Sestamibi parathyroid scintigraphy in multigland disease
Sestamibi parathyroid scintigraphy in multigland disease
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DOI：
10.1097/mnm.0b013e32834bfeb1
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发表时间：
2012-01-01
影响因子：
1.5
通讯作者：
Palestro, Christopher J.
中科院分区：
文献类型：
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作者：
Nichols, Kenneth J.;Tomas, Maria B.;Palestro, Christopher J.
目的在原发性甲状旁腺功能亢进症(甲状旁腺功能亢进症)患者的甲状旁腺功能亢进症(MIBI)研究中，一些研究发现多腺病(MGD)患者的检测敏感性低于单腺病(SGD)患者，而另一些研究报告MIBI显像对MGD和SGD的敏感性相似。因此，这项研究的目的是确定(A)MIBI显像检测MGD和SGD患者甲状旁腺病变的敏感性和特异性是否存在差异，(B)检测敏感性与所涉及的腺体数量之间是否存在关系，(C)MGD和SGD患者的甲状旁腺病变之间是否存在重量差异，(D)MGD和SGD患者的病变部位是否存在差异，以及(E)MGD患者的MIBI敏感性是否与MGD的数量、重量、材料与方法回顾分析651例经生化检查证实的局限于颈部的原发性甲状旁腺功能亢进症患者的资料，这些患者术前采用双示踪剂(99m)Tc-MIBI/(99m)TCO(4)(-)方案进行甲状旁腺病变定位，包括早期和晚期平面针孔(99m)Tc-MIBI、针孔甲状腺显像、图像减影和单光子发射计算机断层扫描。所有患者随后均接受手术治疗。病变部位从手术报告中获得；病变重量从病理报告中获得。一位经验丰富的核内科医生在不知道其他检查结果或最终诊断的情况下，对研究进行了5分评分(0=绝对正常到4=绝对异常)，同时阅读所有核素图像。131例(20%)患者患有弥漫性甲状腺肿，520例(80%)患者患有系统性红斑狼疮。在MGD患者中，74例有2个病变，45例有3个病变，12例有4个病变。MIBI显像敏感性显著降低(61vs.97%，P
Purpose For sestamibi (MIBI) studies in patients with primary hyperparathyroidism, some investigations found that the test sensitivity is lower in patients with multigland disease (MGD) than in those with single-gland disease (SGD), whereas other investigations reported that the sensitivity of MIBI imaging is similar in MGD and SGD. The objectives of this investigation, therefore, were to determine (a) whether there are differences in the sensitivity and specificity of MIBI imaging for detecting parathyroid lesions in patients with MGD and in patients with SGD, (b) whether there is a relationship between test sensitivity and the number of glands involved, (c) whether there are differences in weight between parathyroid lesions in MGD and SGD, (d) whether there are differences in lesion locations between MGD and SGD, and (e) whether MIBI sensitivity in MGD is related to the number, weight, or location of the lesions.Materials and methods This was a retrospective investigation of data for 651 patients with biochemically confirmed primary hyperparathyroidism limited to the neck, who underwent preoperative parathyroid lesion localization using a dual tracer (99m)Tc-MIBI/(99m)TcO(4)(-) protocol that included early and late planar pinhole (99m)Tc-MIBI, pinhole thyroid imaging, image subtraction, and single photon emission computed tomography. All patients underwent surgery subsequently. Lesion locations were obtained from operative reports; lesion weights were obtained from pathology reports. One experienced nuclear physician, who had no knowledge of the other test results or the final diagnoses, graded studies on a 5-point scale (0 = definitely normal to 4=definitely abnormal) while reading all scintigraphic images simultaneously.Results There were 851 lesions among the 651 patients. One hundred and thirty-one (20%) patients had MGD and 520 (80%) patients had SGD. Among the patients with MGD, 74 had two lesions, 45 had three lesions, and 12 had four lesions. MIBI imaging was significantly less sensitive (61 vs. 97%, P