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Nuklearmedizin 2006; 45(03): 115-121
DOI: 10.1055/s-0038-1625329
Originalarbeiten – Original Articles
Schattauer GmbH

Lokalisation von Nebenschilddrüsenadenomen mit planarer 99mTc-Sestamibi-Szintigraphie

Vergleich von Subtraktionsund 2-Phasen-TechnikLocalisation of parathyroid glands using planar 99mTc-sestamibi scintigraphyComparison between subtraction- and dual-phase technique
B. Schommartz
1   Nuklearmedizinische Klinik (Direktor: Prof. Dr. med. H.-W. Müller)
,
K. Cupisti
2   Klinik für Allgemein- und Viszeralchirurgie (Direktor: Prof. Dr. med. W.-T. Knoefel), Heinrich-Heine-Universität Düsseldorf
,
C. Antke
1   Nuklearmedizinische Klinik (Direktor: Prof. Dr. med. H.-W. Müller)
,
D. Schmidt
1   Nuklearmedizinische Klinik (Direktor: Prof. Dr. med. H.-W. Müller)
,
W.-T. Knoefel
2   Klinik für Allgemein- und Viszeralchirurgie (Direktor: Prof. Dr. med. W.-T. Knoefel), Heinrich-Heine-Universität Düsseldorf
,
H.-W. Müller
1   Nuklearmedizinische Klinik (Direktor: Prof. Dr. med. H.-W. Müller)
› Author Affiliations
Further Information

Publication History

Eingegangen: 31 August 2005

angenommen nach Revision: 28 October 2005

Publication Date:
12 January 2018 (online)

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Zusammenfassung

Ziel: Im Rahmen der präoperativen Lokalisationsdiagnostik beim primären Hyperparathyreoidismus (pHPT) wurden die Subtraktions- und die 2-Phasen-Technik der 99mTc-Sestamibi- Szintigraphie untereinander und mit den Operationsergebnissen verglichen. Patienten, Methoden: Prospektiv wurden 126 Patienten mit pHPT präoperativ untersucht. Die Darstellung der Schilddrüse (99mTc-Pertechnetat) wurde von dem Perfusionsbild (99mTc-Sestamibi) subtrahiert, eine weitere Aufnahme 2 h p. i. diente zur Feststellung einer Aktivitätsretention. Die zeitnahe Befunderstellung erfolgte unter Berücksichtigung beider Techniken. Retrospektiv wurden die Auswertungen getrennt vier erfahrenen Fachärzten vorgelegt. Ergebnisse: In der klinischen Routine wurden bei 109 Patienten präoperativ korrekte Befunde erhoben (87%). Von 129 resezierten Nebenschilddrüsenadenomen wurden 118 richtig lokalisiert (Sensitivität 91%, pos. Vorhersagewert 94%). Bei der retrospektiven Analyse führten in 75% der Fälle beide Techniken zum richtigen Ergebnis, bei 14% war nur die 2-Phasen-Technik zielführend, bei 7% nur die Subtraktionstechnik. Mit der 2-Phasen-Technik wurden signifikant mehr Untersuchungen richtig beurteilt als mit der Subtraktionstechnik (88,7 ± 3,2% versus 81,6 ± 1,2%, p <0,01, zweiseitiger t-Test). Schlussfolgerung: Die präoperative szintigraphische Lokalisationsdiagnostik hyperaktiver Nebenschilddrüsen bei pHPT unterstützt das minimal-invasive operative Vorgehen durch eine hohe Rate an richtigen Befunden. Die 2-Phasen- erscheint sensitiver als die Subtraktionstechnik. In einigen Fällen kann die richtige Lokalisation nur mit Hilfe der Subtraktionstechnik angegeben werden. Für eine optimale Vorbereitung der Operation empfiehlt sich die vorgestellte Kombination beider Techniken.

Summary

Aim: In the context of presurgical localisation of parathyroid adenomas in primary hyperparathyreoidism (pHPT) using 99mTc-sestamibi scintigraphy, subtraction- and dualphase technique are compared with each other and with the surgical findings. Patients, methods: Prospectively, 126 patients with pHPT were investigated presurgically. For visualisation of parathyroid adenomas, an image of the thyroid (99mTc-pertechnetat) was subtracted from a perfusion image (99mTc-sestamibi) and 2 h p. i. another image was acquired for identification of retention of activity. Considering both techniques the clinical findings were reported promptly. Retrospectively, the evaluations were presented separately to four experienced raters. Results: In clinical routine for 109 patients correct findings were reported presurgically (87%). From 129 resected parathyroid adenomas 118 were localised correctly (sensitivity 91%, positive predictive value 94%). Concerning the retrospective analysis, in 75% of the cases both techniques provided the correct site, in 14% only the dual-phase technique and in 7% only the subtraction-technique was correct. With the help of the dual-phase technique significantly more investigations were correctly rated than with the help of the subtractiontechnique (88,7 ± 3,2% vs. 81,6 ± 1,2%, p <0.01, two-sided t-test). Conclusion: The presurgical scintigraphic localisation of hyperactive parathyroid glands in pHPT assists minimal invasive surgery serving a high rate of correct findings. According to our data the dual-phase technique seems to be more sensitive than the subtraction technique. In some cases, however, the correct site may only be found using the subtraction technique. For an optimal surgical strategy we suggest the combination of both techniques.

Schlüsselwörter

Primärer Hyperparathyreoidismus - Sestamibi-Szintigraphie - Subtraktionstechnik - 2-Phasen-Technik

Keywords

Primary hyperparathyreoidism - sestamibi-scintigraphy - subtraction technique - dual-phase technique
 

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