氟代胆碱 F-18 PET/CT 对甲状旁腺激素水平升高且常规影像学检查阴性或结果不一致的患者异位甲状旁腺组织的探测效能。

Performance of F-18 Fluorocholine PET/CT for Detection of Hyperfunctioning Parathyroid Tissue in Patients with Elevated Parathyroid Hormone Levels and Negative or Discrepant Results in conventional Imaging.

机构信息

Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.

出版信息

Korean J Radiol. 2020 Feb;21(2):236-247. doi: 10.3348/kjr.2019.0268.

OBJECTIVE

Our aim was to assess the diagnostic performance of F-18 fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) in detecting hyperfunctioning parathyroid tissue (HPT) in patients with elevated parathyroid hormone levels with negative or inconclusive conventional imaging results and to compare the findings with those obtained using technetium-99m sestamibi (MIBI) scintigraphy and neck ultrasonography (US).

MATERIALS AND METHODS

Images of 105 patients with hyperparathyroidism who underwent FCH PET/CT, dual-phase MIBI parathyroid scintigraphy (median interval: 42 days), and neck US were retrospectively analyzed. The gold standard was histopathological findings for 81 patients who underwent parathyroidectomy and clinical follow-up findings in the remaining 24 patients. Sensitivities, positive predictive values (PPVs), and accuracies were calculated for all imaging modalities.

RESULTS

Among the 81 patients who underwent parathyroidectomy, either parathyroid adenoma (n = 64), hyperplasia (n = 9), neoplasia (n = 4), or both parathyroid adenoma and hyperplasia (n = 1) were detected, except 3 patients who did not show HPT. Of the 24 (23%) patients who were followed-up without operation, 22 (92%) showed persistent hyperparathyroidism. FCH PET/CT showed significantly higher sensitivity than MIBI scintigraphy and US in detection of HPT ( < 0.01). Sensitivity, PPV, and accuracy of FCH PET/CT were 94.1% (95/101), 97.9% (95/97), and 92.4% (97/105), respectively. The corresponding values for MIBI scintigraphy and US were 45.1% (46/102), 97.9% (46/47), and 45.7% (48/105) and 44.1% (45/102), 93.8% (45/48), and 42.9% (45/105), respectively. Among the 35 patients showing negative MIBI scintigraphy and neck US findings, 30 (86%) showed positive results on FCH PET/CT. FCH PET/CT could demonstrate ectopic locations of HPT in 11 patients whereas MIBI and US showed positive findings in only 6 and 3 patients, respectively.

CONCLUSION

FCH PET/CT is an effective imaging modality for detection of HPT with the highest sensitivity among the available imaging techniques. Therefore, FCH PET/CT can be recommended especially for patients who show negative or inconclusive results on conventional imaging.

目的

我们旨在评估氟-18 氟胆碱（FCH）正电子发射断层扫描/计算机断层扫描（PET/CT）在检测甲状旁腺激素水平升高且常规影像学检查结果阴性或不确定的患者中功能性甲状旁腺组织（HPT）的诊断性能，并将结果与锝-99m 甲氧基异丁基异腈（MIBI）闪烁扫描和颈部超声检查（US）的结果进行比较。

材料和方法

回顾性分析了 105 例甲状旁腺功能亢进症患者的 FCH PET/CT、双时相 MIBI 甲状旁腺闪烁扫描（中位数间隔：42 天）和颈部 US 图像。81 例行甲状旁腺切除术的患者以组织病理学检查为金标准，24 例患者以临床随访结果为金标准。计算所有影像学方法的灵敏度、阳性预测值（PPV）和准确性。

结果

在 81 例行甲状旁腺切除术的患者中，除 3 例患者未显示 HPT 外，均发现甲状旁腺瘤（n=64）、增生（n=9）、肿瘤（n=4）或两者兼有（n=1）。24 例（23%）未行手术随访的患者中，22 例（92%）持续存在甲状旁腺功能亢进症。FCH PET/CT 在检测 HPT 方面的灵敏度明显高于 MIBI 闪烁扫描和 US（<0.01）。FCH PET/CT 的灵敏度、PPV 和准确性分别为 94.1%（95/101）、97.9%（95/97）和 92.4%（97/105）。MIBI 闪烁扫描和 US 的相应值分别为 45.1%（46/102）、97.9%（46/47）和 45.7%（48/105）和 44.1%（45/102）、93.8%（45/48）和 42.9%（45/105）。在 35 例 MIBI 闪烁扫描和颈部 US 检查结果阴性的患者中，30 例（86%）FCH PET/CT 检查结果阳性。FCH PET/CT 可显示 11 例 HPT 的异位位置，而 MIBI 和 US 仅分别显示 6 例和 3 例阳性。