重新定义原发性甲状旁腺瘤患者术前成像位置，以微创手术为目标

IF 1.6 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Revista Espanola De Medicina Nuclear E Imagen Molecular Pub Date : 2025-07-01 DOI:10.1016/j.remn.2024.500091

S. Casanueva-Eliceiry , M. Manyalich-Blasi , A. Farré-Melero , A. Niñerola-Baizán , D. Saavedra , M. Mora-Porta , F.A. Hanzu , A. Orois , M. Squarcia , M. Rodrigo-Calvo , M. Tormo-Ratera , K. Quintero-Martinez , D. Fuster-Pelfort , O. Vidal-Pérez , S. Vidal-Sicart

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引用次数: 0

摘要

背景与目的比较[18F]-氟胆碱（FCH） PET/CT与常规[99mTc]Tc-MIBI显像及宫颈超声（USG）对原发性甲状旁腺功能亢进（PHPT）患者术前定位甲状旁腺功能亢进（HFPT）的诊断准确性。材料和方法本前瞻性研究纳入90例诊断为PHPT的患者，分别行[18F]F-CH PET/CT、[99mTc]Tc-MIBI SPECT/CT和颈部USG检查。以术中发现和组织病理学证实为金标准评估每种成像方式的诊断准确性。定位精度是基于特定象限检测、侧边性和异位腺体识别来评估的。该研究还探讨了影像学表现与生化参数的相关性，包括术前和术后甲状旁腺激素和钙水平。结果[18F]与[99mTc]Tc-MIBI SPECT/CT和USG相比，F-CH PET/CT对病理性甲状旁腺的检测精度更高。[18F]F-CH PET/CT对病理腺体的正确率为98.9%，其中[18F]F-CH PET/CT、[99mTc]Tc-MIBI SPECT/CT和USG的特异定位正确率分别为93.2%、65.9%和38.8%。对于异位腺瘤，FCH PET/CT的准确率为100%(4/4)，而MIBI和颈部超声的准确率分别为50%（2/4）和0%（0/4）。多腺病变2例，[18F]F-CH PET/CT和[99mTc]Tc-MIBI各1例（50%）检出1个腺体，USG未检出；在另一例中，[18F]F-CH PET/CT和USG检测到两个腺体（100%），[99mTc]Tc-MIBI未检测到腺体。[18F]F-CH PET/CT的SUVmax值与腺体大小、体重和术前PTH水平之间存在显著相关性。结论[18F]F-CH PET/CT在HFPT术前定位方面优于传统成像方式，特别是在异位或多腺疾病等具有挑战性的病例中。这些发现支持其作为治疗原发性甲状旁腺功能亢进的有效和可靠的成像工具的潜力。

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Redefiniendo la localización preoperatoria basada en imágenes de los adenomas en pacientes con hiperparatiroidismo primario candidatos a cirugía mínimamente invasiva

Background and objectives

To compare the diagnostic accuracy of [¹⁸F]-Fluorocholine (FCH) PET/CT with conventional [^99mTc]Tc-MIBI scintigraphy and cervical ultrasound (USG) for the preoperative localization of hyperfunctioning parathyroid tissue (HFPT) in patients with primary hyperparathyroidism (PHPT).

Materials and methods

This prospective study included 90 patients diagnosed with PHPT who underwent [¹⁸F]F-CH PET/CT, [^99mTc]Tc-MIBI SPECT/CT and Neck USG. The diagnostic accuracy of each imaging modality was assessed using intraoperative findings and histopathological confirmation as the gold standard. The localization accuracy was evaluated based on specific quadrant detection, laterality, and ectopic gland identification. The study also explored the correlation between imaging findings and biochemical parameters, including preoperative and postoperative PTH and calcium levels.

Results

[¹⁸F]F-CH PET/CT demonstrated superior accuracy in detecting pathological parathyroid glandscompared to [^99mTc]Tc-MIBI SPECT/CT and USG. [¹⁸F]F-CH PET/CT correctly identified 98.9% of patientswith pathological glands, with a specific location accuracy of 93.2%, 65.9% and 38.8% for [¹⁸F]F-CH PET/CT,[^99mTc]Tc-MIBI SPECT/CT and USG, respectively.

For ectopic adenomas, FCH PET/CT achieved an accuracy of 100% (4/4), while MIBI and neck ultrasound identified these in 50% (2/4) and 0% (0/4) of cases, respectively.

There were two cases of multiglandular disease, [¹⁸F]F-CH PET/CT and [99mTc]Tc-MIBI each detected one gland in one case (50%) while USG detected none; in the other case, [¹⁸F]F-CH PET/CT and USG identified both glands (100%), and [99mTc]Tc-MIBI detected none.

Significant correlations were observed between SUVmax values from [¹⁸F]F-CH PET/CT and gland size, weight, and preoperative PTH levels.

Conclusions

[¹⁸F]F-CH PET/CT outperformed conventional imaging modalities in the preoperative localization of HFPT, particularly in challenging cases such ectopic or multiglandular disease. These findings support its potential as an effective and reliable imaging tool for the management of primary hyperparathyroidism.

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来源期刊

Revista Espanola De Medicina Nuclear E Imagen Molecular RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

1.10

自引率

16.70%

发文量

审稿时长

24 days

期刊介绍： The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles.