■探讨术前18F-FCHPET/CT在原发性甲状旁腺功能亢进(pHPT)患者99mTc-sestamibi甲状旁腺显像阳性的情况下检测其他功能亢进的价值。
■这是一项涉及pHPT患者的回顾性研究,在18F-FCHPET/CT之前进行的甲状旁腺闪烁显像阳性,和甲状旁腺手术后PET/CT。根据EANM实践指南进行成像程序。图像定性解释为阳性或阴性。病理结果的数量,他们的地形,记录异位位置。组织病理学,迈阿密标准,和生物学随访被认为是为了确保有效的甲状旁腺切除术,确认所有功能亢进的腺体完全切除。记录18F-FCHPET/CT对治疗策略的影响。
■64/632扫描pHPT患者(10%)纳入分析。根据基于每个病变的分析,灵敏度,特异性,正预测值,99mTc-sestamibi闪烁显像的阴性预测值为82、95、87和93%,分别。18F-FCHPET/CT的相同值分别为93、99、99和97%,分别。18F-FCHPET/CT显示出明显高于99mTc-sestamibi闪烁显像的整体准确性:98%(CI:95-99)与91%(CI:87-94%)。99mTc-sestamibi闪烁显像和18F-FCHPET/CT的Youden指数分别为0.79和0.92,分别。13/64(20%)患者(49个腺体)的闪烁显像和PET/CT不一致。18F-FCHPET/CT在8例患者(12.5%)中发现了9例未通过99mTc-sestamibi闪烁显像术检测到的病理性甲状旁腺。此外,18F-FCHPET/CT允许重新考虑7例患者(11%)中8例甲状旁腺的假阳性闪烁显像诊断(scinti/PET-)。18F-FCHPET/CT影响了7例(占研究人群的11%)的手术策略。
■在术前设置,在闪烁显像阳性的pHPT患者中,18F-FCHPET/CT似乎比99mTc-sestamibi扫描更准确和有用。颈部手术前甲状旁腺显像阳性不能令人满意,尤其是在多腺疾病患者中,建议需要发展实践并定义新的术前成像算法,包括pHPT患者的前置18F-FCHPET/CT。
UNASSIGNED: To investigate the value of presurgical 18F-FCH PET/CT in detecting additional hyperfunctioning parathyroids despite a positive 99mTc-
sestamibi parathyroid scintigraphy in patients with primary hyperparathyroidism (pHPT).
UNASSIGNED: This is a retrospective study involving patients with pHPT, positive parathyroid scintigraphy performed before 18F-FCH PET/CT, and parathyroid surgery achieved after PET/CT. Imaging procedures were performed according to the EANM practice guidelines. Images were qualitatively interpreted as positive or negative. The number of pathological findings, their topography, and ectopic location were recorded. Histopathology, Miami criterion, and biological follow-up were considered to ensure effective parathyroidectomy confirming the complete excision of all hyperfunctioning glands. The impact of 18F-FCH PET/CT on therapeutic strategy was recorded.
UNASSIGNED: 64/632 scanned pHPT patients (10%) were included in the analysis. According to a per lesion-based analysis, sensitivity, specificity, positive predictive value, and negative predictive value of 99mTc-
sestamibi scintigraphy were 82, 95, 87, and 93%, respectively. The same values for 18F-FCH PET/CT were 93, 99, 99, and 97%, respectively. 18F-FCH PET/CT showed a significantly higher global accuracy than 99mTc-
sestamibi scintigraphy: 98% (CI: 95-99) vs. 91% (CI: 87-94%). Youden Index was 0.79 and 0.92 for 99mTc-
sestamibi scintigraphy and 18F-FCH PET/CT, respectively. Scintigraphy and PET/CT were discordant in 13/64 (20%) patients (49 glands). 18F-FCH PET/CT identified nine pathologic parathyroids not detected by 99mTc-
sestamibi scintigraphy in 8 patients (12.5%). Moreover, 18F-FCH PET/CT allowed the reconsideration of false-positive scintigraphic diagnosis (scinti+/PET-) for 8 parathyroids in 7 patients (11%). The 18F-FCH PET/CT influenced the surgical strategy in 7 cases (11% of the study population).
UNASSIGNED: In a preoperative setting, 18F-FCH PET/CT seems more accurate and useful than 99mTc-sestamibi scan in pHPT patients with positive scintigraphic results. Positive parathyroid scintigraphy could be not satisfactory before neck surgery particularly in patients with multiglandular disease, suggesting a need to evolve the practice and define new preoperative imaging algorithms including 18F-FCH PET/CT at the fore-front in pHPT patients.