Amadou Coralie, Bera Géraldine, Ezziane Malek, Chami Linda, Delbot Thierry, Rouxel Agnès, Leban Monique, Herve Genevieve, Menegaux Fabrice, Leenhardt Laurence, Kas Aurélie, Trésallet Christophe, Ghander Cécile, Lussey-Lepoutre Charlotte
Department of Thyroid and Endocrine Tumours, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
World J Surg. 2019 May;43(5):1232-1242. doi: 10.1007/s00268-019-04910-6.
To evaluate FCH-PET/CT and parathyroid 4D-CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery.
Medical records of all patients referred for a FCH-PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc-99m-sestaMIBI scintigraphy, and furthermore, some patients had 4D-CT. Gold standard was defined by pathological findings and/or US-guided fine-needle aspiration with PTH level measurement in the washing liquid.
Twenty-nine patients were included in this retrospective study. FCH-PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D-CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH-PET/CT guidance. US and Tc-99m-sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH-PET/CT foci in 27 patients. On a per-lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH-PET/CT, 75%, 40%, 80% and 33% for 4D-CT. On a per-patient analysis, sensitivity was 85% for FCH-PET/CT and 63% for 4D-CT. FCH-PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc-99m-sestaMIBI scintigraphy result, with a global cure rate of 73%.
FCH-PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D-CT appears as a confirmatory imaging modality.
评估氟代胆碱正电子发射断层扫描/计算机断层扫描（FCH-PET/CT）和甲状旁腺四维计算机断层扫描（parathyroid 4D-CT），以指导原发性甲状旁腺功能亢进症（pHPT）且有颈部手术史患者的手术。
对我院所有接受FCH-PET/CT检查患者的病历进行系统回顾。仅纳入患有pHPT、有颈部手术史（因pHPT或其他原因）且有再次手术指征的患者。所有患者均接受甲状旁腺超声（US）和锝-99m-甲氧基异丁基异腈（Tc-99m-sestaMIBI）闪烁扫描，此外，部分患者接受了4D-CT检查。金标准由病理结果和/或超声引导下细针穿刺并测量冲洗液中甲状旁腺激素（PTH）水平来定义。
本回顾性研究纳入了29例患者。FCH-PET/CT发现34个异常病灶，其中19个为异位定位。20例患者接受了4D-CT检查，初读时检测到11个异常腺体，在FCH-PET/CT引导下又发现6个。超声和Tc-99m-sestaMIBI在8/29例患者中发现了一致的病灶。27例患者的32个FCH-PET/CT异常病灶获得了金标准。在按病灶分析时，FCH-PET/CT的敏感性、特异性、阳性预测值和阴性预测值分别为96%、13%、77%和50%，4D-CT分别为75%、40%、80%和33%。在按患者分析时，FCH-PET/CT的敏感性为85%，4D-CT为63%。FCH-PET/CT结果使得21例患者成功切除异常腺体成为可能，其中包括12例超声/Tc-99m-sestaMIBI闪烁扫描结果为阴性或不一致的患者，总体治愈率为73%。
FCH-PET/CT是在具有挑战性的再次手术的pHPT患者群体中一种有前景的工具。甲状旁腺4D-CT似乎是一种辅助成像方式。
