Kedarisetty Suraj, Fundakowski Christopher, Ramakrishnan Karthika, Dadparvar Simin
1 Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
2 Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Lewis Katz School of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
Ear Nose Throat J. 2019 Mar;98(3):149-157. doi: 10.1177/0145561319828668. Epub 2019 Feb 19.
Localization of parathyroid adenomas for treatment of primary hyperparathyroidism can be challenging. This retrospective study compared single-photon emission computed tomography/computed tomography (SPECT/CT), 4D-CT, and US studies in detection of adenomas prior to surgery. A retrospective chart review was performed on all consecutive patients with parathyroid adenoma presenting to an urban tertiary care medical center. A total of 58 patients (45 female, 13 male) underwent surgery for parathyroid adenoma. Patients aged 28 to 80 years (mean: 58.8) with parathyroid hormone levels ranging from 42 to 424 pg/mL (mean: 168). All patients underwent preoperative SPECT/CT with 20 mCi technetium-99m MIBI (Tc-MIBI). Fifty-three patients had additional US imaging and 14 patients had 4D-CT scans. Additionally, 34 patients had injection of 20 mCi Tc-MIBI on the day of surgery. Pathological correlation was performed. Comparing SPECT/CT versus 4D-CT resulted in sensitivity (77% vs 80%), specificity (71% vs 75%), and accuracy (77% vs 79%). Ultrasound was less sensitive with similar specificity (44%, 86%, respectively). Combination of SPECT/CT and 4D-CT increased sensitivity to 88%, specificity to 100%, and accuracy to 89%. Combining SPECT/CT with US resulted in sensitivity of 85%, specificity of 83%, and accuracy of 85%. Intraoperative localization substantially improved in patients who received preoperative injections. The SPECT/CT remains the best imaging modality for preoperative localization of parathyroid adenomas with high sensitivity. Combining SPECT/CT with US resulted in increased sensitivity and accuracy. For suspicion of ectopic cases or suspicion of unidentifiable adenoma with negative scintigraphy, addition of 4D-CT is recommended. Intraoperative localization and adjunctive imaging may improve surgical management of patients with hyperparathyroidism.
甲状旁腺腺瘤的定位对于原发性甲状旁腺功能亢进症的治疗可能具有挑战性。这项回顾性研究比较了单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）、4D-CT和超声检查在术前检测腺瘤方面的效果。对一家城市三级医疗中心收治的所有连续性甲状旁腺腺瘤患者进行了回顾性病历审查。共有58例患者（45例女性，13例男性）接受了甲状旁腺腺瘤手术。患者年龄在28至80岁之间（平均：58.8岁），甲状旁腺激素水平在42至424 pg/mL之间（平均：168）。所有患者均接受了术前使用20 mCi锝-99m甲氧基异丁基异腈（Tc-MIBI）的SPECT/CT检查。53例患者还进行了超声成像，14例患者进行了4D-CT扫描。此外，34例患者在手术当天注射了20 mCi Tc-MIBI。进行了病理相关性分析。比较SPECT/CT与4D-CT，其敏感性（分别为77%和80%）、特异性（分别为71%和75%）和准确性（分别为77%和79%）。超声的敏感性较低，但特异性相似（分别为44%和86%）。SPECT/CT与4D-CT联合使用可将敏感性提高到88%，特异性提高到100%，准确性提高到89%。SPECT/CT与超声联合使用的敏感性为85%，特异性为83%，准确性为85%。接受术前注射的患者术中定位有显著改善。SPECT/CT仍然是术前定位甲状旁腺腺瘤的最佳成像方式，具有高敏感性。SPECT/CT与超声联合使用可提高敏感性和准确性。对于怀疑异位病例或闪烁扫描阴性的难以识别的腺瘤，建议加做4D-CT。术中定位和辅助成像可能会改善甲状旁腺功能亢进症患者的手术管理。
