Jitrapinate Worachart, Raruenrom Yutapong, Wongsurawat Nantaporn, Sa-Ngiamwibool Prakasit, Theerakulpisut Daris
Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap highway, Mueang Khon Kaen district, Khon Kaen, 40002, Thailand.
Division of Nuclear Medicine, Department of Radiology, Maha Vajiralongkorn Thanyaburi Hospital, Pathum Thani, Thailand.
EJNMMI Res. 2025 Apr 5;15(1):34. doi: 10.1186/s13550-025-01234-6.
SPECT/CT has been well established as a valuable technique in nuclear medicine parathyroid imaging, but most previous studies were done in patients with primary hyperparathyroidism. In this retrospective study, we examined the diagnostic performance of [Tc]NaTcO4 / [Tc]Tc-MIBI planar subtraction parathyroid scintigraphy (PS), SPECT/CT, and a combination of the two in a patient cohort consisting of mostly end-stage renal disease (ESRD) patients with secondary or tertiary hyperparathyroidism, using histopathological results as the reference standard.
Among 116 patients included, 98 (84.5%) had ESRD. The overall sensitivity of subtraction PS, SPECT/CT and combined interpretation was 69% (95% confidence interval: 64-73%), 67% (61-72%), and 79% (74-84%), while the specificity was 68% (59-76%), 71% (61-80%), and 60% (50-70%), respectively. For patients without ESRD with predominantly primary hyperparathyroidism, the sensitivity was 93% (70-99%), 89% (57-98%), and 100% (70-100%), and the specificity was 88% (76-94%), 87% (71-95%), and 84% (67-93%), respectively. For those with ESRD with predominantly tertiary and secondary hyperparathyroidism, the sensitivity was 67% (62-72%), 66% (60-71%), 78% (73-83%), and the specificity was 55% (42-67%), 57% (43-70%), and 43% (30-58%), respectively.
SPECT/CT was not superior to subtraction PS in ESRD patients with hyperparathyroidism. Combining these two techniques improves sensitivity, but likely with the expense of reduction in specificity. Both planar subtraction PS and SPECT/CT have suboptimal diagnostic performance in ESRD patients compared with non-ESRD patients where these techniques provide impressive sensitivity and specificity.
SPECT/CT已被公认为核医学甲状旁腺显像中的一项重要技术，但此前大多数研究是在原发性甲状旁腺功能亢进患者中进行的。在这项回顾性研究中，我们以组织病理学结果作为参考标准，考察了[锝]高锝酸钠/[锝]锝-甲氧基异丁基异腈平面减影甲状旁腺闪烁显像（PS）、SPECT/CT以及二者联合应用在一个主要由患有继发性或三发性甲状旁腺功能亢进的终末期肾病（ESRD）患者组成的队列中的诊断性能。
在纳入的116例患者中，98例（84.5%）患有ESRD。减影PS、SPECT/CT及联合解读的总体敏感性分别为69%（95%置信区间：64-73%）、67%（61-72%）和79%（74-84%），特异性分别为68%（59-76%）、71%（61-80%）和60%（50-70%）。对于主要患有原发性甲状旁腺功能亢进的非ESRD患者，敏感性分别为93%（70-99%）、89%（57-98%）和100%（70-100%），特异性分别为88%（76-94%）、87%（71-95%）和84%（67-93%）。对于主要患有三发性和继发性甲状旁腺功能亢进的ESRD患者，敏感性分别为67%（62-72%）、66%（60-71%）和78%（73-83%），特异性分别为55%（42-67%）、57%（43-70%）和43%（30-58%）。
在患有甲状旁腺功能亢进的ESRD患者中，SPECT/CT并不优于减影PS。将这两种技术联合应用可提高敏感性，但可能是以降低特异性为代价。与非ESRD患者相比，平面减影PS和SPECT/CT在ESRD患者中的诊断性能均欠佳，而在非ESRD患者中这些技术具有令人印象深刻的敏感性和特异性。
