DIAGNOSTIC VALUE OF CONVENTIONAL DUAL PHASE RADIONUCLIDE IMAGING AND EARLY SPECT/CT IMAGING IN THE DIAGNOSIS OF PARATHYROID PATHOLOGIES
Öz
OBJECTIVE: The objective is to determine the role of early SPECT / CT imaging in the diagnosis and localization of parathyroid pathologies and to compare with the conventional dual phase radionuclide imaging.
MATERIAL AND METHODS: A total of 77 patients operated for hyperparathyroidism and underwent preoperative radionuclide imaging were included in the retrospective study. Pathological foci on conventional dual-phase radionuclide images (early / late planar and pinhol) and early SPECT/CT images were determined. Radionuclide imaging findings were compared with histopathological findings.
RESULTS: A total of 93 pathological parathyroid glands were detected in 77 patients. There were 65 parathyroid adenomas, 24 hyperplastic parathyroid glands and 4 cellular parathyroid tissues. The number adenomas in the atypical / ectopic localization was 10 (15.4%). Conventional dual phase radionuclide imaging was truely determined 86.2% of parathyroid adenomas and 54.2% of hyperplastic glands. In early SPECT / CT images, this ratios were 89.2% and 62.5% respectively. In cellular parathyroid tissues, determination rate was 50.0% for these two imaging methods. Early SPECT / CT images provided accurate and complete anatomical localization for minimally invasive surgical intervention in patients with adenomas in atypical / ectopic localization.
CONCLUSIONS: Early SPECT/CT images increase the visualization rate of parathyroid adenomas. Especially in ectopic / atipic adenomas, the technic determines the correct and clear anatomical localization and contributes to the minimally invasive surgical plan. The detection rate is low in hyperplastic and cellular parathyroid glands.
Anahtar Kelimeler
Kaynakça
- 1- Heath H, Hodgson S, Kennedy M. Primary hyperthyroidism: incidence, morbidity, and potential economic impact on a community. N Engl J Med 1980; 302: 189-93.2- Salti GI, Fedorak I, Yashiro T, et al. Continuing evolution in the operative management of primary hyperparathyroidism. Arch Surg 1992; 127:831-7.3- Lal G, Clark OH. Primary hyperparathyroidism: controversies in surgical management. Trends Endocrinol Metab. 2003;14(9):417-22.4- Hishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound, and MRI for localization of abnormal parathyroid glands. J Nucl Med. 1998;39:320–4. 5- Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med. 1992;33:1801-7.6- Ferrer Ramirez FJ, Amoros Sebastia LI, Cano Terol C, Caballero Calabuig E, Hernandez Mijarez A, Lopez Martinez R. Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism. Acta Otorrinolaringol Esp. 2003;54:220-4.7- Clark PB, Case D, Watson NE, Perrier ND, Morton KA. Enhanced Scintigraphic protocol required for optimal preoperative localization before targeted minimally invasive parathyroidectomy. Clin Nucl Med. 2003;28:955-60.8- Chakraborty D, Mittal BR, Harisankar CN, Bhattacharya A, Bhadada S. Spectrum of single photon emission computed tomography/computed tomography findings in patients with parathyroid adenomas. Indian J Nucl Med. 2011;26:52–5.9- Kim YI, Jung YH, Hwang KT, Lee HY. Efficacy of 99mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy: Comparative study with 99mTc-sestamibi scintigraphy, SPECT, US and CT. Ann Nucl Med. 2012;26:804–10.10- Patel C, Salahudeen H, Lansdown M, Scarsbrook AF. Clinical utility of ultrasound and 99m Tc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 2010;65:278–87.11- Hindie E, Ugur O, Fuster D, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36:1201–16.12- Arveschoug AK, Berteselen H, Vammen B. Presurgical localization of abnormalparathyroid glands using a single injection of Tc-99m sestamibi: comparison of high resolution parallel-hole and pinhole collimators, and interobserver and interobserver variation. Clin Nucl Med. 2002;27:249–54.13- Tomas MB, Pugliese PV, Tronco GG, Love C, Palestro CJ, Nichols KJ. Pinhole versus parallel-hole collimators for parathyroid imaging: an intraindividual comparison. J Nucl Med Technol. 2008;36(4): 189–94.14- Arveschoug AK, Berteselen H, Vammen B, Brochner-Mortensen J. Preoperative dual-phase parathyroid imaging with Tc-99m-sestamibi: accuracy and reproducibility of the pinhole collimator with and without oblique images. Clin Nucl Med. 2007;32(1): 9–12.15- Ozkan ZG, Unal SN, Kuyumcu S, et al. Clinical utility of Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid lesions. Indian J Surg. 2017;79:312-8.16- Krausz Y, Bettman L, Guralnik L, et al. Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism. World J Surg. 2006;30:76–83.17- Ho Shon IA, Yan W, Roach PJ, et al. Comparison of pinhole and SPECT 99mTcMIBI imaging in primary hyperparathyroidism. Nucl Med Commun. 2008;29: 949–55.18- Roach PJ, Schembri GP, Ho Shon IA, Bailey EA, Bailey DL. SPECT/CT imaging using a spiral CT scanner for anatomical localization: impact on diagnostic accuracy and reporter confidence in clinical practice. Nucl Med Commun 2006;27:977-87. 19- Gayed IW, Kim EE, BroussardWF, et al. The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med 2005;46:248–52.20- Serra A, Bolasco P, Satta L, Nicolosi A, Uccheddu A, Piga M. Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients. Radiol Med 2006;111:999–1008.21- Papathanassiou D, Flament JB, Pochart JM, et al. SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery. Clin Nucl Med 2008;33:394–7.22- Perez-Monte JE, Brown ML, Shah AN, et al. Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT. Radiology. 1996; 201:85–91.23- Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med. 2012;26(10):794–803.24- Oksuz MO, Dittmann H, Wicke C, et al. Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol. 2011;17(4):297–307.25- Li P, Liu Q, Tang D, et al. Lesion based diagnostic performance of dual phase 99mTc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism. BMC Med Imaging. 2017;17(1):60.
PARATİROİD PATOLOJİLERİNİN TANISINDA KONVANSİYONEL DUAL FAZ RADYONÜKLİD GÖRÜNTÜLEME VE ERKEN SPECT/BT GÖRÜNTÜLEMENİN TANISAL DEĞERİ
Öz
AMAÇ: Paratiroid patolojilerinin tanısında ve lokalize edilmesinde erken SPECT/BT görüntülemenin rolünün belirlenmesi ve tanısal değerinin konvansiyonel dual faz radyonüklid görüntüleme yöntemi ile karşılaştırılması amaçlanmıştır.
GEREÇ VE YÖNTEM: Hiperparatiroidizm nedeni ile opere edilen ve operasyon öncesi radyonüklid görüntüleme yapılan 77 hasta retrospektif çalışmaya dahil edildi. Konvansiyonel dual faz radyonüklid görüntüler (erken/geç planar ve pinhol) ile erken SPECT/BT görüntülerindeki patolojik odak sayıları belirlendi. Radyonüklid görüntüleme bulguları histopatolojik son tanılar ile karşılaştırıldı.
BULGULAR: Histopatolojik olarak 77 hastada toplam 93 patolojik paratiroid bezi tespit edildi. Adenom saptanan 65 paratiroid bezi, hiperplazi saptanan 24 paratiroid bezi ve selüler paratiroid dokusu lehine yorumlanan 4 paratiroid bezi mevcuttu. Adenom saptanan 10/65 (%15.4) paratiroid bezi atipik / ektopik lokalizasyonda yerleşimli idi. Histopatolojik olarak adenom ve hiperplazi tanısı alan paratiroid bezleri konvansiyonel dual faz radyonüklid görüntülemede sırasıyla %86.2 ve %54.2; erken SPECT/BT görüntülerinde ise sırasıyla %89.2 ve %62.5 oranında doğru olarak tespit edildi. Selüler doku tanısı alan paratiroid bezlerinde ise bu oran her iki görüntüleme yöntemi için %50,0 olarak belirlendi. Atipik / ektopik lokalizasyondaki paratiroid adenomlarının tamamında, erken SPECT/BT görüntüleri ile doğru ve tam anatomik lokalizasyon belirlenerek minimal invaziv cerrahi girişim imkânı sağlandı.
SONUÇ: Erken SPECT/BT görüntüleri paratiroid adenomlarının görüntülenme oranını artırmaktadır. Özellikle ektopik lokalizasyondaki adenomlarda doğru ve net anatomik lokalizasyonu belirleyerek minimal invaziv cerrahi girişim planına katkı sağlamaktadır. Paratiroid hiperplazileri ile selüler paratiroid dokusunun tespitinde ise görüntüleme oranının düşük olduğu görülmektedir.
Anahtar Kelimeler
Kaynakça
- 1- Heath H, Hodgson S, Kennedy M. Primary hyperthyroidism: incidence, morbidity, and potential economic impact on a community. N Engl J Med 1980; 302: 189-93.2- Salti GI, Fedorak I, Yashiro T, et al. Continuing evolution in the operative management of primary hyperparathyroidism. Arch Surg 1992; 127:831-7.3- Lal G, Clark OH. Primary hyperparathyroidism: controversies in surgical management. Trends Endocrinol Metab. 2003;14(9):417-22.4- Hishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound, and MRI for localization of abnormal parathyroid glands. J Nucl Med. 1998;39:320–4. 5- Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med. 1992;33:1801-7.6- Ferrer Ramirez FJ, Amoros Sebastia LI, Cano Terol C, Caballero Calabuig E, Hernandez Mijarez A, Lopez Martinez R. Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism. Acta Otorrinolaringol Esp. 2003;54:220-4.7- Clark PB, Case D, Watson NE, Perrier ND, Morton KA. Enhanced Scintigraphic protocol required for optimal preoperative localization before targeted minimally invasive parathyroidectomy. Clin Nucl Med. 2003;28:955-60.8- Chakraborty D, Mittal BR, Harisankar CN, Bhattacharya A, Bhadada S. Spectrum of single photon emission computed tomography/computed tomography findings in patients with parathyroid adenomas. Indian J Nucl Med. 2011;26:52–5.9- Kim YI, Jung YH, Hwang KT, Lee HY. Efficacy of 99mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy: Comparative study with 99mTc-sestamibi scintigraphy, SPECT, US and CT. Ann Nucl Med. 2012;26:804–10.10- Patel C, Salahudeen H, Lansdown M, Scarsbrook AF. Clinical utility of ultrasound and 99m Tc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 2010;65:278–87.11- Hindie E, Ugur O, Fuster D, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36:1201–16.12- Arveschoug AK, Berteselen H, Vammen B. Presurgical localization of abnormalparathyroid glands using a single injection of Tc-99m sestamibi: comparison of high resolution parallel-hole and pinhole collimators, and interobserver and interobserver variation. Clin Nucl Med. 2002;27:249–54.13- Tomas MB, Pugliese PV, Tronco GG, Love C, Palestro CJ, Nichols KJ. Pinhole versus parallel-hole collimators for parathyroid imaging: an intraindividual comparison. J Nucl Med Technol. 2008;36(4): 189–94.14- Arveschoug AK, Berteselen H, Vammen B, Brochner-Mortensen J. Preoperative dual-phase parathyroid imaging with Tc-99m-sestamibi: accuracy and reproducibility of the pinhole collimator with and without oblique images. Clin Nucl Med. 2007;32(1): 9–12.15- Ozkan ZG, Unal SN, Kuyumcu S, et al. Clinical utility of Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid lesions. Indian J Surg. 2017;79:312-8.16- Krausz Y, Bettman L, Guralnik L, et al. Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism. World J Surg. 2006;30:76–83.17- Ho Shon IA, Yan W, Roach PJ, et al. Comparison of pinhole and SPECT 99mTcMIBI imaging in primary hyperparathyroidism. Nucl Med Commun. 2008;29: 949–55.18- Roach PJ, Schembri GP, Ho Shon IA, Bailey EA, Bailey DL. SPECT/CT imaging using a spiral CT scanner for anatomical localization: impact on diagnostic accuracy and reporter confidence in clinical practice. Nucl Med Commun 2006;27:977-87. 19- Gayed IW, Kim EE, BroussardWF, et al. The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med 2005;46:248–52.20- Serra A, Bolasco P, Satta L, Nicolosi A, Uccheddu A, Piga M. Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients. Radiol Med 2006;111:999–1008.21- Papathanassiou D, Flament JB, Pochart JM, et al. SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery. Clin Nucl Med 2008;33:394–7.22- Perez-Monte JE, Brown ML, Shah AN, et al. Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT. Radiology. 1996; 201:85–91.23- Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med. 2012;26(10):794–803.24- Oksuz MO, Dittmann H, Wicke C, et al. Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol. 2011;17(4):297–307.25- Li P, Liu Q, Tang D, et al. Lesion based diagnostic performance of dual phase 99mTc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism. BMC Med Imaging. 2017;17(1):60.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler-Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 11 Mayıs 2020 |
| Kabul Tarihi | 5 Kasım 2019 |
| Yayımlandığı Sayı | Yıl 2020 |
Kaynak Göster
