Primer Hiperparatiroidide Tc-99m MİBİ ile Yapılan Sintigrafik Görüntüleme Sonuçlarının İncelenmesi ve Biyokimyasal Parametreler ile İlişkisinin Değerlendirilmesi

Öz

Yeni tanı primer hiperparatiroidili (PHPT) hastalarda Teknesyum-99m MIBI ile yapılan sintigrafik görüntüleme yöntemi ile klinik, laboratuvar ve histopatolojik bulgular arasındaki ilişki retrospektif olarak incelenmiş, biyokimyasal ve histopatolojik parametrelerin sintigrafik lezyon tespitindeki rolünün değerlendirilmesi amaçlanmıştır. 2012-2018 yılları arasında paratiroid sintigrafisi için başvurmuş 516 hiperparatiroidili hasta dosyası retrospektif olarak tarandı. Hastalardan PHPT tanısı almış ve ilk defa paratiroidektomi uygulanmış 105 (94 kadın, 11 erkek) hasta dosyası çalışmaya dahil edilerek laboratuvar, ultrason (USG) ve klinik bulgular kaydedildi. Sintigrafik olarak paratiroid dokusu lokalize edilebilenler MIBI-pozitif (n=92) ve edilemeyenler MIBI-negatif (n=13) olarak iki grupta incelendi. USG ve sintigrafi yönteminin ve kombinasyonlarının duyarlılıkları ve tanısal doğruluğu değerlendirildi. MIBI-pozitif hastalarda kalsiyum değeri (11,48±0,75 mg/dl), MIBI-negatif olan gruba göre (11±0,68 mg/dl) anlamlı olarak yüksekti (p=0,047). USG’nin lezyon saptamadaki duyarlılığı %60,2, sintigrafinin %89,1 iken iki yöntemin kombinasyonunda duyarlılık %91,9 olarak saptandı. Sintigrafi tek başına kullanıldığında tanısal keskinlik %87,6 iken USG+sintigrafide %92 olarak saptandı. Paratiroid adenom boyutu ile PTH ve ALP arasında pozitif yönde anlamlı korelasyon saptandı (sırasıyla, p<0,001 r=0,572; p=0,003 r=0,424). Çalışmamızda paratiroid sintigrafisinin kalsiyumun yüksek olduğu durumlarda bir paratiroid patolojisi tanımlamasının daha olası olduğu ve PTH düzeyi arttıkça adenom boyutunun arttığı gösterilmiştir. PHPT’de preoperatif lokalizasyon için sintigrafi USG’den çok daha etkili olmakla beraber USG ile kombinasyonu sintigrafinin etkinliğine katkı sağlamaktadır.

Anahtar Kelimeler

• paratiroid adenom
• primer hiperparatiroidi
• sestamibi sintigrafi

Association of Tc99m-MIBI Scintigraphy and Biochemical Parameters in Primary Hyperparathyroidism

Öz

It was aimed to evaluate the relationship between clinical, laboratory, and histopathological findings with the scintigraphy performed with Technetium-99m MIBI in patients with primary hyperparathyroidism (PHPT). 516 patients who applied for parathyroid scintigraphy between 2012-2018 were retrospectively scanned. Files of 105(94 female, 11 male) patients, which were diagnosed as PHPT, were included in the study and laboratory, ultrasonography (USG), and findings were recorded. The scintigraphically parathyroid tissues that can be localized were examined in two groups as MIBI-positive(n=92) and those that could not be MIBI-negative (n=13). Sensitivity and diagnostic accuracy of USG and scintigraphy and combinations were evaluated. The calcium value (11.48±0.75 mg/dl) in MIBI-positive group was higher than MIBI-negative group (11±0.68 mg/dl) (p=0.047). While the sensitivity of USG in lesion detection was 60.2%, and scintigraphy was 89.1%, the sensitivity in the combination of the those was 91.9%. Diagnostic acuity of scintigraphy was 87.6%, USG+scintigraphy was 92%. A positive correlation was found between parathyroid adenoma size and PTH and ALP (p<0.001 r=0.572; p=0.003 r=0.424, respectively). Parathyroid scintigraphy is more likely to define a parathyroid pathology when calcium is high, and the adenoma size increases consistent with increasing PTH. Although scintigraphy is much more effective than USG for preoperative localization in PHPT, its combination with USG contributes to the localization of PHPT.

Anahtar Kelimeler

• parathyroid adenoma, primary hyperparathyroidism, sestamibi scintigraphy

Kaynakça

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