Kesim Selin, Turoglu Halil Turgut, Kotan Tuncay, Balaban Genc Zeynep Ceren, Niftaliyeva Khanim, Toper Hasan, Gogas Yavuz Dilek, Ozguven Salih, Kaya Handan, Dede Fuat, Ugurlu Mustafa Umit, Oksuzoglu Kevser, Cagliyan Feyza, Gulluoglu Bahadir Mahmut, Ones Tunc, Erdil Tanju Yusuf
Departments of Nuclear Medicine.
General Surgery.
Nucl Med Commun. 2025 Jan 1;46(1):47-54. doi: 10.1097/MNM.0000000000001924. Epub 2024 Nov 8.
Parathyroid imaging with dual-phase technetium-99m methoxyisobutrylizonitrile (Tc-99m MIBI) scintigraphy serves as an important prerequisite for the identification of hyperfunctioning parathyroid gland(s) in patients with primary hyperparathyroidism (PHPT) for a successful targeted parathyroidectomy. This study aimed to evaluate the clinical value of additional lateral imaging and single-photon emission computed tomography/computed tomography (SPECT/CT) versus conventional planar imaging for locating parathyroid pathologies in patients with PHPT.
A retrospective review was performed on 105 patients who underwent dual-phase Tc-99m MIBI scintigraphy and were surgically treated by parathyroidectomy. Dual-phase Tc-99m-MIBI planar scintigraphy with additional lateral pinhole views and SPECT/CT imaging was performed on a routine basis, as per departmental protocol. Comparison study between imaging modalities was done by patient-based analysis and scintigraphy results were compared with the clinical findings, biochemical markers, and histopathological findings.
Sensitivity and specificity for anterior planar dual-phase Tc-99m MIBI scintigraphy were 78.8 and 80%, respectively. In comparison, lateral pinhole scan and SPECT/CT alone were found to have sensitivities of 85.9 and 90.9%, respectively, with the same specificity. Sensitivity decreased in patients with normocalcaemia and multiglandular disease. The mean adenoma weight and size for true-positive studies were significantly higher than those for false-negative or false-positive studies.
SPECT/CT provided the highest diagnostic accuracy for preoperative identification of parathyroid lesions in PHPT patients. Lateral pinhole imaging offers comparable sensitivity and aids in adenoma localisation when SPECT/CT is unavailable.
采用双期99m锝甲氧基异丁基异腈（Tc-99m MIBI）闪烁扫描术进行甲状旁腺成像，是原发性甲状旁腺功能亢进症（PHPT）患者成功进行靶向甲状旁腺切除术时识别功能亢进甲状旁腺的重要前提。本研究旨在评估附加侧位成像及单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）相较于传统平面成像在定位PHPT患者甲状旁腺病变中的临床价值。
对105例行双期Tc-99m MIBI闪烁扫描术并接受甲状旁腺切除术的患者进行回顾性研究。根据科室方案，常规进行双期Tc-99m-MIBI平面闪烁扫描及附加侧位针孔视图和SPECT/CT成像。通过基于患者的分析对成像方式进行比较研究，并将闪烁扫描结果与临床发现、生化标志物及组织病理学结果进行比较。
前位平面双期Tc-99m MIBI闪烁扫描的敏感性和特异性分别为78.8%和80%。相比之下，单独的侧位针孔扫描和SPECT/CT的敏感性分别为85.9%和90.9%，特异性相同。血钙正常和多腺体疾病患者中敏感性降低。真阳性研究的腺瘤平均重量和大小显著高于假阴性或假阳性研究。
SPECT/CT对PHPT患者甲状旁腺病变的术前识别具有最高的诊断准确性。当无法进行SPECT/CT时，侧位针孔成像具有相当的敏感性并有助于腺瘤定位。
