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Register a new userThe Role of 99mtc-Tetrofosmin (Myoview) Scintigraphy in The Detection and Localization of Hyperfunctioning Parathyroid Glands Compared With Ultrasound and Magnetic Resonance, and Its Relation To Parathyroid Hormone Levels
دور التصوير الومضاني99mTc-Tetrofosmin(Myoview) في كشف وتوضع الغدد المفرطة النشاط لمجاورات الدرق مقارنة مع الأمواج الصوتية والرنين المغنطيسي وعلاقته بمستوى هرمون جارات الدرق
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حمزة شبيب( باحث )
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إن تحديد التوضع الدقيق للغدد المجاورة الدرقية المفرطة النشاط مفيد جداً في تقليل الزمن والشق الجراحي ويقلل من الإمراضية. تم في هذا البحث استقصاء 52 مريضاً بفرط نشاط مجاورات الدرق 14 منهم بورم بدئي و38 بفرط النشاط الثانوي التالي للقصور الكلوي. أجري العمل الجراحي في 36 مريضاً منهم (14 بدئي، 22 ثانوي) وتم تقييم حساسية الفحص الومضاني بالـ 99mTc-Tetrofosmin (التيتروفوسمين المشع) بعد العمل الجراحي مقارنة مع الأمواج فوق الصوتية والرنين المغنطيسي. وجد أن حساسية الفحص الومضاني 79,5%متفوقاً على كل من الأمواج فوق الصوتية 68,2% والرنين المغنطيسي 71,6% بالنسبة لعدد الغدد المرضية المكتشفة. أجري معايرة هرمون مجاورات الدرق (ه.م.د) ومستوى الكالسيوم في المصل وتمت مقارنتهما مع إيجابية الفحص الومضاني. تبين أن نسبة اكتشاف الورم الغدي المجاور للدرق بالفحص الومضاني تتناسب مع عيار مستوى الهرمون المجاور للدرق P < 0.001 وأن الفحص الومضاني إيجابي دائماً عندما كان عيار الهرمون 195 وما فوق في فرط النشاط البدئي وعند 1200 وما فوق في فرط النشاط الثانوي. لم يلاحظ فرق إحصائي ذو مغزى في مستويات الكالسيوم في المصل P = 0.1 بين المرضى الذين اكتشف فيهم الورم الغدي بالفحص الومضاني وبين المرضى السلبيي الفحص.
Perfect localization of hyperactive parathyroid glands is useful to minimize operation time, incision and reduce patient morbidity. 52 patients with hyperparathyroidism were investigated, 14 with primary and 38 with secondary hyperparathyroidism following renal failure. Surgery has been done on 36 patients (14 with primary and 22 with secondary hyperparathyroidism). Sensitivity of 99mTc-tetrofosmin scintigraphy was estimated after surgical removal of Hyperfunctioning glands and compared with that of ultrasound and magnetic resonance imaging. The sensitivity of 99mTc-scintigraphy (79,5%) exceeded the sensitivity of ultrasound (68,2%) and magnetic resonance imaging (71,6%). Parathyroid hormone (P.T.H.) and calcium levels in serum were compared with positive 99mTc-tetrofosmin Scintigraphy. Results demonstrated correlation between positive 99mTc-tetrofosmin scintigraphy and parathyroid hormone levels with significant statistical difference of P < 0.001 and all patients with primary hyperparathyroidism with P.T.H. levels of 195 pg/ml or more were scintigraphically positives. All patients with secondary hyperparathyroidism with P.T.H. levels of 1200 or more were positives. No correlation was detected between calcium levels and positivity or negativity of scintigraphic results.
References used
DOMINICO, R, ANDREA, P, COSTANTINO, P. Ectopic Parathyroid Adenoma Located at the Carotid Bifurcation. The Role of Preoperative 99mTc-MIBI scintigraphy and the Intraoperative Gamma Probe Procedure in Surgical Treatment Planning. Clin Nucl Med. Vol. 26, No. 9,2001- pp. 774-776
ROTHMUND, M, DIETHELM, I, BRUNNER, C, et al. Diagnosis and Surgical Treatment of Mediastinal Parathyroid tumors. Ann Surg. Vol. 183, No. 2, 1976- pp 139-145
KRUBSACK, J, WILSON, D, LAWSON, L, et al. Prospective Comparisonof Radionuclide, Computed Tomographic, Sonographic, and Magnetic Resonance Localization of Parathyroid Tumors. Surgery. Vol. 106, No. 4,1989- pp. 639-646
GEATTI, O, SHAPIRO, B, ORSULOM, P. Localization of Parathyroid Enlargement: Experience with Technetium 99m Methoxyisobutylisonitril and Thallium-201 Scintigraphy, Ultrasound and Computed Tomography. Eur J Nucl Med.Vol. 21, No.1,1994- pp 17-22
SHIGEO, T, HIDEO, H, TETSUO, C, et al. Hyperfunctional Parathyroid Glands with 99mTc-MIBI Scan: Semi quantitative Analysis Correlated with Histologic Findings. J Nucl Med. Vol. 40, No. 11,1999- pp. 1792-1797
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