Scheepers Max H M C, Al-Difaie Zaid, Brandts Lloyd, Peeters Andrea, Winkens Bjorn, Al-Taher Mahdi, Engelen Sanne M E, Lubbers Tim, Havekes Bas, Bouvy Nicole D, Postma Alida A
GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.
Diagnostics (Basel). 2023 Dec 22;14(1):25. doi: 10.3390/diagnostics14010025.
Accurate preoperative localization is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Preoperative localization can be challenging in patients with recurrent and/or multigland disease (MGD). This has led clinicians to investigate multiple imaging techniques, most of which are associated with radiation exposure. Magnetic resonance imaging (MRI) offers ionizing radiation-free and accurate imaging, making it an attractive alternative imaging modality. The objective of this systematic review is to provide an overview of the diagnostic performance of MRI in the localization of PHPT. PubMed and Embase libraries were searched from 1 January 2000 to 31 March 2023. Studies were included that investigated MRI techniques for the localization of PHPT. The exclusion criteria were (1) secondary/tertiary hyperparathyroidism, (2) studies that provided no diagnostic performance values, (3) studies published before 2000, and (4) studies using 0.5 Tesla MRI scanners. Twenty-four articles were included in the systematic review, with a total of 1127 patients with PHPT. In 14 studies investigating conventional MRI for PHPT localization, sensitivities varied between 39.1% and 94.3%. When employing more advanced MRI protocols like 4D MRI for PHPT localization in 11 studies, sensitivities ranged from 55.6% to 100%. The combination of MR imaging with functional techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy, with sensitivities ranging from 84.2% to 100% in five studies. Despite the limitations of the available evidence, the results of this review indicate that the combination of MR imaging with functional imaging techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy. Further research on emerging MR imaging modalities, such as 4D MRI and PET/MRI, is warranted, as MRI exposes patients to minimal or no ionizing radiation compared to other imaging modalities.
准确的术前定位对于原发性甲状旁腺功能亢进症（PHPT）患者成功进行微创甲状旁腺切除术至关重要。对于复发性和/或多腺体疾病（MGD）患者，术前定位可能具有挑战性。这促使临床医生研究多种成像技术，其中大多数与辐射暴露有关。磁共振成像（MRI）提供无电离辐射且准确的成像，使其成为一种有吸引力的替代成像方式。本系统评价的目的是概述MRI在PHPT定位中的诊断性能。检索了2000年1月1日至2023年3月31日的PubMed和Embase数据库。纳入了研究MRI技术用于PHPT定位的研究。排除标准为：（1）继发性/三发性甲状旁腺功能亢进症；（2）未提供诊断性能值的研究；（3）2000年以前发表的研究；（4）使用0.5特斯拉MRI扫描仪的研究。24篇文章纳入了本系统评价，共有1127例PHPT患者。在14项研究传统MRI用于PHPT定位的研究中，敏感性在39.1%至94.3%之间。在11项采用更先进的MRI方案（如4D MRI）进行PHPT定位的研究中，敏感性范围为55.6%至100%。将MR成像与功能技术（如18F-FCH-PET/MRI）相结合产生了最高的诊断准确性，在5项研究中敏感性范围为84.2%至100%。尽管现有证据存在局限性，但本评价结果表明，将MR成像与功能成像技术（如18F-FCH-PET/MRI）相结合产生了最高的诊断准确性。鉴于与其他成像方式相比，MRI使患者受到的电离辐射最小或无电离辐射，因此有必要对新兴的MR成像方式（如4D MRI和PET/MRI）进行进一步研究。
