Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland.
Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland; University of Zurich, Switzerland; Jewish General Hospital, McGill University, Montreal, QC, Canada.
Am J Otolaryngol. 2024 Jul-Aug;45(4):104315. doi: 10.1016/j.amjoto.2024.104315. Epub 2024 Apr 21.
For minimally invasive surgery of parathyroid adenomas, exact localization diagnostics are essential. Main imaging modalities used for diagnostics are sonography, SPECT with/without CT (traditional imaging) and F-choline-PET. The aim of our study was to identify predictors for inconclusive SPECT imaging and subsequently determine in which cases F-choline-PET is needed.
Retrospective analysis of 138 patients with histologically confirmed primary hyperparathyroidism (pHPT). After sonography, patients underwent SPECT or SPECT/CT imaging, with subsequent F-choline-PET in cases of disconcordant results. Logistic regression analysis was used to identify clinical and laboratory factors predictive for negative SPECT results.
Sensitivity rates for sonography, SPECT, SPECT/CT, and choline-PET were 47 %, 49 %, 71.7 %, and 97 %, respectively. Logistic regression revealed lower PTH levels (p < 0.001), presence of structural thyroid disease (p = 0.018), and negative sonography (p < 0.001) as predictive of negative/equivocal SPECT outcome. An additional traditional imaging CT scan to a SPECT enhanced detection odds, as did greater adenoma weight. Urolithiasis, osteoporosis, and calcium values as measurement of activity and duration of disease showed no significant association with the detection rate. Furthermore, our study demonstrated that F-choline-PET exhibited remarkable sensitivity in detecting adenomas among patients with negative/equivocal SPECT results.
Our study reveals potential predictive factors for a negative/equivocal SPECT outcome in pHPT. Identifying these factors might allow minimizing futile SPECT examinations and perhaps encourage timely utilization of F-choline-PET imaging. Our study reinforces the clinical significance of F-choline-PET, especially in complex cases with disconcordant results by conventional parathyroid imaging methods.
对于甲状旁腺瘤的微创手术，精确的定位诊断是必不可少的。用于诊断的主要成像方式是超声、SPECT 加/不加 CT（传统成像）和 F-胆碱-PET。我们的研究目的是确定 SPECT 成像不确定的预测因素，并确定在哪些情况下需要进行 F-胆碱-PET。
回顾性分析 138 例经组织学证实的原发性甲状旁腺功能亢进症（pHPT）患者。在超声检查后，患者行 SPECT 或 SPECT/CT 成像，如果结果不一致，则行 F-胆碱-PET。使用逻辑回归分析来确定预测 SPECT 结果阴性的临床和实验室因素。
超声、SPECT、SPECT/CT 和胆碱-PET 的敏感性率分别为 47%、49%、71.7%和 97%。逻辑回归显示，较低的甲状旁腺激素水平（p<0.001）、结构性甲状腺疾病（p=0.018）和阴性超声（p<0.001）是 SPECT 结果阴性/不确定的预测因素。在 SPECT 增强检测时，添加传统成像 CT 扫描可增加检测优势，而腺瘤重量越大则检测优势越大。尿路结石、骨质疏松症和钙值作为疾病活动和持续时间的测量与检测率无显著相关性。此外，我们的研究表明，在 SPECT 结果阴性/不确定的患者中，F-胆碱-PET 对腺瘤的检测具有显著的敏感性。
我们的研究揭示了 pHPT 中 SPECT 结果阴性/不确定的潜在预测因素。确定这些因素可能有助于减少无益的 SPECT 检查，并可能鼓励及时利用 F-胆碱-PET 成像。我们的研究强化了 F-胆碱-PET 的临床意义，特别是在传统甲状旁腺成像方法结果不一致的复杂病例中。
