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甲状旁腺常位于甲状腺的背侧,当其机能亢进时,会表现为血磷水平降低而血钙水平增高,骨的钙盐被过分吸收,导致骨质疏松及钙盐沉积于其他器官。原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)多由单个甲状旁腺腺瘤引起,其诊断基于生化检测,表现为血钙水平升高、甲状旁腺激素(parathyroid hormone,PTH)水平正常或升高,伴不同程度的骨质疏松症和病理性骨折、肾功能不全等[1]。治疗PHPT的主要手段是手术切除功能亢进的甲状旁腺组织,精准切除病灶后,可有效缓解上述症状。但由于甲状旁腺与甲状腺及胸腺的位置很近,而且有血管、淋巴管和神经穿行进入,因此手术的成败及术后复发率取决于术前病灶的精确定位[2],目前临床中常见的PHPT患者多以甲状旁腺腺瘤为主,笔者将以甲状旁腺腺瘤为主要研究对象进行综述。
PET/CT在原发性甲状旁腺亢进症术前定位中的应用价值及其术前定位影像学新进展
Application value of PET/CT in preoperative localization of primary hyperparathyroidism and new advances in preoperative localization imaging
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摘要: 原发性甲状旁腺功能亢进症(PHPT)是一种常见的内分泌疾病,通常由甲状旁腺功能亢进引起。手术切除功能亢进的病灶是治疗PHPT的主要手段,正确定位病灶对于指导PHPT患者的微创手术治疗至关重要。PET/CT目前已经成为甲状旁腺腺瘤术前定位的一线影像学手段,而如何从血清生化水平筛选出适合行PET/CT的患者成为临床应用的重点,从组织病理学和免疫组化水平分析其与PET相关参数的关系也是目前研究的热点。笔者主要就PHPT患者的血清生化水平、组织病理学信息、免疫组化与PET/CT相关参数之间的关系进行分析,并介绍了PHPT术前定位的影像学新进展,以期为PET/CT的临床应用提供指导。
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关键词:
- 甲状旁腺功能亢进,原发性 /
- 甲状旁腺疾病 /
- 正电子发射断层显像术 /
- 体层摄影术,X 线计算机 /
- 体层摄影术,发射型计算机,单光子
Abstract: Primary hyperparathyroidism (PHPT) is a common endocrine disease, which is usually caused by hyperparathyroidism. Surgical resection of hyperfunctional lesions is the main treatment for PHPT, and correct location of the lesions is very important to guide the minimally invasive surgical treatment of PHPT patients. PET/CT has been used as the first-line imaging method for preoperative localization of parathyroid adenoma, and how to screen the patients suitable for PET/CT from the serum biochemistry has become the focus of clinical application, as well as the analysis of its relationship with PET related parameters from the level of pathology and immunohistochemistry is the focus of current research. This article mainly analyzes the relationship between biochemical level, pathological information, immunohistochemical analysis and PET/CT related parameters of PHPT, providing guidance for the clinical application of PET, and further introducing the new imaging progress of preoperative localization of PHPT. -
[1] Walker MD, Silverberg SJ. Primary hyperparathyroidism[J]. Nat Rev Endocrinol, 2018, 14(2): 115−125. DOI: 10.1038/nrendo.2017.104. [2] 李秀梅, 李军, 王宏桥, 等. 高频超声、超声造影与99mTc-MIBI SPECT/CT在难治性甲状旁腺功能亢进术前定位中的比较[J/OL]. 中华医学超声杂志(电子版), 2018, 15(7): 522−529[2023-01-29]. https://d.wanfangdata.com.cn/periodical/zhyxcszz201807010. DOI: 10.3877/cma.j.issn.1672-6448.2018.07.010.
Li XM, Li J, Wang HQ, et al. Localization value of ultrasonography, contrast-enhanced ultrasound and 99mTc-MIBI SPECT/CT in refractory secondary hyperparathyroidism[J/OL]. Chin J Med Ultrasound: Electron Ed, 2018, 15(7): 522−529[2023-01-29]. https://d.wanfangdata.com.cn/periodical/zhyxcszz201807010. DOI: 10.3877/cma.j.issn.1672-6448.2018.07.010.[3] Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003[J]. Otolaryngol Head Neck Surg, 2005, 132(3): 359−372. DOI: 10.1016/j.otohns.2004.10.005. [4] Bossert I, Chytiris S, Hodolic M, et al. PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism[J]. J Endocrinol Invest, 2019, 42(4): 419−426. DOI: 10.1007/s40618-018-0931-z. [5] Giovanella L, Bacigalupo L, Treglia G, et al. Will 18F-fluorocholine PET/CT replace other methods of preoperative parathyroid imaging?[J]. Endocrine, 2021, 71(2): 285−297. DOI: 10.1007/s12020-020-02487-y. [6] Reeder SB, Desser TS, Weigel RJ, et al. Sonography in primary hyperparathyroidism: review with emphasis on scanning technique[J]. J Ultrasound Med, 2002, 21(5): 553−554. DOI: 10.7863/jum.2002.21.5.539. [7] Batur A, Atmaca M, Yavuz A, et al. Ultrasound elastography for distinction between parathyroid adenomas and thyroid nodules[J]. J Ultrasound Med, 2016, 35(6): 1277−1282. DOI: 10.7863/ultra.15.07043. [8] Bleier BS, Livolsi VA, Chalian AA, et al. Technetium Tc 99m sestamibi sensitivity in oxyphil cell-dominant parathyroid adenomas[J]. Arch Otolaryngol Head Neck Surg, 2006, 132(7): 779−782. DOI: 10.1001/archotol.132.7.779. [9] Kuzminski SJ, Sosa JA, Hoang JK. Update in parathyroid imaging[J]. Magn Reson Imaging Clin N Am, 2018, 26(1): 151−166. DOI: 10.1016/j.mric.2017.08.009. [10] Carpentier A, Jeannotte S, Verreault J, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content[J]. J Nucl Med, 1998, 39(8): 1441−1444. [11] Hoang JK, Williams K, Gaillard F, et al. Parathyroid 4D-CT: multi-institutional international survey of use and trends[J]. Otolaryngol Head Neck Surg, 2016, 155(6): 956−960. DOI: 10.1177/0194599816655311. [12] Liddy S, Worsley D, Torreggiani W, et al. Preoperative imaging in primary hyperparathyroidism: literature review and recommendations[J]. Can Assoc Radiol J, 2017, 68(1): 47−55. DOI: 10.1016/j.carj.2016.07.004. [13] Treglia G, Trimboli P, Huellner MW, et al. Imaging in primary hyperparathyroidism: focus on the evidence-based diagnostic performance of different methods[J]. Minerva Endocrinol, 2018, 43(2): 133−143. DOI: 10.23736/S0391-1977.17.02685-2. [14] Piccardo A, Bottoni G, Boccalatte LA, et al. Head-to-head comparison among 18F-choline PET/CT, 4D contrast-enhanced CT, and 18F-choline PET/4D contrast-enhanced CT in the detection of hyperfunctioning parathyroid glands: a systematic review and meta-analysis[J]. Endocrine, 2021, 74(2): 404−412. DOI: 10.1007/s12020-021-02798-8. [15] Boccalatte LA, Higuera F, Gómez NL, et al. Usefulness of 18F-fluorocholine positron emission tomography-computed tomography in locating lesions in hyperparathyroidism: a systematic review[J]. JAMA Otolaryngol Head Neck Surg, 2019, 145(8): 743−750. DOI: 10.1001/jamaoto.2019.0574. [16] Sacconi B, Argirò R, Diacinti D, et al. MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization[J]. Eur Radiol, 2016, 26(3): 664−673. DOI: 10.1007/s00330-015-3854-5. [17] Mahajan A, Starker LF, Ghita M, et al. Parathyroid four-dimensional computed tomography: evaluation of radiation dose exposure during preoperative localization of parathyroid tumors in primary hyperparathyroidism[J]. World J Surg, 2012, 36(6): 1335−1339. DOI: 10.1007/s00268-011-1365-3. [18] Strauss SB, Roytman M, Phillips CD. Parathyroid imaging: four-dimensional computed tomography, sestamibi, and ultrasonography[J]. Neuroimaging Clin N Am, 2021, 31(3): 379−395. DOI: 10.1016/j.nic.2021.04.007. [19] Hofer T, Kronbichler J, Huber H, et al. 18F-Choline PET/CT, MRI, and software-based image fusion analysis in patients with primary hyperparathyroidism[J]. Clin Nucl Med, 2021, 46(9): 710−716. DOI: 10.1097/RLU.0000000000003738. [20] Huber GF, Hüllner M, Schmid C, et al. Benefit of 18F-fluorocholine PET imaging in parathyroid surgery[J]. Eur Radiol, 2018, 28(6): 2700−2707. DOI: 10.1007/s00330-017-5190-4. [21] Alharbi AA, Alshehri FM, Albatly AA, et al. [18F]Fluorocholine uptake of parathyroid adenoma is correlated with parathyroid hormone level[J]. Mol Imaging Biol, 2018, 20(5): 857−867. DOI: 10.1007/s11307-018-1179-x. [22] Grimaldi S, Young J, Kamenicky P, et al. Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-fluorocholine PET/CT[J]. Eur J Nucl Med Mol Imaging, 2018, 45(10): 1772−1780. DOI: 10.1007/s00259-018-4018-z. [23] Evangelista L, Ravelli I, Magnani F, et al. 18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature[J]. Ann Nucl Med, 2020, 34(9): 601−619. DOI: 10.1007/s12149-020-01507-1. [24] Treglia G, Piccardo A, Imperiale A, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis[J]. Eur J Nucl Med Mol Imaging, 2019, 46(3): 751−765. DOI: 10.1007/s00259-018-4123-z. [25] Bioletto F, Barale M, Parasiliti-Caprino M, et al. Comparison of the diagnostic accuracy of 18F-fluorocholine PET and 11C-methionine PET for parathyroid localization in primary hyperparathyroidism: a systematic review and meta-analysis[J]. Eur J Endocrinol, 2021, 185(1): 109−120. DOI: 10.1530/EJE-21-0038. [26] Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging[J]. Eur J Nucl Med Mol Imaging, 2021, 48(9): 2801−2822. DOI: 10.1007/s00259-021-05334-y. [27] Hindié E, Zanotti-Fregonara P, Tabarin A, et al. The role of radionuclide imaging in the surgical management of primary hyperparathyroidism[J]. J Nucl Med, 2015, 56(5): 737−744. DOI: 10.2967/jnumed.115.156018. [28] Piccardo A, Trimboli P, Rutigliani M, et al. Additional value of integrated 18F-choline PET/4D contrast-enhanced CT in the localization of hyperfunctioning parathyroid glands and correlation with molecular profile[J]. Eur J Nucl Med Mol Imaging, 2019, 46(3): 766−775. DOI: 10.1007/s00259-018-4147-4. [29] Araz M, Soydal Ç, Özkan E, et al. The efficacy of fluorine-18-choline PET/CT in comparison with 99mTc-MIBI SPECT/CT in the localization of a hyperfunctioning parathyroid gland in primary hyperparathyroidism[J]. Nucl Med Commun, 2018, 39(11): 989−994. DOI: 10.1097/MNM.0000000000000899. [30] Kluijfhout WP, Vorselaars WMCM, van den Berk SAM, et al. Fluorine-18 fluorocholine PET-CT localizes hyperparathyroidism in patients with inconclusive conventional imaging: a multicenter study from the Netherlands[J]. Nucl Med Commun, 2016, 37(12): 1246−1252. DOI: 10.1097/MNM.0000000000000595. [31] Gatu A, Velicescu C, Grigorovici A, et al. The volume of solitary parathyroid adenoma is related to preoperative Pth and 25OH-D3, but not to calcium levels[J]. Acta Endocrinol (Buchar), 2017, 13(4): 441−446. DOI: 10.4183/aeb.2017.441. [32] Liberini V, Morand GB, Rupp NJ, et al. Histopathological features of parathyroid adenoma and 18F-choline uptake in PET/MR of primary hyperparathyroidism[J]. Clin Nucl Med, 2022, 47(2): 101−107. DOI: 10.1097/RLU.0000000000003987. [33] Ferrari C, Santo G, Mammucci P, et al. Diagnostic value of choline PET in the preoperative localization of hyperfunctioning parathyroid gland(s): a comprehensive overview[J]. Biomedicines, 2021, 9(3): 231. DOI: 10.3390/biomedicines9030231. [34] Zajíčková K, Zogala D, Kubinyi J. Parathyroid imaging by 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and inconclusive conventional methods: clinico-pathological correlations[J]. Physiol Res, 2018, 67(S3): S551−557. DOI: 10.33549/physiolres.934029. [35] Tomita T. Immunocytochemical staining patterns for parathyroid hormone and chromogranin in parathyroid hyperplasia, adenoma, and carcinoma[J]. Endocr Pathol, 1999, 10(2): 145−156. DOI: 10.1007/BF02739826. [36] Kluijfhout WP, Pasternak JD, Gosnell JE, et al. 18F fluorocholine PET/MR imaging in patients with primary hyperparathyroidism and inconclusive conventional imaging: a prospective pilot study[J]. Radiology, 2017, 284(2): 460−467. DOI: 10.1148/radiol.2016160768.
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