Three-Dimensional Metabolic and Radiologic Gathered Evaluation Using VR-RENDER Fusion: A Novel Tool to Enhance Accuracy in the Localization of Parathyroid Adenomas
Three-Dimensional Metabolic and Radiologic Gathered Evaluation Using VR-RENDER Fusion: A Novel Tool to Enhance Accuracy in the Localization of Parathyroid Adenomas
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DOI：
10.1007/s00268-013-2021-x
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发表时间：
2013-07-01
影响因子：
2.6
通讯作者：
Marescaux, Jacques
中科院分区：
文献类型：
--
作者：
D'Agostino, Jacopo;Diana, Michele;Marescaux, Jacques
本研究的目的是评估一种新的成像方式--三维(3D)代谢和放射学聚集评估(MERGE)--对甲状旁腺腺瘤(PAS)定位的准确性。采用VR-Render进行三维虚拟颈部探查(3D-VNE)，获得3D-CT重建图像。然后将MIBI扫描与3D重建融合，获得3D-Merge。评估了敏感性、特异性和准确性。分析27例108个颈部象限的甲状旁腺体积和术前甲状旁腺激素(PTH)水平作为正确定位(即正确象限)的预测因素。3D-Merge、3D-VNE、MIBI和CT的敏感性分别为79.31%、75.86%、65.51%和58.61%。CT的特异度最高(94.93%)，3D-VNE次之(92.4%)。MIBI和3D-Merge的特异度相同(88.6%)。3D-MERGE和3D-VNE的诊断准确率高于MIBI和CT。在3D-VNE(219.60+/-A 212.77 vs.98.75+/-A12.76pg/ml；p=0.01)和3D-Merge(217.69+/-A 213.76 vs.09.75+/-A20.48pg/ml；p=0.02)中，正确识别病变(真阳性，TP)的患者的平均甲状旁腺素水平显著高于漏掉病变(假阴性，FN)的患者。除CT外，TP和FN的甲状旁腺体积差异均有统计学意义。3D-Merge和3D-VNE对PAS的定位具有较高的准确性。3D-Merge在检出小腺瘤和低甲状旁腺激素水平方面优于单纯MIBI或CT。
The aim of this study was to assess the accuracy of a novel imaging modality, three-dimensional (3D) metabolic and radiologic gathered evaluation (MeRGE), for localizing parathyroid adenomas (PAs).Consecutive patients presenting with primary hyperparathyroidism who underwent both thin-slice cervical computed tomography (CT) and Tc-99m-sestamibi (MIBI) scanning were included. 3D-CT reconstruction was obtained using VR-RENDER, which was used to perform 3D virtual neck exploration (3D-VNE). The MIBI scan was then fused with the 3D reconstruction to obtain 3D-MeRGE. Sensitivity, specificity, and accuracy were assessed. Parathyroid gland volume and preoperative parathormone (PTH) levels were analyzed as predictive factors of correct localization (i.e., correct quadrant).A total of 108 cervical quadrants (27 patients) were analyzed. Sensitivities were 79.31, 75.86, 65.51, and 58.61 % with 3D-MeRGE, 3D-VNE, MIBI, and CT, respectively. Specificity was highest with CT (94.93 %) followed by 3D-VNE (92.4 %). MIBI and 3D-MeRGE had the same specificity (88.6 %). 3D-MeRGE and 3D-VNE achieved higher accuracy than MIBI or CT alone. Mean PTH values were significantly higher in patients with lesions that were correctly identified (true positive, TP) than in those whose lesions were missed (false negative, FN) with 3D-VNE (219.60 +/- A 212.77 vs. 98.75 +/- A 12.76 pg/ml; p = 0.01) and 3D-MeRGE (217.69 +/- A 213.76 vs. 09.75 +/- A 20.48 pg/ml; p = 0.02). The mean parathyroid gland volume difference between TP and FN was statistically significant with all modalities except CT.3D-MeRGE and 3D-VNE showed high accuracy for localization of PAs. 3D-MeRGE performed better than MIBI or CT alone for detecting small adenomas and those with a low PTH level.