Hellman P, Ahlström H, Bergström M, Sundin A, Långström B, Westerberg G, Juhlin C, Akerström G, Rastad J
Department of Surgery, Uppsala University, Sweden.
Surgery. 1994 Dec;116(6):974-81.
Positron emission tomography (PET) has not been evaluated for preoperative localization and functional characterization of the parathyroid tissue in hyperparathyroidism.
Images of the neck and upper mediastinum of 23 patients with hyperparathyroidism were obtained by PET after intravenous administration of 400 to 800 MBq L-[methyl-11C]-methionine. The investigation was repeated in six patients after Na2-ethylenediamine tetraacetic acid infusion, whereby stable 65% to 157% rise in intact serum parathyroid hormone values was attained.
Parathyroid surgical procedure revealed single (21 patients) or two enlarged parathyroid glands (two patients) that were characterized as chief cell adenoma (n = 13), hyperplasia (n = 10), or carcinoma (n = 2) and weighed 80 to 6000 mg. Twenty (80%) of these glands were localized by PET. The remaining examinations (20%) were false negative and mainly encompassed small parathyroids in juxtathyroid position. Among 15 patients undergoing parathyroid reoperation true-positive localizations were obtained for 87% of the glands. The images displayed lower tracer uptake in residual thyroid lobes (n = 40), esophagus, and cervical vertebrae. Na2-ethylenediamine tetraacetic acid infusion failed to enhance parathyroid uptake values. Ultrasonography, computed tomography, technetium-thallium scintigraphy, and venous sampling revealed 25% to 53% of the pathologic parathyroid tissues of the patients undergoing reoperation and was largely complementary to PET.
The results suggest that PET may provide novel possibilities for the imaging of pathologic parathyroid glands in hyperparathyroidism.
正电子发射断层扫描（PET）尚未用于甲状旁腺功能亢进症患者甲状旁腺组织的术前定位及功能特征分析。
23例甲状旁腺功能亢进症患者静脉注射400至800MBq L-[甲基-11C]-蛋氨酸后，采用PET获取颈部及上纵隔图像。6例患者在输注乙二胺四乙酸二钠后重复检查，由此血清甲状旁腺激素完整值稳定升高65%至157%。
甲状旁腺手术显示单个（21例患者）或两个增大的甲状旁腺（2例患者），其特征为主细胞腺瘤（n = 13）、增生（n = 10）或癌（n = 2），重量为80至6000mg。其中20个（80%）腺体通过PET定位。其余检查（20%）为假阴性，主要包括位于甲状旁腺旁位置的小甲状旁腺。在15例接受甲状旁腺再次手术的患者中，87%的腺体获得了真阳性定位。图像显示残余甲状腺叶（n = 40）、食管和颈椎的示踪剂摄取较低。乙二胺四乙酸二钠输注未能提高甲状旁腺摄取值。超声、计算机断层扫描、锝-铊闪烁扫描和静脉取样显示，接受再次手术患者的病理甲状旁腺组织中有25%至53%被发现，且在很大程度上与PET互补。
结果表明，PET可能为甲状旁腺功能亢进症中病理性甲状旁腺的成像提供新的可能性。
