目的:回顾甲状旁腺囊性腺瘤(PCA)的影像诊断方法。由于PCAs是甲状旁腺腺瘤的一个罕见的亚类(0.5%-1%),由于它们的囊性成分,已知可有效诊断实性腺瘤的成像方式可能无法定位它们。
方法:我们使用PubMed和Cochrane数据库对1995年至2020年间发表的PCAs英文文章进行了系统评价。对检索到的数据进行荟萃分析。
结果:总体而言,39项研究,总共报告了160名患者,包括在分析中。三分之二(68%)的患者是女性,平均年龄53.9岁。在98.1%的病例中检测到单个囊性腺瘤。白蛋白水平校正后的平均血钙为12.6±2.7mg/dL,平均甲状旁腺激素水平为565.5±523.8pg/mL。通过超声(US)测量的平均PCA大小,计算机断层扫描(CT),离体测量为4.8±3.6、5.2±3.2和3.5cm,分别。中位体重为8.1g。在86%的美国检查中检测到PCA;100%的美国引导的细针抽吸,4维计算机断层扫描(4D-CT),或磁共振成像检查;用单光子发射计算机断层扫描((99m)Tc-SPECT)进行99m-sestamibi扫描的61%。(99m)Tc-SPECT显示诊断率明显低于US(比值比,3.589),美国引导的细针抽吸,CT结合4D-CT,和美国的结合,CT,4D-CT,磁共振成像(P<0.001)。
结论:尽管US和4D-CT在诊断PCA中显示出较高的比率,(99m)Tc-SPECT显示较低的PCA诊断率。这些发现表明,应使用4D-CT而不是(99m)Tc-SPECT进一步评估怀疑为PCAs的较大囊性病变。
OBJECTIVE: To
review diagnostic imaging modalities for parathyroid cystic adenomas (PCA). Since PCAs are a rare (0.5%-1%) subclass of parathyroid adenomas, and due to their cystic component, imaging modalities known to be efficient for diagnosing solid adenomas might fail in localizing them.
METHODS: We conducted a systematic
review using the PubMed and Cochrane databases for English articles on PCAs published between 1995 and 2020. A meta-analysis of the retrieved data was performed.
RESULTS: Overall, 39 studies, reporting on a total of 160 patients, were included in the analysis. Two thirds (68%) of the patients were female, with a mean age of 53.9 years. A single cystic adenoma was detected in 98.1% of cases. The mean blood calcium corrected for albumin level was 12.6 ± 2.7 mg/dL, and the mean parathyroid hormone level was 565.5 ± 523.8 pg/mL. The mean PCA sizes as measured by ultrasound (US), computed tomography (CT), and ex vivo measurement were 4.8 ± 3.6, 5.2 ± 3.2, and 3.5 cm, respectively. The median weight was 8.1 g. PCA was detected in 86% of US examinations; 100% of US-guided fine needle aspiration, 4-dimensional computed tomography (4D-CT), or magnetic resonance imaging examinations; and 61% of 99m-technetium sestamibi scan with single-photon emission computed tomography ((99m)Tc-SPECT). (99m)Tc-SPECT showed a significantly lower diagnostic rate than US (odds ratio, 3.589), US-guided fine needle aspiration, CT combined with 4D-CT, and the combination of US, CT, 4D-CT, and magnetic resonance imaging (P < .001).
CONCLUSIONS: Although US and 4D-CT showed a significantly high rate in diagnosing PCA, (99m)Tc-SPECT showed a lower PCA diagnostic rate. These findings suggest that larger cystic lesions suspected as PCAs should be further evaluated using 4D-CT rather than (99m)Tc-SPECT.