Thompson G B, Mullan B P, Grant C S, Gorman C A, van Heerden J A, O'Connor M K, Goellner J R, Ilstrup D M
Surgery. 1994 Dec;116(6):966-72; discussion 972-3.
The ideal method for preoperative localization of abnormal parathyroid glands has yet to be determined. Technetium-99m-sestamibi, previously used for myocardial perfusion studies, has recently been introduced for parathyroid imaging.
From August 1991 to September 1993, 44 patients underwent Tc-99m-sestamibi scanning (45 scans) and surgical exploration for hyperparathyroidism at our institution. These 44 patients form the database for this retrospective study. Twenty-eight patients had persistent hyperparathyroidism, six had recurrent disease, three had prior thyroid operation, and seven underwent first time neck operations. The nature of disease was complex and varied: single gland, 26; primary hyperplasia, 5; multiple endocrine neoplasia type 1, 5; familial, 3; secondary or tertiary, 5. One patient with single gland disease and one patient with multiple endocrine neoplasia type 1 had parathyroid carcinoma. All patients had biochemical confirmation of hyperparathyroidism.
Twenty-six (58%) of 45 scans accurately predicted the location(s) of all abnormal gland(s) involved (true positive). Surgical removal of these glands was curative. Sixteen (36%) of 45 scans were false negative because they did not show all abnormal glands involved; however, 7 of these 16 scans did localize at least one abnormal gland. The overall sensitivity of this test was 62% when all abnormal glands were considered but increased to 79% with the demonstration of at least one abnormal gland. These values increased to 80% and 90% (p = 0.03), respectively, in the last 20 patients when the injected dose of Tc-99m-sestamibi was increased from 10 to 15 mCi. Thirty-seven of 44 patients were cured after operation. Six of the seven patients who experienced surgical failure had multigland disease, one of which was malignant. Sestamibi scans correctly identified abnormal cervical glands in 18 (58%) of 31 patients and abnormal mediastinal glands in six (75%) of eight patients.
Tc-99m-sestamibi scanning is helpful in the reoperative setting as an adjunct to localizing abnormal parathyroid tissue. A higher percentage of positive tests occurs in patients with mediastinal and single gland disease. A higher dose of Tc-99m-sestamibi (15 mCi) significantly improves test sensitivity.
异常甲状旁腺术前定位的理想方法尚未确定。锝-99m-甲氧基异丁基异腈（Tc-99m-sestamibi），此前用于心肌灌注研究，最近已被引入用于甲状旁腺显像。
1991年8月至1993年9月，44例患者在我院接受了Tc-99m-sestamibi扫描（45次扫描）并因甲状旁腺功能亢进接受手术探查。这44例患者构成了这项回顾性研究的数据库。28例患者患有持续性甲状旁腺功能亢进，6例患有复发性疾病，3例曾接受过甲状腺手术，7例接受首次颈部手术。疾病性质复杂多样：单发性腺体病变26例；原发性增生5例；多发性内分泌腺瘤1型5例；家族性3例；继发性或三发性5例。1例单发性腺体病变患者和1例多发性内分泌腺瘤1型患者患有甲状旁腺癌。所有患者均经生化检查确诊为甲状旁腺功能亢进。
45次扫描中有26次（58%）准确预测了所有受累异常腺体的位置（真阳性）。手术切除这些腺体可治愈疾病。45次扫描中有16次（36%）为假阴性，因为它们未显示所有受累异常腺体；然而，这16次扫描中有7次至少定位了一个异常腺体。当考虑所有异常腺体时，该检查的总体敏感性为62%，但当显示至少一个异常腺体时，敏感性提高到79%。当Tc-99m-sestamibi的注射剂量从10 mCi增加到15 mCi时，在最后20例患者中，这些值分别提高到80%和90%（p = 0.03）。44例患者中有37例术后治愈。7例手术失败的患者中有6例患有多腺体疾病，其中1例为恶性。Sestamibi扫描在31例患者中的18例（58%）中正确识别出颈部异常腺体，在8例患者中的6例（75%）中正确识别出纵隔异常腺体。
Tc-99m-sestamibi扫描有助于再次手术时定位异常甲状旁腺组织。在纵隔和单发性腺体疾病患者中阳性检查的比例更高。更高剂量的Tc-99m-sestamibi（15 mCi）可显著提高检查敏感性。
