Читать книгу Parathyroid Disorders - Группа авторов - Страница 32

Some patients with asymptomatic PHPT have positive imaging with a parathyroid sestamibi scan, but because they do not meet other criteria for surgery, surgery is delayed. However, some asymptomatic patients will eventually become symptomatic or meet the criteria for surgery. Most centers prefer to use ^99mTc-sestamibi scanning first to localize parathyroid adenomas, but there is variability, and some prefer to use ultrasound, 4D-CT scans, or MRI as the imaging method of choice.

In a small series, Cheng et al. [26] assessed whether a positive ^99mTc-sestamibi scan could predict future surgical eligibility in patients with asymptomatic PHPT. In a retrospective study of 94 asymptomatic patients who had PHPT and underwent a ^99mTc-sestamibi scan with SPECT/CT imaging, 35 patients had scan results and follow-up for at least 1 year. Of these 35 patients, 12 had positive scans and 23 had negative scans at baseline, and did not meet criteria for surgery at the time of imaging. At a median follow-up of 2.4 years (range 1–4 years), 6 of 12 patients with a positive scan at baseline became eligible for surgery later, whereas 20 of 23 patients with negative scans remained asymptomatic and did not meet the criteria for surgery. The authors concluded that a positive parathyroid ^99mTc-sestamibi scan with SPECT/CT imaging predicted a higher possibility of meeting the surgical criteria later in patients with asymptomatic PHPT who do not meet criteria for surgery when they initially present.