Amélioration de la détection des lésions par la tomographie sténopéïque au MIBI-Tc 99m dans l'hyperparathyroïdie primaire.
Tc 99m -MIBI pinhole SPECT in primary hyperparathyroidism: improvement of parathyroid lesion detection.Oudoux A 1 , Carlier T 1 , Mirallié E 2 , Bodet-Milin C 1 , Seret A 3 , Defrise M 4 , Aubron F 5 , Daumy I 5 , Leux C 6 , Kraeber-Bodéré F 1 et Ansquer C 1 . Methods: Fifty one patients cured after surgery were studied. pSPECT was reconstructed with a dedicated OSEM algorithm. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extra-thyroidal location of suspected lesions and was defined as follows: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive.Results: Surgery revealed 55 lesions. Sensitivity of ultrasonography, planar imaging, cSPECT and pSPECT were respectively 51%, 76%, 82% and 87%. Five glands were only detected by pSPECT. Combination of ultrasonography, planar and pSPECT showed the highest sensitivity (94.5%). The mean CS of the 55 pathologic glands was significantly higher with pSPECT compared with planar imaging and cSPECT (p<0.0001). Compared with planar imaging and cSPECT, pSPECT increased CS for 42% and 53% of parathyroid lesions respectively, and contributed to markedly reduce the number of uncertain results.Nevertheless, planar imaging and ultrasonography were useful to analyze thyroid morphology and to detect some ectopic glands.
Conclusion:The use of pSPECT increases sensitivity and CS of scintigraphy. Combination of ultrasonography, planar and pSPECT appears to be complementary and the optimal preoperative imaging procedure in primary hyperparathyroidism.