Casas A T, Burke G J, Mansberger A R, Wei J P
Department of Surgery, Medical College of Georgia, Augusta 30912.
Am J Surg. 1993 Oct;166(4):369-73. doi: 10.1016/s0002-9610(05)80335-6.
Surgery for primary hyperparathyroidism is successful in 95% of patients, but ectopic glands and anatomic variations in location are causes of surgical failure. The radionuclide imaging agent, technetium (Tc)-99m-sestamibi, in conjunction with subtraction iodine-123 scanning, is a new method of preoperative localization of abnormal parathyroid glands. In a study approved by the Institutional Review Board, 22 patients with primary hyperparathyroidism underwent preoperative evaluation with high-resolution ultrasonography and Tc-99m-sestamibi/I-123 radionuclide scanning for attempted localization of abnormal parathyroid glands. Results of Tc-99m-sestamibi scanning and ultrasound were correlated with surgical and pathologic findings. Of 22 patients, 16 had a solitary parathyroid adenoma, 1 had a double adenoma, and 5 had diffuse parathyroid hyperplasia. The Tc-99m-sestamibi/I-123 radionuclide scan preoperatively identified a solitary adenoma in 14 of 16 patients (sensitivity: 88%). However, when the data were analyzed retrospectively along with surgical and pathologic findings, the Tc-99m-sestamibi scan correctly localized all parathyroid adenomas for a sensitivity of 100%. The one patient with a double adenoma had a localization image consistent with two enlarged glands. All patients with diffuse parathyroid hyperplasia had Tc-99m-sestamibi imaging consistent with diffuse hyperplasia, although delineation of individual enlarged glands was not possible. High-resolution ultrasound identified 11 of 16 parathyroid adenomas (sensitivity: 69%). The patient with a double adenoma had a negative ultrasound. Ultrasound was less accurate in five patients with diffuse hyperplasia: one scan was completely negative, two scans revealed only one enlarged gland, and two scans revealed two enlarged glands. The Tc-99m-sestamibi/I-123 subtraction radionuclide scan is more sensitive than high-resolution ultrasonography for the preoperative localization of abnormal parathyroid glands. Tc-99m-sestamibi/I-123 radionuclide scanning may be more useful than ultrasonography to the surgeon in the preoperative localization of abnormal parathyroid glands.
原发性甲状旁腺功能亢进症手术在95%的患者中取得成功，但异位腺体和位置的解剖变异是手术失败的原因。放射性核素显像剂锝（Tc）-99m-甲氧基异丁基异腈，结合减影碘-123扫描，是术前定位异常甲状旁腺的一种新方法。在一项经机构审查委员会批准的研究中，22例原发性甲状旁腺功能亢进症患者接受了高分辨率超声检查和Tc-99m-甲氧基异丁基异腈/碘-123放射性核素扫描，以尝试定位异常甲状旁腺。Tc-99m-甲氧基异丁基异腈扫描和超声检查结果与手术及病理结果相关。22例患者中，16例有单发甲状旁腺腺瘤，1例有双发腺瘤，5例有弥漫性甲状旁腺增生。Tc-99m-甲氧基异丁基异腈/碘-123放射性核素扫描术前在16例患者中的14例中发现了单发腺瘤（敏感性：88%）。然而，当回顾性分析数据并结合手术和病理结果时，Tc-99m-甲氧基异丁基异腈扫描正确定位了所有甲状旁腺腺瘤，敏感性为100%。1例双发腺瘤患者的定位图像与两个增大的腺体一致。所有弥漫性甲状旁腺增生患者的Tc-99m-甲氧基异丁基异腈显像与弥漫性增生一致，尽管无法分辨单个增大的腺体。高分辨率超声发现了16例甲状旁腺腺瘤中的11例（敏感性：69%）。双发腺瘤患者的超声检查结果为阴性。超声对5例弥漫性增生患者的诊断准确性较低：1例扫描完全阴性，2例扫描仅显示一个增大的腺体，2例扫描显示两个增大的腺体。Tc-99m-甲氧基异丁基异腈/碘-123减影放射性核素扫描在术前定位异常甲状旁腺方面比高分辨率超声更敏感。对于外科医生来说，Tc-99m-甲氧基异丁基异腈/碘-123放射性核素扫描在术前定位异常甲状旁腺方面可能比超声更有用。
