Kobylecka Małgorzata, Koperski Łukasz, Chudziński Witold, Pihowicz Paweł, Mączewska Joanna, Płazińska Maria Teresa, Bogdańska Magdalena, Królicki Leszek
Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland.
Department of Pathology, Medical University of Warsaw, Warsaw, Poland.
Nucl Med Rev Cent East Eur. 2019;22(1):29-33. doi: 10.5603/NMR.2019.0005.
Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between 99mTc MIBI accumulation and oxyphil cell content or parathyroid gland volume. The aim of our work was to assess the relationship between the pathological structure of parathyroids, their volume, oxyphil cell content and parathyroid 99mTc-MIBI retention.
A total of 62 hyperfunctioning parathyroid glands in 46 patients were retrospectively analyzed. Preoperative 99mTc-MIBI scintigraphy was performed according to the double-phase and subtraction protocol. After surgery all glands were evaluated histologically, oxyphil cell content was assessed and volume of each excised gland was calculated.
Scintigraphy was positive in 41 of 62 parathyroid glands (66%). The median volume of positive glands was larger than that of negative glands (1.33 ml vs 0.7 ml, p = 0.015). Of the parathyroid lesions, there were 14 (22.6%) cases of nodular hyperplasia, 23 (37.1%) cases of diffuse hyperplasia, and 25 (40.3%) cases of adenomas. A high (≥ 25%) oxyphil cell content was found in 16 glands (25.8%) and a low ( < 25%) oxyphil cell content in 46 (74.2%) glands. Histopathology of parathyroid glands was related to the scintigraphy result (p = 0.002), but not to the 99mTc-MIBI uptake pattern (p = 0.868). The overall result of scintigraphy was not related to the oxyphil cell content (p = 0.797). 99mTc-MIBI uptake pattern wasn't related to the oxyphil cell content (p = 0.833). In general, parathyroid lesions with low oxyphil cell content were larger than parathyroid glands with high oxyphil cell content (1.33 ml vs 0.5 ml, respectively; p = 0.01). The median volume of parathyroids containing a high number of oxyphil cells and having a prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.62 ml vs 0.3 ml, respectively; p = 0.008). The median volume of parathyroids with low oxyphil cells content and showing prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.95 ml vs 1.07 ml, respectively; p = 0.014).
Our findings suggest that a positive scintigraphy result depends on parathyroid histopathology and gland volume and does not depend on the presence of oxyphil cells. Prolonged 99mTc-retention is not related to the parathyroid gland histopathology and the presence of oxyphil cells but to the gland volume.
99m锝-甲氧基异丁基异腈（99mTc-MIBI）在甲状旁腺中摄取呈阳性的机制尚不清楚，一些作者认为99mTc-MIBI的积聚与嗜酸性细胞含量或甲状旁腺体积之间存在相关性。我们研究的目的是评估甲状旁腺的病理结构、体积、嗜酸性细胞含量与甲状旁腺99mTc-MIBI滞留之间的关系。
回顾性分析46例患者共62个功能亢进的甲状旁腺。术前按照双时相和减影方案进行99mTc-MIBI闪烁扫描。术后对所有腺体进行组织学评估，评估嗜酸性细胞含量并计算每个切除腺体的体积。
62个甲状旁腺中41个（66%）闪烁扫描呈阳性。阳性腺体的中位体积大于阴性腺体（1.33 ml对0.7 ml，p = 0.015）。甲状旁腺病变中，结节性增生14例（22.6%），弥漫性增生23例（37.1%），腺瘤25例（40.3%）。16个腺体（25.8%）嗜酸性细胞含量高（≥25%），46个腺体（74.2%）嗜酸性细胞含量低（<25%）。甲状旁腺的组织病理学与闪烁扫描结果相关（p = 0.002），但与99mTc-MIBI摄取模式无关（p = 0.868）。闪烁扫描的总体结果与嗜酸性细胞含量无关（p = 0.797）。99mTc-MIBI摄取模式与嗜酸性细胞含量无关（p = 0.833）。一般来说，嗜酸性细胞含量低的甲状旁腺病变大于嗜酸性细胞含量高的甲状旁腺（分别为1.33 ml对0.5 ml；p = 0.01）。含有大量嗜酸性细胞且99mTc-MIBI滞留时间延长的甲状旁腺的中位体积大于无99mTc-MIBI滞留时间延长的甲状旁腺（分别为1.62 ml对0.3 ml；p = 0.008）。嗜酸性细胞含量低且99mTc-MIBI滞留时间延长的甲状旁腺的中位体积大于无99mTc-MIBI滞留时间延长的甲状旁腺（分别为1.95 ml对1.07 ml；p = 0.014）。
我们的研究结果表明，闪烁扫描阳性结果取决于甲状旁腺组织病理学和腺体体积，而不取决于嗜酸性细胞的存在。99mTc滞留时间延长与甲状旁腺组织病理学和嗜酸性细胞的存在无关，而与腺体体积有关。
