背景:放射定位成像有助于识别导致原发性甲状旁腺功能亢进(PHPT)的异常甲状旁腺,从而促进微创甲状旁腺手术。有时初始成像可能无法识别异常腺体,因此可能会重复成像。这项研究探讨了重复甲状旁腺定位成像的患者结果,在最初的阴性腺体定位后,在英国的一个机构。
方法:回顾性收集并分析了在五年期间(2015-2020年)接受重复成像的PHPT患者的数据。扫描的总次数,执行的扫描类型,记录扫描之间的时间间隔和腺体定位的成像成功。我们探索了重复成像的原因,并试图确定可能预测后续阳性放射学定位的任何因素。
结果:共有45例患者在首次定位成像阴性后接受了反复定位成像。其中,尽管进行了重复成像,但仍有39例患者未接受手术;这39例患者中有11例(28%)随后进行了阳性定位扫描。再一次,很大一部分患者接受了保守治疗,尽管进行了重复的成像。接受三组或四组重复成像的患者没有成像或手术成功。
结论:应遵循流线型甲状旁腺通路,在重复成像之前,应根据患者是否适合手术进行分类。当患者不适合保守治疗并且愿意并且适合接受手术时,应提供第二组扫描。重复成像超过两次是没有好处的。
BACKGROUND: Radiological localization imaging aids in the identification of abnormal parathyroid glands resulting in primary hyperparathyroidism (PHPT), thereby facilitating minimally invasive parathyroid surgery. Sometimes initial imaging may fail to identify the abnormal gland and imaging may therefore be repeated. This study explored patient outcomes of repeated parathyroid localization imaging, after initial negative gland localization, at a United Kingdom institution.
METHODS: Data was retrospectively collected and analyzed for patients with PHPT undergoing repeated imaging during a five-year period (2015-2020). The total number of episodes of scanning, types of scans performed, the time interval between scans and the imaging success of gland localization were recorded. We explored the reasons for repeated imaging and attempted to identify any factors that might predict subsequent positive radiological localization.
RESULTS: A total of 45 patients were identified who underwent repeated localizing imaging after first localizing imaging was negative. Of these, 39 did not undergo surgery despite repeat imaging being undertaken; 11 out of these 39 patients (28%) had subsequent positive localization scans. Again, a large proportion of patients were managed conservatively, despite the repeated sets of imaging being done. Patients undergoing three or four sets of repetitive imaging did not have imaging or surgical success.
CONCLUSIONS: A streamlined parathyroid pathway should be followed whereby patients should be triaged for suitability for surgery prior to repeated imaging. A second set of scans should be offered when patients are unsuitable for conservative management and are willing and fit to undergo surgery. There is no merit to repeating imaging more than twice.