Nagoya Daini Red Cross Hospital, Department of Transplant and Endocrine Surgery, 466-8650, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, Japan.
Sci Rep. 2019 Oct 10;9(1):14634. doi: 10.1038/s41598-019-51265-y.
Complete parathyroidectomy (PTx) is essential during total PTx for secondary hyperparathyroidism (SHPT) to prevent recurrent and persistent hyperparathyroidism. Pre-operative imaging evaluations, including computed tomography (CT), ultrasonography (US), and Tc-99m sestamibi (MIBI) scans, are commonly performed. Between June 2009 and January 2016, 291 patients underwent PTx for SHPT after pre-operative evaluations involving CT, US, and MIBI scans, and the diagnostic accuracies of these imaging modalities for identifying the parathyroid glands were evaluated in 177 patients whose intact parathyroid hormone (PTH) levels were <9 pg/mL after the initial PTx. Additional PTx procedures were performed on 7 of 114 patients whose intact PTH levels were >9 ng/mL after PTx, and the diagnostic validities of the imaging modalities for the remnant parathyroid glands were evaluated. A combination of CT, US, and MIBI scans achieved the highest diagnostic accuracy (75%) for locating bilateral upper and lower parathyroid glands before initial PTx. The accuracies of CT, US, and MIBI scans with respect to locating remnant parathyroid glands before additional PTx were 100%, 28.6%, and 100%, respectively. A combination of CT, US, and MIBI scans is useful for initial PTx for SHPT, and CT and MIBI scans are useful imaging modalities for additional PTx procedures.
甲状旁腺全切除（PTx）对于治疗继发性甲状旁腺功能亢进症（SHPT）至关重要，可防止甲状旁腺功能亢进症的复发和持续存在。术前常进行影像学评估，包括计算机断层扫描（CT）、超声检查（US）和 Tc-99m 甲氧基异丁基异腈（MIBI）扫描。2009 年 6 月至 2016 年 1 月，291 例患者在术前 CT、US 和 MIBI 扫描评估后接受了 SHPT 的 PTx，177 例初始 PTx 后甲状旁腺激素（PTH）水平<9pg/ml 的患者评估了这些影像学方法对甲状旁腺的诊断准确性。对 114 例 PTx 后 PTH 水平>9ng/ml 的患者进行了额外的 PTx 手术，评估了影像学方法对残留甲状旁腺的诊断准确性。在初始 PTx 前，CT、US 和 MIBI 扫描联合应用对双侧上下甲状旁腺的定位具有最高的诊断准确性（75%）。在进行额外的 PTx 术前，CT、US 和 MIBI 扫描对残留甲状旁腺的定位准确性分别为 100%、28.6%和 100%。CT、US 和 MIBI 扫描联合应用有助于治疗 SHPT 的初始 PTx，CT 和 MIBI 扫描是额外的 PTx 手术的有用影像学方法。
