Itoh K
Hokkaido Igaku Zasshi. 1984 Nov;59(6):701-20.
201T1-99mTc subtraction parathyroid scintigraphy assisted by computer (CASPS) was performed in 59 patients with suspected hyperparathyroidism (HPT). There were 32 patients operated on and 40 hyperfunctioning parathyroid glands histologically proven on 33 surgical explorations. Positive rate of scintigrams in surgically explored patients was preoperatively 66% (21/32) and retrospectively 78% (25/32). In seven of surgically explored patients, ten hyperfunctioning parathyroid glands could not be recognizable retrospectively. True positive rate of preoperative and retrospective localization as to each hyperfunctioning parathyroid glands were 53% (21/40) and 75% (30/40), respectively. There was a close but not statistically significant correlation between scintigraphic localization and weight of the hyperfunctioning parathyroid glands. However, visualization of hyperfunctioning parathyroid glands was statistically significant (p less than 0.05) in X2-test in correlation between ones of less and more than 0.500 g in weight. Plain 201T1-image delineated only one of 15 hyperfunctioning parathyroid glands which were less than 0.500 g in weight and subtraction image six. This result was also statistically significant (p less than 0.05) in X2-test. Subtraction technique was proved to be essential for delineating hyperfunctioning parathyroid glands which were especially less than 0.500 g in weight. There are two adenoma which concentrated 99mTc-pertchnetate rather than 201T1 chloride. Subtraction images of these cases was not useful for positive delineation and showed an area of a decreased radioactive distribution corresponding to the presence of adenoma located at the left anterior mediastinum. However, subtraction caused false positive localization in a few cases. Quantitatively analytic method on hot regions demonstrated by subtraction, which could be helpful for avoiding false negative and false positive estimation, has been developed. Results by 201T1-99mTc subtraction parathyroid scintigraphy is not necessarily satisfactory. However, this is noninvasive and is still a challenging method for preoperative localization of hyperfunctioning parathyroid glands rather than a ultrasonography and CT scan.
对59例疑似甲状旁腺功能亢进症（HPT）患者进行了计算机辅助的201Tl - 99mTc减影甲状旁腺闪烁显像（CASPS）。32例患者接受了手术，在33次手术探查中，有40个甲状旁腺功能亢进腺体经组织学证实。手术探查患者术前闪烁显像阳性率为66%（21/32），回顾性分析为78%（25/32）。在7例手术探查患者中，回顾性分析无法识别出10个甲状旁腺功能亢进腺体。术前和回顾性分析对每个甲状旁腺功能亢进腺体的真阳性率分别为53%（21/40）和75%（30/40）。闪烁显像定位与甲状旁腺功能亢进腺体重量之间存在密切但无统计学意义的相关性。然而，在X2检验中，重量小于和大于0.500 g的甲状旁腺功能亢进腺体之间的相关性中，甲状旁腺功能亢进腺体的显影具有统计学意义（p小于0.05）。普通201Tl图像仅显示了15个重量小于0.500 g的甲状旁腺功能亢进腺体中的1个，而减影图像显示了6个。在X2检验中，该结果也具有统计学意义（p小于0.05）。事实证明，减影技术对于描绘特别是重量小于0.500 g的甲状旁腺功能亢进腺体至关重要。有2例腺瘤摄取99mTc - 高锝酸盐而非201Tl氯化物。这些病例的减影图像对阳性描绘无用，且显示出对应于位于左前纵隔的腺瘤存在的放射性分布降低区域。然而，减影在少数情况下会导致假阳性定位。已经开发了通过减影显示的热区定量分析方法，这有助于避免假阴性和假阳性估计。201Tl - 99mTc减影甲状旁腺闪烁显像的结果不一定令人满意。然而，这是一种非侵入性方法，对于甲状旁腺功能亢进腺体的术前定位而言，仍然是一种具有挑战性的方法，优于超声检查和CT扫描。
