锝 99m 核素标记甲氧基异丁基异腈 SPECT 与多期多排 4D CT 检测孤立性甲状旁腺腺瘤定位。
Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT.
机构信息
From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.).
出版信息
AJNR Am J Neuroradiol. 2019 Jan;40(1):142-149. doi: 10.3174/ajnr.A5901. Epub 2018 Dec 6.
BACKGROUND AND PURPOSE
Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT).
MATERIALS AND METHODS
We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference.
RESULTS
Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT.
CONCLUSIONS
For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT.
背景与目的
微创甲状旁腺手术严重依赖于图像引导，但比较各种成像方式疗效的数据很少。我们的目的是对锝 Tc99m sestamibi SPECT 单光子发射计算机断层扫描（SPECT）、多期多排 4D CT 和这两种方式的组合（锝 Tc99m sestamibi SPECT+多期多排 4D CT）的定位能力进行盲法比较。
材料与方法
我们回顾了 2009 年 11 月至 2010 年 3 月期间连续 31 例（6 名男性，25 名女性；中位年龄 56 岁）经生化证实为原发性甲状旁腺功能亢进症患者的病历，这些患者均接受了术前锝 Tc99m sestamibi SPECT 和多期多排 4D CT 检查，且均在同一台扫描仪上进行，并通过切除单个甲状旁腺腺瘤来进行病理证实。准确性分别为定位到正确侧和象限，以手术定位为参考标准。
结果
手术切除发现 14 例左侧和 17 例右侧甲状旁腺腺瘤，2 例左侧下极、12 例左侧上极、11 例右侧下极和 6 例右侧上极甲状旁腺腺瘤。对于左侧/右侧定位，锝 Tc99m sestamibi SPECT 的准确性为 93.5%（31 例中的 29 例），多期多排 4D CT 的准确性为 96.8%（31 例中的 30 例），锝 Tc99m sestamibi SPECT+多期多排 4D CT 的准确性为 96.8%（31 例中的 30 例）。对于象限定位，锝 Tc99m sestamibi SPECT 的准确性为 67.7%（31 例中的 21 例），多期多排 4D CT 的准确性为 87.1%（31 例中的 27 例），锝 Tc99m sestamibi SPECT+多期多排 4D CT 的准确性为 93.5%（31 例中的 29 例）。读者诊断信心评分始终最低的是锝 Tc99m sestamibi SPECT，最高的是锝 Tc99m sestamibi SPECT+多期多排 4D CT。
结论
对于甲状旁腺腺瘤的左侧/右侧定位，所有方式的效果相当。对于象限定位，锝 Tc99m sestamibi SPECT+多期多排 4D CT 优于锝 Tc99m sestamibi SPECT。
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