Okada Y, Mizutani Y, Takeuchi H, Shigeno C, Konishi J, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Sakyo-ku, Japan.
Int J Urol. 1997 Jul;4(4):338-42. doi: 10.1111/j.1442-2042.1997.tb00204.x.
We retrospectively studied the results of diagnostic imaging using 3 different modalities to determine their usefulness for preoperative localization of the parathyroid, and whether accurate preoperative localization information could be used to modify the surgical approach for parathyroidectomy in patients with primary hyperparathyroidism.
Images of 37 parathyroid adenomas or hyperplasias in 35 patients with primary hyperparathyroidism were obtained using ultrasonography, computed tomography, and subtraction scintigraphy (using thallium 201 [thallous chloride] and either iodine 123 or technetium 99m pertechnetate [99mTcO4-]).
Approximately three fourths of the adenomas or hyperplasias were successfully identified by ultrasound (76.7%) and computed tomography (76.4%), even when the weight of the tumor was less than 500 mg. However, subtraction scintigraphy was of limited use (61.3% successfully identified). A combination of these modalities gave excellent results for detecting adenomas and hyperplasias, leading to an accurate prediction rate of 96.0%.
We conclude that using the combination of these 3 imaging modalities is very useful for the detection of parathyroid adenomas and hyperplasias, and that with such accurate localization information, the unilateral approach alone, or even simple excision of the parathyroid tumors might be feasible, enabling less invasive surgical treatment.
我们回顾性研究了使用3种不同模式的诊断成像结果，以确定它们对甲状旁腺术前定位的有用性，以及准确的术前定位信息是否可用于修改原发性甲状旁腺功能亢进患者甲状旁腺切除术的手术方法。
对35例原发性甲状旁腺功能亢进患者的37个甲状旁腺腺瘤或增生进行超声、计算机断层扫描和减影闪烁扫描（使用铊201[氯化亚铊]以及碘123或高锝酸盐99mTcO4-）成像。
即使肿瘤重量小于500mg，约四分之三的腺瘤或增生可通过超声（76.7%）和计算机断层扫描（76.4%）成功识别。然而，减影闪烁扫描的用途有限（成功识别率为61.3%）。这些模式的组合在检测腺瘤和增生方面取得了优异结果，准确预测率达96.0%。
我们得出结论，使用这3种成像模式的组合对检测甲状旁腺腺瘤和增生非常有用，并且有了如此准确的定位信息，仅采用单侧手术方法，甚至简单切除甲状旁腺肿瘤可能是可行的，从而实现侵入性较小的手术治疗。
