核素扫描为假阴性原发性甲状旁腺功能亢进症手术时机及治疗策略的把握_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王雪薇 , 张妍妍 , 韩哲 , 张欢 ,  陈光

吉林大学第一医院甲状腺外科（长春 130021）;

Corresponding author：

陈光, Email: cg9293@sina.com

Keywords：

⁹⁹Tc^m-MIBI SPECT/CT 扫描; 原发性甲状旁腺功能亢进症; 手术时机; 治疗策略

DOI：

10.7507/1007-9424.201909039

Video：

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目的结合临床病例分析原发性甲状旁腺功能亢进症（PHPT）患者行 ⁹⁹锝^m-甲氧基异丁基异腈（⁹⁹Tc^m-MIBI）SPECT/CT 核素扫描结果为假阴性的原因，为在临床工作中核素扫描结果为假阴性或与其他影像学定位结果不一致的 PHPT 患者提供把握手术时机及治疗策略的思路。方法回顾性分析吉林大学第一医院甲状腺外科收治的 4 例核素扫描结果为假阴性的 PHPT 患者的临床病理资料。结果 PHPT 患者甲状旁腺病灶的大小、是否伴有出血、坏死、囊性变以及是否为恶性肿瘤伴发广泛转移都可导致 ⁹⁹Tc^m-MIBI SPECT/CT 呈现假阴性结果。结论 ⁹⁹Tc^m-MIBI SPECT/CT 扫描结果不能作为 PHPT 是否行手术治疗的判定标准，在临床工作中当 ⁹⁹Tc^m-MIBI SPECT/CT 结果呈现假阴性或与其他影像学定位结果不一致时，应结合患者实验室检查及其他影像学检查结果综合考虑，定位病灶，避免临床误诊，把握好手术时机以避免遗漏多发甲状旁腺病灶，减少不必要的双侧颈部探查，提高手术成功率。

Citation： 王雪薇, 张妍妍, 韩哲, 张欢, 陈光. 核素扫描为假阴性原发性甲状旁腺功能亢进症手术时机及治疗策略的把握. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 880-883. doi: 10.7507/1007-9424.201909039 Copy

1.	Dy BM, Richards ML, Vazquez BJ, et al. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol, 2012, 19(7): 2272-2278.
2.	宁志伟, 王鸥, 徐竞英, 等. 原发性甲状旁腺功能亢进症患者术前病变甲状旁腺定位方法的评估. 中国医学科学院学报, 2003, 25(3): 280-284.
3.	Melloul M, Paz A, Koren R, et al. ^99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med, 2001, 28(2): 209-213.
4.	Bénard F, Lefebvre B, Beuvon F, et al. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med, 1995, 36(2): 241-243.
5.	Gupta Y, Ahmed R, Happerfield L, et al. P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. Br J Surg, 2007, 94(12): 1491-1495.
6.	Uchida N, Yoshida M, Matsui Y, et al. A case report of a functioning mediastinal parathyroid cyst with no ^99mTc-MIBI uptake. International J Surg Open, 2018, 12: 5-8.
7.	Lussey-Lepoutre C, Trésallet C, Ghander C, et al. The role of imaging in the preoperative management of primary hyperparathyroidism: A current up-date. Médecine Nucléaire, 2018, 42(1): 49-58.
8.	Lundstroem AK, Trolle W, Soerensen CH, et al. Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT. Eur Arch Otorhinolaryngol, 2016, 273(5): 1253-1259.
9.	Beheshti M, Hehenwarter L, Paymani Z, et al. ¹⁸F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with ^99mTc-MIBI or ^99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging, 2018, 45(10): 1762-1771.
10.	何泱, 孙立昊, 刘建民. 原发性甲状旁腺功能亢进症患者即使影像学定位不能确定也应手术探查治疗. 中华内分泌代谢杂志, 2017, 33(11): 920-922.
11.	殷德涛, 唐艺峰. 原发性甲状旁腺功能亢进的手术探查策略. 临床外科杂志, 2018, 26(6): 405-407.
12.	Beyer TD, Solorzano CC, Starr F, et al. Parathyroidectomy outcomes according to operative approach. Am J Surg, 2007, 193(3): 368-372.
13.	Wang Y, Zhang X, Wang P, et al. Intraoperative parathyroid hormone monitoring in parathyroidectomy for PHPT//International Conference on Information Technology in Medicine and Education. IEEE, 2017: 214-218.

1. Dy BM, Richards ML, Vazquez BJ, et al. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol, 2012, 19(7): 2272-2278.
2. 宁志伟, 王鸥, 徐竞英, 等. 原发性甲状旁腺功能亢进症患者术前病变甲状旁腺定位方法的评估. 中国医学科学院学报, 2003, 25(3): 280-284.
3. Melloul M, Paz A, Koren R, et al. ^99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med, 2001, 28(2): 209-213.
4. Bénard F, Lefebvre B, Beuvon F, et al. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med, 1995, 36(2): 241-243.
5. Gupta Y, Ahmed R, Happerfield L, et al. P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. Br J Surg, 2007, 94(12): 1491-1495.
6. Uchida N, Yoshida M, Matsui Y, et al. A case report of a functioning mediastinal parathyroid cyst with no ^99mTc-MIBI uptake. International J Surg Open, 2018, 12: 5-8.
7. Lussey-Lepoutre C, Trésallet C, Ghander C, et al. The role of imaging in the preoperative management of primary hyperparathyroidism: A current up-date. Médecine Nucléaire, 2018, 42(1): 49-58.
8. Lundstroem AK, Trolle W, Soerensen CH, et al. Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT. Eur Arch Otorhinolaryngol, 2016, 273(5): 1253-1259.
9. Beheshti M, Hehenwarter L, Paymani Z, et al. ¹⁸F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with ^99mTc-MIBI or ^99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging, 2018, 45(10): 1762-1771.
10. 何泱, 孙立昊, 刘建民. 原发性甲状旁腺功能亢进症患者即使影像学定位不能确定也应手术探查治疗. 中华内分泌代谢杂志, 2017, 33(11): 920-922.
11. 殷德涛, 唐艺峰. 原发性甲状旁腺功能亢进的手术探查策略. 临床外科杂志, 2018, 26(6): 405-407.
12. Beyer TD, Solorzano CC, Starr F, et al. Parathyroidectomy outcomes according to operative approach. Am J Surg, 2007, 193(3): 368-372.
13. Wang Y, Zhang X, Wang P, et al. Intraoperative parathyroid hormone monitoring in parathyroidectomy for PHPT//International Conference on Information Technology in Medicine and Education. IEEE, 2017: 214-218.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

核素扫描为假阴性原发性甲状旁腺功能亢进症手术时机及治疗策略的把握

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