Subscribe to RSS
DOI: 10.1055/s-0038-1629840
99mTc-MIBI-SPECT-Nebenschilddriisen-szintigraphie zur präoperativen Lokalisation kleiner Nebenschilddrüsenadenome
99mTc-MIBI-SPECT for the Location of Small Parathyroid AdenomaPublication History
Eingegangen:
21 February 1997
in revidierter Form:
30 April 1997
Publication Date:
03 February 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/199707/lookinside/thumbnails/10-1055-s-0038-1629840_de-1.jpg)
Zusammenfassung
Ziel dieser Studie war es, den Wert einer 99mTc-MIBI-Szintigraphie in SPECT-Technik mit 3D-Darstellung in der präoperativen Seitenlokalisa-tion von Nebenschilddrüsenadenomen (NSD-Adenom) zu untersuchen. Methode: Eingeschlossen wurden 25 Patienten (8 männlich, 17 weiblich, Alter: 63 ± 13 Jahre) mit gesichertem primären Hyperparathyreo-idismus, sonographisch nicht lokalisierbarem, kleinen NSD-Adenom. Nach Schilddrüsendiagnostik zur Lokalisation radionuklidspeichernder Schilddrüsenadenome wurden 20 min und 120 min p.i. von 740 MBq 99mTc-MIBI planare und SPECT-Aufnahmen mit Hilfe einer Dreikopfkamera (Picker Prism 3000) aufgezeichnet. Bei den ersten 10 Patienten wurde in einem 2-Tage-Protokoll auch eine 201TI/99mTc-Subtraktionsszin-tigraphie durchgeführt.
Ergebnis: Die 201TI/99mTc-Subtraktionsszintigraphie (n = 10) zeigte nur eine Sensitivität von 50% bei den kieinen NSD-Adenomen (<1 g). Bei der planaren MIBI-NSD-Szintigraphie konnte 18 mal die Halsseite richtig lokalisiert werden (Sensitivität: 72%). Durch die SPECT-Technik und die 3D-Darstellung konnte eine Steigerung der Sensitivität auf 96% erzielt werden.
Schlußfolgerung: Im Vergleich zur in der Sensitivität deutlich unterlegenen 201TI/99mTc-Subtraktionsszintigraphie erlaubt die 99mTc-MIBI-Szin-tigraphie bei Einsatz der SPECT-Technik und der 3D-Darstellung eine zuverlässige Seitenlokalisation auch von kleinen Nebenschilddrüsenadenomen und ermöglicht so dem Chirurgen die unilaterale Parathyreo-idektomie.
Summary
It was the aim of this study to assess the value of the 99mTc-MIBI scintigraphy in SPECT technique in the preoperative lateral location of small parathyroid adenoma (PTA). Methods: 25 consecutive patients (8 male, 17 female, mean age 63 ± 13 years) with the established diagnosis of primary hyperparathyroidism and non-diagnostic ultrasonography were scanned preoperatively. After a thyroid examination to exclude radionuclide accumulating thyroid adenoma, planar and tomographic images were acquired 20 min. and 120 min. after i.v. injection of 740 MBq 99mTc-MIBI using a 3 head gamma camera (Picker Prism 3000). The first 10 patients underwent an additional 201TI/99mTc subtraction scintigraphy in a 2 days protocol. Results: All patients had small, solitary PTA (<1g). 201TI/99mTc subtraction scintigraphy (n = 10) showed only a sensitivity of 50%. Using planar MIBI-scintigraphy lateral location of PTA was possible in 18 cases (sensitivity: 72%). There was an increase in sensitivity up to 96% using the SPECT technique and the 3D display (volume-rendered reprojection). Conclusion: In contrast to 201TI/99mTc subtraction scintigraphy, which showed only a low sensitivity, a reliable lateral location of small PTA was obtained using the tomographic 99mTc-MIBI scintigraphy. This method offers e.g. the possibility for the surgeon to perform an unilateral parathyroidectomy.
-
Literatur
- 1 Basso LV, Keeling C, Goris ML. Parathyroid imaging. Use of dual isotope scintigraphy for the localization of adenomas before surgery. Clin Nucl Med 1992; 17: 380-3.
- 2 Billotey C, Sarfati E, Aurengo A, Duet M, Mundler O, Toubert ME, Rain JD, Najean Y. Advantages of SPECT in technetium-99m sestamibi parathyroid scintigraphy. J Nucl Med 1996; 37: 1773-8.
- 3 Blockett D, Martin P, Schoutens A, Verhas M, Hooghe L, Kinnaert P. Presurgical localization of abnormal parathyroid glands using a single injection of technetium-99m methoxyisobutylisonitrile: comparison of different techniques including factor analysis of dynamic structures. Eur J Nucl Med 1997; 24: 46-51.
- 4 Burke GJ, Wei JP, Binet EE. Parathyroid scintigraphy with iodine-123 and 99mTc-sestamibi: imaging findings. Am J Roentgenol 1993; 161: 1265-8.
- 5 Caravalho J, Balingit AG, Rivera-Rodriguez J, Shriver CD, Koops MK. Localization of an ectopic parathyroid adenoma by double-phase technetium-99m-sestamibi scintigraphy. J Nucl Med 1995; 36: 1840-2.
- 6 Carlson GL, Farndon JR, Clayton B, Rose PG. Thallium isotope scintigraphy and ultrasonography: comparative studies of localization techniques in primary hyperparathyroidism. Br J Surg 1990; 77: 327-9.
- 7 Casas AT, Burke GJ, Mansberger AJ, Wei JP. Impact of technetium-99m-sestamibi localization on operative time and success of operations for primary hyperparathyroidism. Am Surg 1994; 60: 12-6.
- 8 Coakley AJ, Kettle AG, Wells CP, O’Doher-ty MJ, Collins RE. 99mTc sestamibi-a new agent for parathyroid imaging. Nucl Med Commun 1989; 10: 791-4.
- 9 Davis RK, Hoffmann J, Dart D, Datz FL. Unilateral parathyroidectomy: the role of thallium-technetium subtraction scans. Otolaryngol Head Neck Surg 1990; 102: 635-8.
- 10 Erdman WA, Breslau NA, Weinreb JC, Weatherall P, Setiawan H, Harrell R, Snyder W. Noninvasive localization of parathyroid adenomas: a comparison of X-ray computerized tomography, ultrasound, scintigraphy and MRI. Magn Reson Imaging 1989; 7: 187-94.
- 11 Foster GS, Bekerman C, Blend MJ, Byrom E, Pinsky SM. Preoperative imaging in primary hyperparathyroidism. Role of thallium-technetium subtraction scintigraphy. Arch Otolaryngol Head Neck Surg 1989; 115: 1197-202.
- 12 Gallacher SJ, Kelly P, Shand J, Logue FC, Cooke T, Boyle IT, McKillop JH. A comparison of 10 MHz ultrasound and 201 -thalli-um/99m-technetium subtraction scanning in primary hyperparathyroidism. Postgrad Med J 1993; 69: 376-80.
- 13 Grünwald F, Späth G, Menzel C, Pavics L, Sudhop T, Liesegang P, Klingmtiller D, Schomburg A, Biersack HJ. Nebenschild-drusenszintigraphie mit 99mTc-MIBI. Med Klin 1995; 90: 450-5.
- 14 Heath H, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: incidence, morbidity and potential economic impact in a community. N Engl J Med 1980; 203: 189-93.
- 15 Heller KS, Attie JN, Dubner S. Parathyroid localization: inability to predict multiple gland involvement. Am J Surg 1993; 166: 357-9.
- 16 Irvin III G, Prudhomme DL, Deriso GT, Sfakianakis G, Chandarlapaty SK. A new approach to parathyroidectomy. Ann Surg 1994; 219: 574-9.
- 17 Krubsack AJ, Wilson SD, Lawson TL, Knee-land JB, Thorsen MK, Collier BD, Hellman RS, Isitman AT. Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors. Surgery 1989; 106: 639-44.
- 18 Maltby C, Russell CF, Laird JD, Ferguson WR. Thallium-technetium isotope subtraction scanning in primary hyperparathyroidism. J R Coll Surg Edinb 1989; 34: 40-3.
- 19 McBiles M, Lambert AT, Cote MC, Kim SY. Sestamibi parathyroid imaging. Sem Nucl Med 1995; 25/3: 221-34.
- 20 O’Doherty MJ, Kettle AG, Wells P, Collins RE, Coakley AJ. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 1992; 33: 313-8.
- 21 Perez-Monte JE, Brown ML, Shah AN, Ranger NT, Watson CG, Carty SE, Clarke MR. Parathyroid adenomas: Accurate detection and localization with Tc-99m Sestamibi SPECT. Radiology 1996; 201: 85-91.
- 22 Petti GJ, Chonkich GD, Morgan JW. Unilateral parathyroidectomy: the value of the localizing scan. J Otolaryngol 1993; 22: 307-10.
- 23 Reiners C. Endokrine Organe. In: Nuklearmedizin. Büll U, Schicha H, Biersack HJ, Knapp WH, Reiners Chr, Schober O. eds. Stuttgart: Thieme; 1994: 192-3.
- 24 Russell CF, Laird JD, Ferguson WR. Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach?. World J Surg 1990; 14: 406-9.
- 25 Salti Gl, Fedorak I, Yashiro T, Fulton N, Hara H, Yousefzadeh D, Kaplan EL. Continuing evolution in the operative management of primary hyperparathyroidism. Arch Surg 1992; 127: 831-6.
- 26 Sandrock D, Merino MJ, Norton JA, Neumann RD. Parathyroid imaging by Tc/Tl scintigraphy. Eur J Nucl Med 1990; 16: 607-13.
- 27 Sfakianakis GN, Irvin III GL, Foss J, Mallin W, Georgiou M, Deriso GT, Molinari AS, Ezuddin S, Ganz W, Serafini A, Jabir AM, Chandarlapaty SKC. Efficient parathyroidectomy guided by SPECT-MIBI and hormonal measurement. J Nucl Med 1996; 37: 798-804.
- 28 Shaha AR, LaRosa CA, Jaffe BM. Parathyroid localization prior to primary exploration. Am J Surg 1993; 166: 289-93.
- 29 Staudenherz A, Abela C, Niederle B, Steiner E, Helbrich T, Puig S, Kaserer K, Becherer A, Leitha T, Kletter K. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases. Eur J Nucl Med 1997; 24: 143-9.
- 30 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.
- 31 Uden P, Aspelin P, Berglund J, Lilja B, Nyman U, Olsson LE, Zederfeldt B. Preoperative localization in unilateral parathyroid surgery. A cost-benefit study on ultrasound, computed tomography and scintigraphy. Acta Chir Scand 1990; 156: 29-35.
- 32 Weber CJ, Vansant J, Alazraki N, Christy J, Watts N, Phillips LS, Mansour K, Sewell W, McGarity WC. Value of technetium 99m sestamibi iodine 123 imaging in reoperative parathyroid surgery. Surgery 1993; 114: 1011-8.
- 33 Wen S, Düren M, Morita E, Higgins C, Bum Q, Siperstein A, Clark O. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 1996; 131: 861-9.
- 34 Yao M, Jamieson C, Blend R. Magnetic resonance imaging in preoperative localization of diseased parathyroid glands: a comparison with isotope scanning and ultrasonography. Can J Surg 1993; 36: 241-4.