Khafif Avi, Masalha Muhamed, Landsberg Roee, Domachevsky Liran, Bernstine Hanna, Groshar David, Azoulay Ofer, Lockman Yehudit
A. R. M. Center of Otolaryngology, Head and Neck Surgery, Department of Otolaryngology, Head and Neck Surgery, Assuta Medical Center, Faculty of Medicine, Tel Aviv. Affiliated with Ben Gurion University, 20 Habarzel St., 69710, Beersheba, Israel.
Department of Otolaryngology, Head and Neck Surgery, Emeq Medical Center, Technion University, Haifa, Israel.
Eur Arch Otorhinolaryngol. 2019 May;276(5):1509-1516. doi: 10.1007/s00405-019-05301-2. Epub 2019 Mar 16.
Preoperative localization of a parathyroid adenoma is usually obtained by the combination of ultrasound and scintigraphy with technetium-99m methoxyisobutylisonitrile. We evaluated the role of F18-fluorocholine in neck positron emission tomography/magnetic resonance imaging as a novel tool for localizing parathyroid adenomas.
Patients with primary hyperparathyroidism were recruited from February 2016 to August 2017 and F18-fluorocholine positron emission tomography/magnetic resonance imaging was performed to localize the parathyroid adenoma prior to surgery. We compared sensitivity and accuracy of this modality with ultrasound and technetium-99m methoxyisobutylisonitrile scintigraphy using the verified location of the diseased parathyroid as found in surgery.
Nineteen patients were included in our study (15 women and 4 men, mean age 60.5 ± 9.8 years). Positron emission tomography/magnetic resonance imaging precisely localized the pathologic parathyroid gland in 16/19 cases (84.2%) and predicted the diseased side in 19/19 cases (100%). Ultrasound and technetium 99 m methoxyisobutylisonitrile sestamibi scintigraphy predicted the location of the parathyroid adenoma in 16/19 (84.2%) and 14/19 (74%), respectively. In 3/19 patients, positron emission tomography/magnetic resonance imaging localized the parathyroid adenoma where as other modalities failed. Positron emission tomography/magnetic resonance imaging was more accurate when compared to each modality separately (p < 0.001, p = 0.017), however, when comparing the three modalities all together no differences were found (p = 0.506).
Localizing parathyroid adenomas with F18-fluorocholine positron emission tomography/magnetic resonance imaging may be a promising secondary imaging modality.
甲状旁腺腺瘤的术前定位通常通过超声与锝-99m甲氧基异丁基异腈闪烁扫描相结合来实现。我们评估了F18-氟胆碱在颈部正电子发射断层扫描/磁共振成像中的作用，将其作为一种定位甲状旁腺腺瘤的新工具。
2016年2月至2017年8月招募原发性甲状旁腺功能亢进患者，并在手术前进行F18-氟胆碱正电子发射断层扫描/磁共振成像以定位甲状旁腺腺瘤。我们使用手术中发现的患病甲状旁腺的已证实位置，将这种检查方法的敏感性和准确性与超声及锝-99m甲氧基异丁基异腈闪烁扫描进行比较。
我们的研究纳入了19例患者（15名女性和4名男性，平均年龄60.5±9.8岁）。正电子发射断层扫描/磁共振成像在16/19例（84.2%）中精确地定位了病理性甲状旁腺，并在19/19例（100%）中预测了患病侧。超声和锝-99m甲氧基异丁基异腈显像分别在16/19例（84.2%）和14/19例（74%）中预测了甲状旁腺腺瘤的位置。在3/19例患者中，正电子发射断层扫描/磁共振成像定位了甲状旁腺腺瘤，而其他检查方法未能做到。与单独的每种检查方法相比，正电子发射断层扫描/磁共振成像更准确（p<0.001，p=0.017），然而，当将这三种检查方法一起比较时，未发现差异（p=0.506）。
使用F18-氟胆碱正电子发射断层扫描/磁共振成像定位甲状旁腺腺瘤可能是一种有前景的二级成像检查方法。
