Blanco I, Carril J, Banzo I, Quirce R, Gutiérrez C, Uriarte I, Montero de la Peña A, Hernández A
Servicio de Medicina Nuclear. H.U. Marqués de Valdecilla. Avda. Valdecilla, s/n. 39008 Santander.
Rev Esp Med Nucl. 1998;17(1):8-14.
The preoperative use of imaging techniques to localize the diseased glands in primary hyperparathyroidism is still the subject of controversy. This paper assess the use of double-phase 99mTc-MIBI scintigraphy with that purpose. We examined 37 patients with primary hyperparathyroidism before surgical intervention. Two planar images 10 minutes and 3 hours after injection of 99mTc-MIBI were acquired. Final diagnosis was adenoma in 32 patients, 30 of whom had a positive scintigraphy (sensitivity 94%), with only two false negative results. In the other five patients, four with hyperplasia and one carcinoma, scintigraphy was also positive. Radioisotopic study was of particular interest in 5 patients who had undergone previous surgery; in one case, other diseased gland was located in the neck, and an ectopic adenoma was found in the remaining four cases. Two other ectopic lesions were also MIBI positive and, in these cases, scintigraphy was a direct indication for mediastinal surgery. There was no false positive results. We conclude that the high sensitivity and easy performance make double-phase 99mTc-MIBI scintigraphy the technique of choice for the preoperative localization of diseased glands in primary hyperparathyroidism, especially in cases of adenoma. Its use is of particular interest in adenomas with aberrant location and in patients who have undergone previous surgery.
术前使用成像技术对原发性甲状旁腺功能亢进症中的病变腺体进行定位仍存在争议。本文旨在评估双期99mTc-MIBI闪烁扫描术在此方面的应用。我们在手术干预前检查了37例原发性甲状旁腺功能亢进症患者。注射99mTc-MIBI后10分钟和3小时采集了两张平面图像。最终诊断为腺瘤的有32例患者，其中30例闪烁扫描呈阳性（敏感性94%），仅有两例假阴性结果。在其他5例患者中，4例为增生，1例为癌，闪烁扫描也呈阳性。放射性同位素研究对5例曾接受过手术的患者特别有意义；1例患者，另一个病变腺体位于颈部，其余4例发现异位腺瘤。另外两个异位病变MIBI也呈阳性，在这些病例中，闪烁扫描是纵隔手术的直接指征。没有假阳性结果。我们得出结论，高敏感性和操作简便使双期99mTc-MIBI闪烁扫描术成为原发性甲状旁腺功能亢进症中病变腺体术前定位的首选技术，尤其是在腺瘤病例中。其应用在位置异常的腺瘤和曾接受过手术的患者中特别有意义。
