Apostolopoulos D J, Houstoulaki E, Giannakenas C, Alexandrides T, Spiliotis J, Nikiforidis G, Vlachojannis J G, Vassilakos P J
University of Patras Medical School, Regional University Hospital of Patras, Greece.
J Nucl Med. 1998 Aug;39(8):1433-41.
The efficacy of 99mTc-tetrofosmin for the detection of parathyroid lesions was investigated prospectively in patients with hyperparathyroidism referred for surgical treatment.
Twenty-seven patients with primary and 18 with tertiary hyperparathyroidism were studied. Twelve patients had undergone one or more previous neck explorations. Static imaging with 201Tl was performed first, immediately followed by a 30-min 99mTc-tetrofosmin dynamic study. Delayed views of up to 3 hr postinjection were also obtained. Technetium-99m-pertechnetate was used for thyroid delineation. The tetrofosmin/99mTc-pertechnetate subtraction scan (TF/TC), the single-tracer washout technique and the thallium/technetium subtraction (TL/TC) were compared. Quantification of relative uptakes of tracers in the thyroid and abnormal parathyroids was accomplished by measuring activity within regions of interest. Kinetics of tetrofosmin in the thyroid and abnormal parathyroids were studied by evaluating the plots of the parathyroid to thyroid ratios against time as well as by calculation of the half-clearance times from the slow component of the time-activity curves.
The overall sensitivity, specificity and accuracy of TF/TC and TL/TC were 76%, 92% and 83% and 52%, 85% and 65%, respectively. The respective sensitivities were 87% and 70% for adenomas and 72% and 46% for hyperplasia. The parathyroid-to-thyroid activity ratios of tetrofosmin were significantly higher than those of thallium (p < 0.001). The tetrofosmin single-tracer washout study was less accurate than the subtraction technique (overall sensitivity and specificity, 70% and 69%, respectively). The washout properties of tetrofosmin in abnormal parathyroids were not substantially different from those in the thyroid, with a few exceptions (p = 0.4). No correlation of half-clearance times with parathyroid size, degree of early uptake, parathyroid hormone levels or histology could be established. Comparing adenomas to hyperplasia in respect to tetrofosmin retention, a statistically significant difference was observed (p = 0.005).
Technetium-99m-tetrofosmin is suitable for parathyroid imaging. The kinetic properties of this agent in parathyroid and thyroid tissues do not warrant differential washout protocols. The diagnostic impact of the observed difference in tetrofosmin kinetics between parathyroid adenomas and hyperplasia requires further investigation.
前瞻性研究了99mTc-替曲膦用于检测因手术治疗而转诊的甲状旁腺功能亢进患者甲状旁腺病变的疗效。
研究了27例原发性甲状旁腺功能亢进患者和18例继发性甲状旁腺功能亢进患者。12例患者曾接受过一次或多次颈部探查。首先进行201Tl静态显像，随后立即进行30分钟的99mTc-替曲膦动态研究。还获取了注射后长达3小时的延迟图像。使用99mTc-高锝酸盐进行甲状腺显像。比较了替曲膦/99mTc-高锝酸盐减影扫描（TF/TC）、单示踪剂洗脱技术和铊/锝减影（TL/TC）。通过测量感兴趣区域内的活性来量化示踪剂在甲状腺和异常甲状旁腺中的相对摄取。通过评估甲状旁腺与甲状腺比值随时间的曲线以及根据时间-活性曲线的慢成分计算半清除时间来研究替曲膦在甲状腺和异常甲状旁腺中的动力学。
TF/TC和TL/TC的总体敏感性、特异性和准确性分别为76%、92%和83%以及52%、85%和65%。腺瘤的各自敏感性分别为87%和70%，增生的敏感性分别为72%和46%。替曲膦的甲状旁腺与甲状腺活性比值显著高于铊（p<0.001）。替曲膦单示踪剂洗脱研究的准确性低于减影技术（总体敏感性和特异性分别为70%和69%）。替曲膦在异常甲状旁腺中的洗脱特性与在甲状腺中的洗脱特性没有实质性差异，少数情况除外（p = 0.4）。无法确定半清除时间与甲状旁腺大小、早期摄取程度、甲状旁腺激素水平或组织学之间的相关性。就替曲膦滞留而言，腺瘤与增生之间存在统计学显著差异（p = 0.005）。
99mTc-替曲膦适用于甲状旁腺显像。该药物在甲状旁腺和甲状腺组织中的动力学特性不支持采用不同的洗脱方案。甲状旁腺腺瘤和增生之间观察到的替曲膦动力学差异的诊断影响需要进一步研究。
