Pogosian Karina, Karonova Tatiana, Ryzhkova Daria, Yanevskaya Liubov, Tsoy Uliana, Yudina Olga, Berkovich Gleb, Dalmatova Anna, Grineva Elena
Almazov National Medical Research Center, Saint Petersburg, Russian Federation.
Quant Imaging Med Surg. 2023 Apr 1;13(4):2352-2363. doi: 10.21037/qims-22-584. Epub 2023 Feb 16.
It is well known that primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders. Precise preoperative adenoma localization is essential for increasing PHPT cure rate. Conventional localization techniques include neck ultrasound, 99m-Tc-sestamibi scintigraphy, and computed tomography (CT). However, all of these methods have limitations. C-methionine positron emission tomography/computed tomography (PET/CT) combines both anatomical and functional modalities; it may be useful in terms of lowering the imaging procedures number and improving accuracy.
A retrospective diagnostic accuracy study with sensitivity and specificity evaluation was conducted. We studied the data of 91 patients with PHPT, who were hospitalized at Almazov National Medical Research Centre. Medical records, lab results, and CT imaging of all patients were analyzed. All of them underwent ultrasound. 99m-Tc-sestamibi/99m-Tc-pertechnetate subtraction scintigraphy and CT were performed on 56 and 86 patients, respectively. Since 2020 C-methionine PET/CT has been performed on 45 patients. Then, minimally invasive parathyroidectomy (PTX) was carried out in all patients. Histological results were used as a benchmark in order to evaluate diagnostic accuracy of studied methods. Parathyroid adenoma or hyperplasia was confirmed in all patients. Multiple lesions were found in 5 patients. Nineteen lesions were ectopic. All patients with multiple lesions required at least 3 localization techniques, and 2 of them required 4.
The sensitivity of C-methionine PET/CT was 98%, CT, 99m-Tc-sestamibi scintigraphy, and ultrasound showed sensitivity at 75%, 79%, and 67%, respectively. The estimated specificities of C-methionine PET/CT, CT, 99m-Tc-sestamibi scintigraphy and ultrasound were 93%, 73%, 75%, and 70%, respectively.
Our study showed that C-methionine PET/CT has higher sensitivity and specificity than conventional techniques in a group of 19 patients. C-methionine PET/CT may take a place in the imaging of parathyroid adenomas, it may replace CT and 99m-Tc-sestamibi scintigraphy while simultaneously providing information about lesion topography and function.
众所周知，原发性甲状旁腺功能亢进症（PHPT）是最常见的内分泌疾病之一。术前精确的腺瘤定位对于提高PHPT治愈率至关重要。传统的定位技术包括颈部超声、99m锝-甲氧基异丁基异腈闪烁扫描和计算机断层扫描（CT）。然而，所有这些方法都有局限性。碳-蛋氨酸正电子发射断层扫描/计算机断层扫描（PET/CT）结合了解剖和功能模式；在减少成像程序数量和提高准确性方面可能很有用。
进行了一项回顾性诊断准确性研究，并评估了敏感性和特异性。我们研究了91例在阿尔马佐夫国家医学研究中心住院的PHPT患者的数据。分析了所有患者的病历、实验室结果和CT影像。所有患者均接受了超声检查。分别对56例和86例患者进行了99m锝-甲氧基异丁基异腈/99m锝-高锝酸盐减影闪烁扫描和CT检查。自2020年以来，对45例患者进行了碳-蛋氨酸PET/CT检查。然后，对所有患者进行了微创甲状旁腺切除术（PTX）。组织学结果用作评估所研究方法诊断准确性的基准。所有患者均确诊为甲状旁腺腺瘤或增生。5例患者发现有多个病灶。19个病灶为异位。所有有多个病灶的患者至少需要3种定位技术，其中2例需要4种。
碳-蛋氨酸PET/CT的敏感性为98%，CT、99m锝-甲氧基异丁基异腈闪烁扫描和超声的敏感性分别为75%、79%和67%。碳-蛋氨酸PET/CT、CT、99m锝-甲氧基异丁基异腈闪烁扫描和超声的估计特异性分别为93%、73%、75%和70%。
我们的研究表明，在一组19例患者中，碳-蛋氨酸PET/CT比传统技术具有更高的敏感性和特异性。碳-蛋氨酸PET/CT可能在甲状旁腺腺瘤成像中占有一席之地，它可以取代CT和99m锝-甲氧基异丁基异腈闪烁扫描，同时提供有关病灶位置和功能的信息。
