Preoperative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease

被引:72
作者
Krausz, Y
Lebensart, PD
Klein, M
Weininger, J
Blachar, A
Chisin, R
Shiloni, E
机构
[1] Hadassah Univ Hosp, Dept Med Biophys & Nucl Med, IL-91120 Jerusalem, Israel
[2] Hadassah Univ Hosp, Dept Radiol, IL-91120 Jerusalem, Israel
[3] Soreq Nucl Res Ctr, Radiopharmaceut Div, IL-81800 Yavne, Israel
[4] Hadassah Univ Hosp, Dept Surg, IL-91120 Jerusalem, Israel
关键词
D O I
10.1007/s002680010280
中图分类号
R61 [外科手术学];
学科分类号
摘要
We have previously demonstrated the role of high-resolution ultrasonography (US) in preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism (PHPT) and no thyroid abnormalities. The present study prospectively evaluated the possible additional value of Tc-99m-sestamibi (MIBI) in patients with PHPT and concomitant multinodular thyroid disease (MND). Patients with PHPT underwent US and MIBI scintigraphy prior to neck exploration. Imaging data were correlated with the site and pathology of the parathyroid tissue removed and were analyzed separately for patients with MND and those with a normal thyroid gland. Among 77 patients with a solitary parathyroid adenoma at surgery, 40 had concomitant MND, whereas 37 patients had no morphologic changes in the thyroid gland, on US or at surgery. Prior to surgery, MIBI scintigraphy depicted 58 of the 77 adenomas (75%) and US localized 51 (66%); the combined sensitivity was 87% (67/77). Among the 37 patients with no thyroid nodules, MIBI located 29 (78%) and US identified 30 (81%) of the adenomas; the combined sensitivity was 89%. In the 40 patients with MND, MIBI identified 29 adenomas (73%) and US localized only 53% (21/40); the combined sensitivity was 85%. Overall, the positive predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma was 94%, for US it was 88%, and with the two tests combined it was 97%. In patients with no thyroid abnormalities, the PPV of MIBI and US was 97%, but it decreased to 91% and 78%; respectively, in patients with MND. Two patients with false-positive findings on both MIBI and US had associated thyroid disease. Hence MIBI scintigraphy contributes to localization of a solitary parathyroid adenoma mainly in patients with concomitant MND. The combined MIBI and US modalities result in sparing these patients bilateral neck exploration.
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页码:1573 / 1578
页数:6
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