Shin Muheon, Choi Joon Young, Kim Sun Wook, Kim Jung Han, Cho Young Seok
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Endocrinology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Nucl Med Mol Imaging. 2021 Dec;55(6):285-292. doi: 10.1007/s13139-021-00722-6. Epub 2021 Oct 30.
Tc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). The purpose of this study is to investigate the usefulness of Tc-sestamibi scintigraphy in persistent hyperparathyroidism after kidney transplant (KT).
Retrospectively evaluated 50 patients who received parathyroidectomy after KT at a single medical center. The parathyroid lesion with the highest sestamibi uptake intensity of a patient was graded from 0 to 3. Uptake intensity was analyzed in correlation with parathyroid hormone (PTH), calcium, ionized calcium, phosphorus, and vitamin D.
Per-patient analysis, 43 patients had hyperplasia, 6 patients had adenomas, and 1 patient had a carcinoma. Only 3 patients with hyperplasia did not demonstrate any sestamibi uptake in the parathyroid scans. Out of the 148 pathologically confirmed parathyroid lesions, SPECT/CT images were able to identify 89 lesions (60%) and planar images of 71 lesions (48%). The average of sestamibi uptake intensity was mild at grade 1.6. Uptake intensity showed a positive correlation with parathyroid hormone (PTH) level but not with phosphorus, calcium, ionized calcium, or vitamin D levels. The largest lesion showed a high positive predictive value, especially in lesions with a diameter over 1.0 cm.
Regardless of relatively low and less discrete uptake in KT patients, it well depicts the largest and the most hyperfunctioning lesion.
锝标记的 sestamibi 闪烁扫描术联合单光子发射计算机断层扫描（SPECT）对原发性甲状旁腺功能亢进症（pHPT）中功能亢进的甲状旁腺病变进行定位具有较高的阳性预测价值，但在继发性甲状旁腺功能亢进症（sHPT）和三发性甲状旁腺功能亢进症（tHPT）中敏感性和特异性相对较低。本研究的目的是探讨锝 - sestamibi 闪烁扫描术在肾移植（KT）后持续性甲状旁腺功能亢进症中的应用价值。
回顾性评估了在单一医疗中心接受 KT 后行甲状旁腺切除术的 50 例患者。将患者甲状旁腺病变中 sestamibi 摄取强度最高的病变从 0 到 3 进行分级。分析摄取强度与甲状旁腺激素（PTH）、钙、离子钙、磷和维生素 D 的相关性。
按患者分析，43 例患者为增生，6 例患者为腺瘤，1 例患者为癌。仅 3 例增生患者在甲状旁腺扫描中未显示任何 sestamibi 摄取。在 148 个经病理证实的甲状旁腺病变中，SPECT/CT 图像能够识别 89 个病变（60%），平面图像能够识别 71 个病变（48%）。sestamibi 摄取强度的平均值为轻度，分级为 1.6。摄取强度与甲状旁腺激素（PTH）水平呈正相关，但与磷、钙、离子钙或维生素 D 水平无关。最大的病变显示出较高的阳性预测价值，尤其是直径超过 1.0 cm 的病变。
尽管 KT 患者的摄取相对较低且不太离散，但它能很好地描绘出最大且功能最亢进的病变。
