Neumann D R, Esselstyn C B, Madera A, Wong C O, Lieber M
Department of Nuclear Medicine, Cleveland Clinic Foundation, Ohio 44195, USA.
J Clin Endocrinol Metab. 1998 Nov;83(11):3867-71. doi: 10.1210/jcem.83.11.5241.
123I/99mTc-sestamibi subtraction single photon emission computed tomography (SPECT) has been proposed to detect hyperplastic parathyroid tissue, but the clinical usefulness of this technique in secondary hyperparathyroidism is uncertain. The purpose of this study was to evaluate preoperative parathyroid localization using 123I/99mTc-sestamibi subtraction SPECT in patients with renal failure and secondary hyperparathyroidism. Nineteen patients with chronic renal failure and secondary hyperparathyroidism underwent 123I/99mTc-sestamibi subtraction SPECT imaging preoperatively. None of these patients had undergone previous neck surgery. The location, weight, and histopathological results of all identified parathyroid glands were recorded. Surgery was considered successful in all patients, with resection of a total of 74 hyperplastic parathyroid glands. 123I/99mTc-sestamibi subtraction SPECT correctly identified 57 of these parathyroid glands (77% sensitivity). The mean weight among the true positive glands (n = 57) was 1031 mg (range, 45-7900 mg), and that among the false negative glands (n = 17) was 465 mg (range, 20-1800 mg). This difference between the mean weights was statistically significant (P = 0.018). There was a positive correlation between parathyroid weight and detectability with 123I/99mTc-sestamibi subtraction SPECT (Spearman correlation = 0.28; P = 0.0167). 123I/99mTc-sestamibi subtraction SPECT is able to correctly localize hyperplastic parathyroid glands in patients with renal failure and secondary hyperparathyroidism, but there is a fairly weak relationship between preoperative detection rate and anatomical parathyroid gland size.
123I/99mTc - 甲氧基异丁基异腈减影单光子发射计算机断层扫描（SPECT）已被用于检测增生的甲状旁腺组织，但该技术在继发性甲状旁腺功能亢进中的临床实用性尚不确定。本研究的目的是评估123I/99mTc - 甲氧基异丁基异腈减影SPECT在肾衰竭和继发性甲状旁腺功能亢进患者中的术前甲状旁腺定位情况。19例慢性肾衰竭和继发性甲状旁腺功能亢进患者术前接受了123I/99mTc - 甲氧基异丁基异腈减影SPECT成像。这些患者均未接受过颈部手术。记录所有识别出的甲状旁腺的位置、重量和组织病理学结果。所有患者的手术均被认为成功，共切除74个增生的甲状旁腺。123I/99mTc - 甲氧基异丁基异腈减影SPECT正确识别出其中57个甲状旁腺（灵敏度为77%）。真阳性腺体（n = 57）的平均重量为1031毫克（范围为45 - 7900毫克），假阴性腺体（n = 17）的平均重量为465毫克（范围为20 - 1800毫克）。平均重量之间的差异具有统计学意义（P = 0.018）。甲状旁腺重量与利用123I/99mTc - 甲氧基异丁基异腈减影SPECT的可检测性之间存在正相关（Spearman相关系数 = 0.28；P = 0.0167）。123I/99mTc - 甲氧基异丁基异腈减影SPECT能够正确定位肾衰竭和继发性甲状旁腺功能亢进患者增生的甲状旁腺，但术前检测率与甲状旁腺解剖大小之间的关系相当微弱。
