Huang Zhongke, Lou Cen
Department of Nuclear Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
J Int Med Res. 2019 Feb;47(2):836-845. doi: 10.1177/0300060518813742. Epub 2018 Dec 16.
To investigate the accuracy of dual-tracer scintigraphy for locating parathyroid adenomas in patients with primary hyperparathyroidism (PHPT).
We reviewed 268 patients with PHPT. All patients underwent technetium-99m pertechnetate (TcO) scintigraphy and technetium-99m methoxyisobutylisonitrile (Tc-MIBI) dual-tracer scintigraphy of the thyroid and parathyroid glands, respectively. TcO planar scintigraphy was carried out initially followed by dual-phase Tc-MIBI single-photon emission computed tomography (SPECT)/CT the next day. The findings were combined and interpreted. Individual Tc-MIBI and dual-tracer scintigraphy were both analyzed. The sensitivity, specificity, and accuracy were determined in relation to surgical findings. The average interval between scan and surgery was 13 days.
The positive and negative predictive values of Tc-MIBI SPECT/CT were 92.0% and 71.3%, respectively, and the sensitivity, specificity, and accuracy were 88.3%, 79.2%, and 85.8%, respectively. The positive and negative predictive values of dual-tracer scintigraphy were 96.3% and 82.3%, respectively, and the sensitivity, specificity, and accuracy were 92.9%, 90.3%, and 92.2%, respectively. Youden's index for dual-tracer scintigraphy and Tc-MIBI SPECT/CT were 0.83 and 0.63, respectively.
These finding suggest that TcO and Tc-MIBI dual-tracer scintigraphy is more accurate than other scintigraphy methods for detecting parathyroid adenoma, and may thus be the most suitable imaging technique in patients with PHPT.
探讨双示踪剂闪烁扫描术在原发性甲状旁腺功能亢进症（PHPT）患者中定位甲状旁腺腺瘤的准确性。
我们回顾了268例PHPT患者。所有患者分别接受了甲状腺和甲状旁腺的高锝酸盐（TcO）闪烁扫描术及甲氧基异丁基异腈（Tc-MIBI）双示踪剂闪烁扫描术。首先进行TcO平面闪烁扫描，次日进行双期Tc-MIBI单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）。将结果合并并解读。分别分析单独的Tc-MIBI和双示踪剂闪烁扫描术。根据手术结果确定敏感性、特异性和准确性。扫描与手术之间的平均间隔为13天。
Tc-MIBI SPECT/CT的阳性和阴性预测值分别为92.0%和71.3%，敏感性、特异性和准确性分别为88.3%、79.2%和85.8%。双示踪剂闪烁扫描术的阳性和阴性预测值分别为96.3%和82.3%，敏感性、特异性和准确性分别为92.9%、90.3%和92.2%。双示踪剂闪烁扫描术和Tc-MIBI SPECT/CT的约登指数分别为0.83和0.63。
这些结果表明，TcO和Tc-MIBI双示踪剂闪烁扫描术在检测甲状旁腺腺瘤方面比其他闪烁扫描方法更准确，因此可能是PHPT患者最合适的成像技术。
