Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Uchida M, Hayabuchi N
Division of Nuclear Medicine, Department of Radiology, Kurume University School of Medicine, Kurume City, Japan.
Eur J Nucl Med. 1997 Feb;24(2):197-201. doi: 10.1007/BF02439553.
The aim of the study was to compare the accuracy of technetium-99m sestamibi imaging for localization of ectopic parathyroid glands in patients with hyperparathyroidism with that of magnetic resonance (MR) and computed tomographic (CT) imaging. Eleven patients with primary (n=3) or secondary (n=8) hyperparathyroidism were studied with 99mTc sestamibi parathyroid imaging CT and MR imaging. Images of the neck were acquired at 10 min and 2-3 after tracer injection. The three patients with primary hyperparathyroidism and five patients with secondary hyperparathyroidism underwent parathyroidectomy. The ectopic glands were confirmed by histopathological examination of the resected specimens. In respect of 20 parathyroid glands in the eight patients explored surgically, the sensitivity and specificity of sestamibi imaging were 70% (14/20) and 88%, respectively, those of CT, 40% (8/20) and 88%, and those of MR imaging, 60% (12/20) and 88%. Of these patients, three had parathyroid adenomas while five had hyperplasia (17 glands). Sestamibi imaging localized eight ectopic parathyroid glands, which were surgically confirmed (six were located in the thymus and two in the mediastinum). In one patient explored surgically, the ectopic gland was located outside the field of the MR coil. Although the remaining three cases of secondary hyperparathyroidism were not confirmed surgically, these patients demonstrated sestamibi uptake in five parathyroid glands, including three ectopic glands. MR images demonstrated abnormal parathyroid glands in the same regions as sestamibi imaging. Our data indicate that 99mTc-sestamibi imaging should be used initially to localize the ectopic parathyroid glands in patients with hyperparathyroidism for anatomical guidance prior to MR or CT imaging.
本研究的目的是比较锝-99m甲氧基异丁基异腈（99mTc sestamibi）显像、磁共振（MR）成像和计算机断层扫描（CT）成像在甲状旁腺功能亢进患者中定位异位甲状旁腺的准确性。对11例原发性（n = 3）或继发性（n = 8）甲状旁腺功能亢进患者进行了99mTc sestamibi甲状旁腺显像、CT和MR成像检查。在注射示踪剂后10分钟以及2 - 3小时采集颈部图像。3例原发性甲状旁腺功能亢进患者和5例继发性甲状旁腺功能亢进患者接受了甲状旁腺切除术。通过对切除标本的组织病理学检查确认异位腺体。在接受手术探查的8例患者的20个甲状旁腺中，sestamibi显像的敏感性和特异性分别为70%（14/20）和88%，CT的敏感性和特异性分别为40%（8/20）和88%，MR成像的敏感性和特异性分别为60%（12/20）和88%。这些患者中，3例患有甲状旁腺腺瘤，5例患有增生（17个腺体）。Sestamibi显像定位了8个异位甲状旁腺，经手术证实（6个位于胸腺，2个位于纵隔）。在1例接受手术探查的患者中，异位腺体位于MR线圈视野之外。尽管其余3例继发性甲状旁腺功能亢进患者未接受手术证实，但这些患者在5个甲状旁腺中显示出sestamibi摄取，包括3个异位腺体。MR图像在与sestamibi显像相同的区域显示出异常甲状旁腺。我们的数据表明，对于甲状旁腺功能亢进患者，在进行MR或CT成像之前，应首先使用99mTc sestamibi显像来定位异位甲状旁腺，以提供解剖学指导。
