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DOI: 10.1055/s-0038-1629701
Szintigraphische Darstellung von Adenomen der Nebenschilddrüse mit 99mTc-Sestamibi in einem Strumaendemiegebiet
Imaging of Parathyroid Adenomas with 99mTc-Sestamibi in an Endemic Goiter AreaPublikationsverlauf
Eingegangen:
25. November 1993
in revidierter Form:
25. Dezember 1993
Publikationsdatum:
04. Februar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/199403/lookinside/thumbnails/10-1055-s-0038-1629701_de-1.jpg)
Zusammenfassung
Als nuklearmedizinische Standardmethode zur Darstellung von Adenomen der Nebenschilddrüsen gilt die Tl/Tc-Subtraktionsszintigraphie. Ziel dieser Untersuchung war es zu untersuchen, ob sich 99mTc-Sestamibi, das sich als Ersatz für 201TI in der Myokardszintigraphie bewährt hat, auch in einem Strumaendemiegebiet zur Nebenschilddrüsenszintigraphie eignet. Wir untersuchten 25 Patienten mit klinisch und biochemisch gesichertem primären und 9 mit sekundärem Hyperparathyreoidismus (HPT) am Tage vor der Operation. 5 Patienten, bei denen der zunächst vermutete HPT ausgeschlossen werden konnte, dienten als Kontrollgruppe. Planare Aufnahmen der Halsregion und des Mediastinums wurden 5, 15 und 120 min nach der i.v. Injektion von 444 MBq 99mTc-Sestamibi durchgeführt. Im Mibi-Szintigramm wurden 20 der 25 Adenome richtig lokalisiert, während sich nur bei 6 der 9 Patienten mit sekundärem HPT eine lokale Anreicherung fand. Die Ursache eines falsch-positiven Befundes war ein follikuläres Adenom der Schilddrüse. Die Nebenschilddrüsenszintigraphie mit 99mTc-Sestamibi als einziges Radiopharmakon hat mit 80% die gleiche Sensitivität im Adenomnachweis wie die Tl/Tc-Subtraktionsszintigraphie. Da im Strumaendemiegebiet die Prävalenz von Schilddrüsenadenomen hoch ist, muß mit einer höheren Rate falsch-positiver Befunde auch dieser Methode gerechnet werden.
Summary
Recently 99mTc-Sestamibi (MIBI) has been introduced into parathyroid imaging. The purpose of this study was to evaluate the MIBI scan in an endemic goiter area. 25 patients with primary and 9 with secondary hyperparathyroidism (HPT) underwent a MIBI scan one day prior to surgical exploration of the neck. Cervico-thoracic planar scintigraphy was performed 5, 15 and 120 min after i. v. injection of 444 MBq of 99mTc-Sestamibi. The MIBI scan correctly detected 20 of 25 adenomas in 25 patients with pHPT. In only 6 of 9 patients with parathyroid hyperplasia a focal uptake was found. The cause of one false-positive result in the control group was an increased MIBI uptake by a follicular adenoma of the thyroid. Parathyroid scintigraphy using 99mTc-Sestamibi as a single radiopharmaceutical is as sensitive in detecting and localizing parathyroid adenomas as the TI/Tc-scintigraphy. Due to a high prevalence of thyroid adenomas in an endemic goiter area a higher rate of falsely positive results may be expected.
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Literatur
- 1 Auffermann W, Gooding GAW, Okerlund MD. et al. Diagnosis of recurrent hyperparathyroidism: comparison of MR imaging and other imaging techniques. Am J Radiol 1988; 150: 1027-33.
- 2 Beierwalters WH. Endocrine imaging: Parathyroid, adrenal cortex and medulla, and other endocrine tumors. J Nucl Med 1991; 32: 1627-39.
- 3 Brownless SM, Gimlett TM. Comparison of techniques for Thallium-201-Technetium-99m parathyroid imaging. Br J Radiol 1989; 62: 532-5.
- 4 Cance WG, Otsuka FL, Dilley WG. et al. A potential new radiopharmaceutical for parathyroid imaging: radiolabeled parathyroid-specific monoclonal antibody-I. Evaluation of I-labeled antibody in a nude mouse model system. Int J Radiat Appl Instrum 1988; 15: 299-303.
- 5 Chiu ML, Kronange JF, Piwnica-Worms D. Effect of mitochondrial and plasma-membrane potentials on accumulation of hexakis (2-me-thoxyisobutylisonitrile) Technetium in cultured mouse fibroblasts. J Nucl Med 1990; 31: 1646-53.
- 6 Clark OH, Okerlund M, Moss AA. et al. Localization studies in patients with persistent or recurrent hyperparathyroidism. Surgery 1985; 98: 1083-93.
- 7 Coakley AJ. Parathyroid imaging - how and when. Eur J Nucl Med 1991; 18: 151-2.
- 8 Coakley AJ, Kettle AG, Wells CP, O’Doherty MJ, Collins REC. 99mTc-Sestamibi - a new agent for parathyroid imaging. Nucl Med Commun 1989; 10: 791-4.
- 9 Doppman JL. Reoperative parathyroid surgery; localization procedures. Progr Surg 1986; 18: 117-32.
- 10 Doppman JL, Krudy AG, Marx SJ. et al. Aspiration of enlarged parathyroid glands for parathyroid hormone assay. Radiology 1983; 148: 31-5.
- 11 Ferlin G, Bursato N, Camerani M, Conte N, Zotti D. New perspectives in localizing enlarged parathyroid glands by Technetium-Thallium subtraction scan. J Nucl Med 1983; 24: 438-41.
- 12 Fine EJ. Parathyroid imaging: its current status and future role. Sem Nucl Med 1987; 17: 350-9.
- 13 Foldes I, Levay A, Stotz G. Comparative scanning of thyroid nodules with Technetium-99m pertechnetate and Technetium-99m methoxyisobutylisonitrile. Eur J Nucl Med 1993; 20: 330-3.
- 14 Fogelman I, McKillop JH, Bessent RG. et al. Successful localization of parathyroid adenomata by Thallium-201 and Technetium-99m subtraction scintigraphy: description of an improved technique. Eur J Nucl Med 1984; 9: 545-7.
- 15 Gimlette TMD, Brownless SM, Taylor WH, Shields R, Simkin EP. Limits to parathyroid imaging with Thallium-201 confirmed by tissue uptake and phantom studies. J Nucl Med 1986; 27: 1262-5.
- 16 Gooding GA, Okerlund MD, Stark DD, Clark OH. Parathyroid imaging: comparison of double-tracer (Tl-201. Tc-99m) scintigraphy and high-resolution US. Radiology 1986; 16: 57-64.
- 17 Goris ML, Basso LV, Keeling C. Parathyroid imaging. J Nucl Med 1991; 32: 887-9.
- 18 Gunther RW, Miiller-Leisse C. Lokalisations-diagnostik bei Hyperparathyreoidismus. In: Hyperparathyreoidismus. Rotmund M. (Hrsg.). Stuttgart: Thieme; 1991: 120-44.
- 19 Hauty M, Swartz K, McClung M, Lowe DK. Technetium-Thallium scintiscanning for localization of parathyroid adenomas and hyperplasia, a reappraisal. Am J Surg 1987; 153: 479-86.
- 20 Krubsack AJ, Wilson SD, Lawson TL. et al. Prospective comparison of radionuclide, computed tomographic and sonographic localization of parathyroid tumors. World J Surg 1986; 10: 579-85.
- 21 McFarlane SD, Hanelin LG, Taft DA, Ryan Jr JA, Fredlund PN. Localization of abnormal parathyroid glands using Thallium-201. Am J Surg 1984; 148: 7-12.
- 22 MacCall A, Henkin R, Calendra D. et al. Routine use of the Thallium-Technetium scan prior to parathyroidectomy. Am Surgeon 1987; 53: 380-4.
- 23 Miller DL. Pre-operative localizaton and interventional treatment of parathyroid tumors: when and how?. World J Surg 1991; 15: 706-15.
- 24 O’Doherty MJ, Kettle AG, Wells P, Collins REC, Coakley A-J. Parathyroid imaging with Technetium-99m-Sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 1992; 33: 313-8.
- 25 Okerlund MD, Sheldon K, Corpuz S. et al. A new method with high sensitivity and specificity for localization of abnormal parathyroid glands. Ann Surg 1984; 200: 381-8.
- 26 Opelka FG, Brigham RA, Davies RS, Kaplan KA. The role of dual radionuclide scintigraphy in the preoperative localization of abnormal glands. Am Surgeon 1988; 54: 240-2.
- 27 Peck WW, Higgins CB, Fisher MR. et al. Hyperparathyroidsm: comparison of MR imaging with radionuclide scanning. Radiology 1987; 163: 415-20.
- 28 Picard D, D’Amour P, Carrier L, Chartrand R, Poisson R. Localization of abnormal parathyroid glands using 201Thallium/123Iodine subtraction scintigraphy in patients with primary hyperparathyroidism. Clin Nucl Med 1987; 12: 61-4.
- 29 Potchen EJ. Parathyroid imaging: current status and future prospects. J Nucl Med 1992; 33: 1807-9.
- 30 Reading CC, Charboneau JW, James EM. et al. High-resolution parathyroid sonography. Am J Roentgenol 1982; 139: 539-46.
- 31 Rothmund M. Chirurgische Therapie des primaren Hyperparathyreoidismus. In: Hyperparathyreoidismus. Rothmund M. (Hrsg.). Stuttgart: Thieme; 1991: 145-50.
- 32 Samata A, Wilson B, Iqbal J. et al. A clinical audit of Thallium-Technetium subtraction parathyroid scans. Postgraduate Med J 1990; 66: 441-5.
- 33 Sandrock D, Merino MJ, Norton JA. et al. Light and electron-microscopic analyses of parathyroid tumours explain results of Tc-99m parathyroid scintigraphy. Eur J Nucl Med 1989; 15: 410 (Abstr.)
- 34 Sandrock D, Merino MJ, Norton JN, Neumann RD. Parathyroid imaging by Tc/Tl scintigraphy. Eur J Nucl Med 1990; 16: 607-13.
- 35 Scheible W, Deutsch AL, Leopold GR. Parathyroid adenoma: accuracy of preoperative localization by high-resolution real-time sonography. J Clin Ultrasound 1981; 9: 325-30.
- 36 Stark DD, Moss AA, Gamsu G. et al. Magnetic resonance imaging of the neck. II: pathologic findings. Radiology 1984; 150: 455-61.
- 37 Stein BL, Wexler MJ. Preoperative parathyroid localization: a prospective evaluation of ultrasonography and Thallium-Technetium scintigraphy in hyperparathyroidism. Can J Surg 1990; 33: 175-9.
- 38 Taillefer R, van 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.
- 39 Vattimo A, Berteiii P, Burroni L. et al. Tc99m-MIBI thyroid scintigraphy in the assessment of the autonomously functioning thyroid nodule (AFTN). Eur J Nucl Med 1992; 19: 684.
- 40 Winzelberg GG, Hydovitz JD. Radionuclide imaging of parathyroid tumors: historical perspectives and newer techniques. Sem Nucl Med 1985; 15: 161-70.