Biochemical Metrics for Parathyroid Scintigraphy in the Pre-Surgical Evaluation of Hyperparathyroidism.

IF 3.7 3区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Ryan L Smith, Victoria Linehan, Steven Burrell, Ian R Macdonald
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引用次数: 0

Abstract

Purpose: To correlate parathyroid scintigraphy results with patient biochemistry, surgery, and pathology to inform appropriateness criteria and assess biochemical metrics in the imaging workup of hyperparathyroidism.

Methods: This retrospective study included 421 patients who underwent parathyroid scintigraphy. Patients were grouped based on primary versus secondary hyperparathyroidism, and clinical profiles were reviewed for scan result, blood work, surgical results, and pathology. Performance metrics of scintigraphy were analyzed. Demographics, bloodwork, and location were compared between positive and negative scans. Predictors of positive scans were identified by multivariate logistic regression analysis. The performance of biochemistry to predict scan results was evaluated by ROC analyses.

Results: Positive tests-occurring in 52% of patients-were associated with higher parathyroid hormone (PTH) and corrected calcium. However, PTH was only predictive of a positive test in patients with secondary hyperparathyroidism. On multivariate analysis, male sex, corrected calcium, and younger age were predictors of a positive scan. Corrected calcium was the most predictive with an OR of 1.28 for every 0.1 mmol/L increase. Based on ROC analysis, corrected calcium had an AUC of 0.628 and a cutoff of 2.65 mmol/L maximized sensitivity (88%) and specificity (35%) for a positive test.

Conclusion: In this large retrospective cohort, several biochemical metrics, including corrected calcium levels, were predictive of a positive scintigraphy study. Furthermore, biochemistry, including PTH levels, significantly differed between primary and secondary hyperparathyroidism suggesting that tailored biochemical metrics are required. This work sets a foundation for the development of a robust biochemical scoring system to optimize patient selection for parathyroid imaging.

甲状旁腺造影在甲状旁腺功能亢进术前评价中的生化指标。
目的:将甲状旁腺造影结果与患者的生物化学、手术和病理相关联,以告知甲状旁腺功能亢进影像学检查的适当标准和评估生化指标。方法:回顾性研究纳入421例行甲状旁腺显像检查的患者。根据原发性甲状旁腺功能亢进和继发性甲状旁腺功能亢进对患者进行分组,并回顾了扫描结果、血液检查、手术结果和病理的临床资料。分析了闪烁成像的性能指标。在阳性和阴性扫描之间比较了人口统计学、血检和位置。通过多变量逻辑回归分析确定阳性扫描的预测因素。采用ROC分析评价生化指标对扫描结果的预测能力。结果:52%的患者检测呈阳性,与较高的甲状旁腺激素(PTH)和校正钙有关。然而,PTH仅预测继发性甲状旁腺功能亢进患者的阳性检测。在多变量分析中,男性、校正钙和年轻年龄是扫描阳性的预测因素。校正钙是最具预测性的,每增加0.1 mmol/L OR为1.28。基于ROC分析,校正钙的AUC为0.628,临界值2.65 mmol/L为阳性检测的最大灵敏度(88%)和特异性(35%)。结论:在这个大型的回顾性队列中,包括校正钙水平在内的几个生化指标可以预测阳性的显像研究。此外,包括甲状旁腺激素水平在内的生化指标在原发性和继发性甲状旁腺功能亢进之间存在显著差异,这表明需要定制生化指标。这项工作为建立健全的生化评分系统奠定了基础,以优化甲状旁腺成像的患者选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.20
自引率
12.90%
发文量
98
审稿时长
6-12 weeks
期刊介绍: The Canadian Association of Radiologists Journal is a peer-reviewed, Medline-indexed publication that presents a broad scientific review of radiology in Canada. The Journal covers such topics as abdominal imaging, cardiovascular radiology, computed tomography, continuing professional development, education and training, gastrointestinal radiology, health policy and practice, magnetic resonance imaging, musculoskeletal radiology, neuroradiology, nuclear medicine, pediatric radiology, radiology history, radiology practice guidelines and advisories, thoracic and cardiac imaging, trauma and emergency room imaging, ultrasonography, and vascular and interventional radiology. Article types considered for publication include original research articles, critically appraised topics, review articles, guest editorials, pictorial essays, technical notes, and letter to the Editor.
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