^99mTc-MIBI-SPECT-Nebenschilddriisen-szintigraphie zur präoperativen Lokalisation kleiner Nebenschilddrüsenadenome

Zusammenfassung

Ziel dieser Studie war es, den Wert einer ^99mTc-MIBI-Szintigraphie in SPECT-Technik mit 3D-Darstellung in der präoperativen Seitenlokalisa-tion von Nebenschilddrüsenadenomen (NSD-Adenom) zu untersuchen. Methode: Eingeschlossen wurden 25 Patienten (8 männlich, 17 weiblich, Alter: 63 ± 13 Jahre) mit gesichertem primären Hyperparathyreo-idismus, sonographisch nicht lokalisierbarem, kleinen NSD-Adenom. Nach Schilddrüsendiagnostik zur Lokalisation radionuklidspeichernder Schilddrüsenadenome wurden 20 min und 120 min p.i. von 740 MBq ^99mTc-MIBI planare und SPECT-Aufnahmen mit Hilfe einer Dreikopfkamera (Picker Prism 3000) aufgezeichnet. Bei den ersten 10 Patienten wurde in einem 2-Tage-Protokoll auch eine ²⁰¹TI/^99mTc-Subtraktionsszin-tigraphie durchgeführt.

Ergebnis: Die ²⁰¹TI/^99mTc-Subtraktionsszintigraphie (n = 10) zeigte nur eine Sensitivität von 50% bei den kieinen NSD-Adenomen (<1 g). Bei der planaren MIBI-NSD-Szintigraphie konnte 18 mal die Halsseite richtig lokalisiert werden (Sensitivität: 72%). Durch die SPECT-Technik und die 3D-Darstellung konnte eine Steigerung der Sensitivität auf 96% erzielt werden.

Schlußfolgerung: Im Vergleich zur in der Sensitivität deutlich unterlegenen ²⁰¹TI/^99mTc-Subtraktionsszintigraphie erlaubt die ^99mTc-MIBI-Szin-tigraphie bei Einsatz der SPECT-Technik und der 3D-Darstellung eine zuverlässige Seitenlokalisation auch von kleinen Nebenschilddrüsenadenomen und ermöglicht so dem Chirurgen die unilaterale Parathyreo-idektomie.

Summary

It was the aim of this study to assess the value of the ^99mTc-MIBI scintigraphy in SPECT technique in the preoperative lateral location of small parathyroid adenoma (PTA). Methods: 25 consecutive patients (8 male, 17 female, mean age 63 ± 13 years) with the established diagnosis of primary hyperparathyroidism and non-diagnostic ultrasonography were scanned preoperatively. After a thyroid examination to exclude radionuclide accumulating thyroid adenoma, planar and tomographic images were acquired 20 min. and 120 min. after i.v. injection of 740 MBq ^99mTc-MIBI using a 3 head gamma camera (Picker Prism 3000). The first 10 patients underwent an additional ²⁰¹TI/^99mTc subtraction scintigraphy in a 2 days protocol. Results: All patients had small, solitary PTA (<1g). ²⁰¹TI/^99mTc subtraction scintigraphy (n = 10) showed only a sensitivity of 50%. Using planar MIBI-scintigraphy lateral location of PTA was possible in 18 cases (sensitivity: 72%). There was an increase in sensitivity up to 96% using the SPECT technique and the 3D display (volume-rendered reprojection). Conclusion: In contrast to ²⁰¹TI/^99mTc subtraction scintigraphy, which showed only a low sensitivity, a reliable lateral location of small PTA was obtained using the tomographic ^99mTc-MIBI scintigraphy. This method offers e.g. the possibility for the surgeon to perform an unilateral parathyroidectomy.

Schlüsselwörter

^99mTc-MIBI-SPECT - Nebenschilddrüsenadenome - primärer Hyperpara-thyreoidismus

Key words

^99mTc-MIBI-SPECT - parathyroid adenoma - primary hyperparathyroidism

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