^99mTc-MIBI-SPECT: Eine nicht invasive, sensitive Lokalisationsdiagnostik bei Verdacht auf Nebenschilddrüsenadenom

Zusammenfassung

Die Aufgabe des Nuklearmediziners nach Diagnosestellung eines meist primären Hyperparathyreoidismus besteht in der erfolgreichen Lokalisation eines oder mehrerer Nebenschilddrüsenadenome. Die präoperative Lokalisation erlaubt die gezielte, heutzutage oft minimalinvasive Resektion. Hierzu ist ^99 mTc-MIBI-SPECT eine klinisch fest etablierte Methode mit hoher Sensitivität. Wichtig ist die Kenntnis über Einflussfaktoren, die zu falsch-positiven oder falsch-negativen Ergebnissen führen. Eine wichtige Differenzialdiagnose für eine pathologische Anreicherung ist ein MIBI-positiver Schilddrüsenknoten. Häufigere Ursachen für negative Befunde sind kleinere hyperplastische Nebenschilddrüsen oder ein Vitamin-D-Mangel. In manchen Zentren ist als weiterführende Lokalisationsmethode C-11-MET PET/CT verfügbar. Ob sich neben der chirurgischen Therapie in Zukunft perkutan-ablative Verfahren etablieren können, was eine gezielte prätherapeutische Lokalisation voraussetzt, kann zum jetzigen Zeitpunkt noch nicht definitiv beantwortet werden.

Abstract

Patients with an established diagnosis of mostly primary hyperparathyroidism are scanned by ^99 mTc-MIBI-scintigraphy by nuclear medicine physicians. Thereby ^99 mTc-MIBI-SPECT is a sensitive and specific tool for topographic localization even of small parathyroid adenomas in order to improve the efficiency of minimal invasive parathyroidektomie. Important to know are the parameters which lead to false positive (e. g. MIBI-positive thyroid nodule) and false negative results (e. g. vitamin-D-deficiency, small hyperplastic parathyroid adenomas) in the interpretation of ^99 mTc-MIBI-SPECT scans. C-11 methionine positron emission tomography computed tomography is the latest technique for localization of hyperfunctioning parathyroid glands. The treatment of patients with hyperparathyroidism is usually by surgery. Maybe non-invasive ablative techniques will be a good alternative to surgery for treatment of parathyroid adenomas in future.

Schlüsselwörter

Hyperparathyreoidismus - Nebenschilddrüse - Nebenschilddrüsenadenom - ^99 mTc-MIBI-SPECT - C-11-Methionin-PET/CT

Keywords

hyperparathyroidism - parathyroid gland - parathyroid adenoma - ^99 mTc-MIBI-SPECT - C-11 Methionin PET/CT

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