本研究旨在评估早期动态氟-18-氟胆碱（F-FCH）PET/计算机断层扫描在检测甲状旁腺病变以及区分甲状旁腺病变与颈部淋巴结（LN）方面的效用。
对14例经临床及生化检查证实为原发性甲状旁腺功能亢进且Tc- sestamibi扫描呈阳性的患者进行了一项前瞻性研究。患者在静脉注射5 - 8 mCi（185 - 296 MBq）的F-FCH后，以每分钟1帧的速度进行15分钟的早期动态PET/计算机断层扫描。在45至60分钟之间采集每个床位位置2 - 3分钟的延迟静态图像。在甲状旁腺腺瘤、颈部淋巴结和甲状腺上绘制三维感兴趣区（3D-VOI）。由两名核医学专家独立解读动态和静态图像，并计算甲状旁腺腺瘤和颈部淋巴结的以下参数：最大标准化摄取值（SUVmax）、SUVmax的时间-活性曲线、t峰。计算每个动态和静态图像的腺瘤与甲状腺比值（A/T）以及颈部淋巴结与甲状腺比值。
本研究纳入了14例患者（8例女性和6例男性）。与延迟静态图像相比，所有患者在早期动态图像中的腺瘤和颈部淋巴结均显示出更高的SUVmax。比较动态和静态图像中获得的A/T比值，发现差异无统计学意义（P = 0.2255）。在动态研究期间，发现平均A/T与淋巴结与甲状腺比值之间的差异具有统计学意义（P = 0.0117）。
腺瘤动态图像中SUVmax较高的一个可能解释可能是血管增多/早期F-FCH摄取增加。结果表明早期动态成像就足够了，无需45分钟后的延迟图像，并且该技术能够充分区分甲状旁腺腺瘤与颈部淋巴结。
