Tsoy Uliana, Pogosian Karina, Ryzhkova Daria, Yudina Olga, Yakovenko Ksenia, Ryazanov Pavel, Matsueva Irina, Sokolnikova Polina, Salov Maksim, Karonova Tatiana, Grineva Elena
Almazov National Medical Research Centre, 2 Akkuratova Street, Saint Petersburg 197341, Russia.
Diagnostics (Basel). 2024 Dec 3;14(23):2718. doi: 10.3390/diagnostics14232718.
Parathyroid tumors are classified as parathyroid neuroendocrine neoplasia (NEN) by the IARC-WHO classification. These tumors can occur with NENs from other sites, which often require total-body [68Ga]-DOTA-peptides PET/CT. This study aimed to assess the utility of [68Ga]-DOTA-peptide PET/CT in imaging parathyroid NENs and to evaluate the underlying mechanisms.
Fifty patients with primary hyperparathyroidism (PHPT) and parathyroid NENs histologically confirmed as parathyroid adenomas (PAs) were included. PET/CT with [68Ga]-DOTA-peptide was performed in 16 patients with localized PAs, including 10 with MEN1 syndrome. Somatostatin receptor types 2 and 5 (SST2 and SST5) staining was performed on PAs from 48 patients. Somatostatin analogs (SSA) were prescribed in four patients with MEN 1 syndrome and 1 with persistent acromegaly, all with PAs and PHPT. The therapy effects on calcium and parathyroid hormone (iPTH) were evaluated.
[68Ga]-DOTA-peptide PET/CT detected 20 PAs with high radiopharmaceutical uptake. SST2 expression was negative on PA cell membranes in all cases and positive on endothelium in 39 (81%) PAs. Membrane SST5 expression was positive in 25 (52%) PAs and endothelial was positive in 40 (83%). Serum calcium levels decreased in patients on SSA therapy, while iPTH did not.
PET/CT with [68Ga]-DOTA-peptides can detect parathyroid NENs. The incidental detection of high [68Ga]-DOTA-peptide uptake in the parathyroid region during whole-body PET/CT may prompt biochemical evaluation for PHPT. We suggest that endothelial SST expression mediates high radiopharmaceutical uptake by PAs and that SSA treatment can reduce hypercalcemia in PHPT patients.
根据国际癌症研究机构（IARC）-世界卫生组织（WHO）的分类，甲状旁腺肿瘤被归类为甲状旁腺神经内分泌肿瘤（NEN）。这些肿瘤可与其他部位的NEN一起发生，这通常需要进行全身[68Ga]-DOTA肽PET/CT检查。本研究旨在评估[68Ga]-DOTA肽PET/CT在甲状旁腺NEN成像中的效用，并评估其潜在机制。
纳入50例原发性甲状旁腺功能亢进症（PHPT）患者，其甲状旁腺NEN经组织学确诊为甲状旁腺腺瘤（PA）。对16例局限性PA患者进行了[68Ga]-DOTA肽PET/CT检查，其中10例患有MEN1综合征。对48例患者的PA进行了生长抑素受体2型和5型（SST2和SST5）染色。对4例MEN1综合征患者和1例持续性肢端肥大症患者（均患有PA和PHPT）使用了生长抑素类似物（SSA）。评估了对钙和甲状旁腺激素（iPTH）的治疗效果。
[68Ga]-DOTA肽PET/CT检测到20个放射性药物摄取高的PA。所有病例中PA细胞膜上的SST2表达均为阴性，39个（81%）PA的内皮细胞上SST2表达为阳性。25个（52%）PA的细胞膜SST5表达为阳性，40个（83%）PA的内皮细胞SST5表达为阳性。接受SSA治疗的患者血清钙水平下降，而iPTH未下降。
[68Ga]-DOTA肽PET/CT可检测甲状旁腺NEN。在全身PET/CT期间甲状旁腺区域偶然检测到高[68Ga]-DOTA肽摄取可能会促使对PHPT进行生化评估。我们认为内皮细胞SST表达介导了PA对放射性药物的高摄取，并且SSA治疗可降低PHPT患者的高钙血症。
