Suh Hoon Young, Na Hee Young, Park So Yeon, Choi June Young, So Young, Lee Won Woo
Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine.
Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University.
Medicine (Baltimore). 2020 Jul 10;99(28):e21176. doi: 10.1097/MD.0000000000021176.
Tc-99m sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has been used to help surgeons explore the location of parathyroid diseases, but quantitative parameters have not been systemically investigated for this purpose. We aimed to establish objective criteria for adenoma and hyperplasia using the standardized uptake value (SUV) in patients with hyperparathyroidism.Thirty-nine hyperparathyroid patients (male/female: 17/22, age: 58.33 ± 11.69 years) with at least 1 uptake-positive lesion of any degree by visual assessment in preoperative Tc-99m sestamibi quantitative SPECT/CT were included from Oct 2015 to Oct 2017. Pathologically, 44 lesions (32 adenomas and 12 hyperplasia) were identified. All patients experienced normalized levels of intact parathyroid hormone immediately after surgery. Quantitative SPECT/CT was performed at 10 minute and 2 hour post injection of Tc-99m sestabmibi (dose = 740 MBq), and maximum SUV (SUVmax) was measured for the parathyroid lesions. Experienced pathologists evaluated the percentage cellular proportions of chief cells, oxyphil cells, and clear cells.SUVmax (g/mL) of adenomas, hyperplasia, and reference thyroid tissue were 12.92 ± 6.68, 7.90 ± 5.49, and 7.01 ± 2.62 at 10min (early phase), decreasing to 7.46 ± 5.66, 4.65 ± 3.14, and 2.21 ± 1.07 at 2 hour (delayed phase), respectively. The adenomas showed significantly higher SUVmax than both the hyperplasia (P = .0131) and reference thyroid tissue (P < .0001) along the early and delayed phases, but the SUVmax of the hyperplasia did not differ from that of the reference thyroid tissue (P = .4196). The adenomas and hyperplasia were discriminated from the reference thyroid tissue using a cutoff SUVmax of 3.26 at the delayed phase. The adenomas had lower %proportions of oxyphil cells than the hyperplasia (P = .0054), but its SUVmax at the delayed phase was positively correlated with the %proportions of mitochondria-abundant oxyphil cells (rho = 0.418, P = .0173). The hyperplasia showed no correlation between SUVmax and cellular proportions.SUVmax at the delayed phase in the Tc-99m sestamibi quantitative SPECT/CT was useful for the identification and differentiation of parathyroid lesions causing hyperparathyroidism.
锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）已被用于帮助外科医生探寻甲状旁腺疾病的位置，但尚未就此目的对定量参数进行系统研究。我们旨在利用甲状旁腺功能亢进患者的标准化摄取值（SUV）建立腺瘤和增生的客观标准。
2015年10月至2017年10月纳入了39例甲状旁腺功能亢进患者（男/女：17/22，年龄：58.33±11.69岁），这些患者在术前锝-99m甲氧基异丁基异腈定量SPECT/CT中经视觉评估至少有1个任何程度的摄取阳性病变。病理检查发现44个病变（32个腺瘤和12个增生）。所有患者术后即刻甲状旁腺激素水平恢复正常。在注射锝-99m甲氧基异丁基异腈（剂量 = 740 MBq）后10分钟和2小时进行定量SPECT/CT，并测量甲状旁腺病变的最大SUV（SUVmax）。经验丰富的病理学家评估主细胞、嗜酸性细胞和透明细胞的细胞比例百分比。
腺瘤、增生和对照甲状腺组织在10分钟（早期）时的SUVmax（克/毫升）分别为12.92±6.68、7.90±5.49和7.01±2.62，在2小时（延迟期）时分别降至7.46±5.66、4.65±3.14和2.21±1.07。在早期和延迟期，腺瘤的SUVmax均显著高于增生（P = 0.0131）和对照甲状腺组织（P < 0.0001），但增生的SUVmax与对照甲状腺组织的SUVmax无差异（P = 0.4196）。在延迟期，使用SUVmax临界值3.26可将腺瘤和增生与对照甲状腺组织区分开来。腺瘤的嗜酸性细胞比例百分比低于增生（P = 0.0054），但其在延迟期的SUVmax与富含线粒体的嗜酸性细胞比例百分比呈正相关（rho = 0.418，P = 0.0173）。增生的SUVmax与细胞比例之间无相关性。
锝-99m甲氧基异丁基异腈定量SPECT/CT延迟期的SUVmax有助于识别和区分导致甲状旁腺功能亢进的甲状旁腺病变。
