原发性甲状旁腺功能亢进的核素定位诊断

应了~（99m）Tc-MIBI进行了甲状旁腺显像,并对方法学进行了探讨。10例患者经临床、生化确诊为原发甲旁亢,但均未触及增大的甲状旁腺或甲状腺。其中7例在应用~（99m）Tc-MIBI和~（99m）Tc两种示踪剂分别进行甲状旁腺显像和甲状腺显像,3例仅用~（99m）Tc-MIBI,但在显像过程中给予了过氯酸盐。在静泳注射~（99m）Tc-MIBI后不同时间采集图象并选用产P/T值（甲状旁腺计数/甲状腺计数）做参数,以了解示踪剂的代谢及确定最佳显像时间。10例患者经手术共摘除12枚肿大的甲状旁腺,病理证实10枚为甲状旁腺腺瘤,2枝为甲状旁腺增生,B超检查9例中发现2枚腺瘤,CT检查8例共发现3枚腺瘤,核素显像10例患者各发现腺瘤一个,其阳性部位与手术所见完全吻合。尽管例数较少,但初步看,此方法简便、准确,对于原发甲旁亢的定位诊断确有临床价值。     

甲状旁腺肿瘤的诊断及治疗

目的探讨甲状旁腺肿瘤的诊断及治疗方法。方法对10例临床疑似甲状旁腺肿瘤患者的临床、病理资料作回顾性分析。结果本组10例就诊原因分别为颈部肿块3例,反复血尿、尿路结石形成4例,病理性骨折伴多发尿路结石1例,无任何不适2例。10例B超检查发现单侧甲状旁腺区肿瘤,6例行CT检查提示单侧甲状旁腺区肿瘤。10例均行手术探查,术中冰冻病理切片检查证实甲状旁腺腺瘤5例、甲状旁腺囊肿4例、甲状腺结节1例;9例行单侧甲状旁腺腺瘤或囊肿切除,1例行患侧甲状腺腺叶＋甲状旁腺区甲状腺结节切除。术后随访1～3 a,无甲状旁腺肿瘤复发。结论甲状旁腺区肿瘤的定性诊断较困难,遇到甲状旁腺功能亢进表现者要考虑甲状旁腺肿瘤可能,对于无功能性甲状旁腺区占位者,亦要考虑非甲状旁腺来源可能。B超检查为首选检查项目。本病以手术治疗为主,建议术中只行单侧甲状旁腺探查。     

CT诊断甲状旁腺腺瘤的价值

原发甲状旁腺机能亢进(简称甲旁亢)85%由单发甲状旁腺腺瘤所致,后者的确诊有利于甲旁亢的诊治.笔者结合18例甲状旁腺腺瘤的临床表现,对CT扫描技术对该肿瘤的定位、定性诊断价值进行分析,现报告如下. 　　……     

甲状旁腺腺瘤9例临床特点及延误诊断分析

目的探讨甲状旁腺腺瘤患者的临床特点和延误诊断的原因。方法回顾性分析2000年1月至2005年6月华中科技大学同济医学院协和医院收治的经手术确诊的9例甲状旁腺腺瘤患者的资料。结果9例中男性4例,女性5例。误诊时间8个月至11年。9例患者均有骨骼系统临床表现,同时兼有泌尿系统、消化系统表现者各有7例和6例。所有患者均有低血磷和血碱性磷酸酶升高,8例有高血钙和高尿钙。7例患者血清甲状旁腺素(PTH)明显升高。99m锝-甲氧基异丁基异腈(99mTc-MIBI)甲状旁腺显像是最佳定位检查。结论完整的病史,细致的体检和实验室检查对于甲状旁腺腺瘤的诊断十分重要。     

甲状旁腺腺瘤9例临床特点及延误诊断分析

目的 探讨甲状旁腺腺瘤患者的临床特点和延误诊断的原因。方法 回顾性分析2000年1月至2005年6月华中科技大学同济医学院协和医院收治的经手术确诊的9例甲状旁腺腺瘤患者的资料。结果 9例中男性4例，女性5例。误诊时间8个月至11年。9例患者均有骨骼系统临床表现，同时兼有泌尿系统、消化系统表现者各有7例和6例。所有患者均有低血磷和血碱性磷酸酶升高，8例有高血钙和高尿钙。7例患者血清甲状旁腺素（PTH）明显升高。^99m锝-甲氧基异丁基异腈（^99mTc-MIBI）甲状旁腺显像是最佳定位检查。结论 完整的病史，细致的体检和实验室检查对于甲状旁腺腺瘤的诊断十分重要。     

甲状旁腺腺瘤出血囊性变致高钙危象1例报道

本文报道1例罕见的甲状旁腺腺瘤出血囊性变引发的高钙危象患者, 并复习相关文献。患者术前影像学检查难以明确颈部囊性病灶的组织学来源, 经积极药物治疗和血液透析不能缓解高钙危象, 予手术探查并切除颈部病灶, 病理诊断证实为甲状旁腺腺瘤出血囊性变, 术后血钙和肾功能恢复正常。     

原发性甲状旁腺机能亢进症与心绞痛

本文报道了一例女性患者,50岁,心绞痛,运动试验阳性,冠状动脉造影正常。用心痛定治疗使心绞痛解除,实验室检查证实为高钙血症,诊断为甲状旁腺腺瘤,手术切除腺瘤,血钙恢复正常,随访四年无心绞痛发生,期间两次运动试验均为阴性。 一般认为原发性甲状旁腺机能亢进症(甲旁     

螺旋CT及超声对肝腺瘤的诊断价值

目的分析肝腺瘤螺旋CT及超声表现,评估其诊断价值。方法回顾性分析2009年7月-2015年12月在廊坊市中医医院经病理证实的15例肝腺瘤患者的螺旋CT及超声表现。结果 15例患者超声呈低回声、等回声或高回声。其中7例为单发肝腺瘤,低密度4例、略低密度1例、等密度2例;动脉期呈明显强化5例、中度强化1例、轻度强化1例;门静脉期及延时期呈强化降低3例、等密度2例、渐进性强化2例。8例为多发肝腺瘤,80个病灶,4个病灶(3例)呈混杂密度、40个病灶(4例)呈低密度、36个病灶(4例)呈略低密度;8个病灶(4例)动脉期明显强化,门静脉期及延时期强化降低;3个病灶(1例)动脉期明显强化,门静脉期及延时期呈等密度;18个病灶(2例)动脉期及门静脉期明显强化,延时期强化降低;49个病灶(5例)动脉期中度强化,门静脉期及延时期强化降低;2个病灶(1例)各期未见明显强化。螺旋CT对单发肝腺瘤和多发肝腺瘤的诊断正确率分别为14.3%(1/7)、87.5%(7/8)。结论超声仅能提示占位,但不能定性;螺旋CT三期增强扫描对肝腺瘤的诊断,尤其是对多发肝腺瘤的诊断有较高价值。     

高频多普勒彩色超声对40例甲状旁腺腺瘤的诊断价值

甲状旁腺腺瘤属内分泌肿瘤,多数引起原发甲状旁腺功能亢进。甲状旁腺腺瘤术前病灶的检出和准确定位是治疗的关键,高频多普勒超声在甲状旁腺疾病的诊断和治疗方面的应用也越来越多。笔者总结经手术、病理证实的40例甲状旁腺腺瘤,探讨高频超声成像对其的诊断价值,现报道如下。     

原发性甲状旁腺机能亢进

作者报导自1965～1972年经手术病理证实的65例原发性甲状旁腺机能亢进。活检结果为:腺瘤15例,增生14例,腺瘤和增生混合的34例,癌2例。临床所见:女性39例,男性26例。平均年龄为52.5岁。最常见的临床表现为肾结石,占51％。少数病人其主要表现为高血压,消化性溃疡,精神病,骨骼疼痛和胰腺炎。25例曾用过克尿塞药物治疗,有人报告可能克尿塞刺激甲状旁腺引起甲状旁腺机能亢进。4例有假性痛风史,关节内曾抽出焦磷酸盐的结晶。25例无甲状旁腺机能亢进的临床表现,只是在内科常规生化检查时才被诊断。生化检查:65例都作血钙、血磷的测定。血钙的     

Ultrasonographic features of intrathyroidal parathyroid adenoma causing primary hyperparathyroidism

Preoperative localization study is difficult in patients with primary hyperparathyroidism (PHPT) caused by intrathyroidal parathyroid adenoma. The objective of this study was to evaluate the usefulness of ultrasonography (US) in the diagnosis of intrathyroidal parathyroid adenoma. Between January 2004 and December 2009, seven of 373 patients who underwent parathyroidectomy because of PHPT in our hospital were found to have intrathyroidal parathyroid adenoma. The ultrasonographic features of intrathyroidal parathyroid adenoma were examined retrospectively. The most characteristic feature of intrathyroidal parathyroid adenoma was a hyperechoic line on the ventral surface of the parathyroid gland. A hyperechoic line was clearly detected even in small adenomas in which feeding vessels could not be detected on color Doppler sonography. In comparison with feeding vessels, a hyperechoic line was frequently detected in normally located parathyroid adenoma. (99m)Tc-sestamibi (MIBI) scintigraphy and computed tomography (CT) could show parathyroid adenoma in the intrathyroidal position in only three of five and in only one of three patients examined, respectively. Since a hyperechoic line is characteristic of parathyroid adenoma, an intrathyroidal parathyroid adenoma could be suspected by only non-invasive US.     

65-jährige Patientin mit persistierender Hyperkalzämie

A 65-year old patient presented with newly diagnosed hypercalcemia and elevated parathyroid hormone levels. Exploration of parathyroid glands was performed under the diagnosis of primary hyperparathyroidism and was combined with thyreoidectomy due to concomittant multinodular goiter. However, no parathyroid adenoma was identified despite careful exploration. Therefore, the operation was terminated and an ectopic adenoma was suspected. A (99m)Tc-sestamibi scintigraphy with SPECT, neck ultrasound, neck CT scan with contrast media and selective venous sampling were performed for further localization of the adenoma. A single adenoma localized in the submandibular area of the left jaw was suspected and confirmed during surgical reexploration. Postoperatively, parathyroid hormone levels were below detection level and the patient required short-term calcium supplementation for symptomatic hypocalcemia.     

Technetium-99m tetrofosmin parathyroid imaging in patients with primary hyperparathyroidism

OBJECTIVE: To confirm the clinical significance of 99mTc-tetrofosmin imaging for the localization of hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism. METHODS: All patients were imaged with 99mTc-tetrofosmin at 10 minutes and 2 hours after radiotracer injection, and with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The parathyroid/thyroid uptake ratio of 99mTc-tetrofosmin (P/T uptake ratio) was calculated. PATIENTS: Twenty patients with primary hyperparathyroidism were referred to our clinic, underwent surgical neck exploration or mediastinotomy and were diagnosed as having parathyroid adenoma. These patients were investigated for the preoperative localization by 99mTc-tetrofosmin scintigraphy. RESULTS: 99mTc-tetrofosmin imaging demonstrated focal uptake in 19 out of 20 patients with parathyroid adenoma. Two of the lesions were ectopic. US identified 17 parathyroid glands. CT and MRI initially detected 17 parathyroid glands. However, two additional parathyroid glands were localized on repeated CT and MRI in tandem with the results of the 99mTc-tetrofosmin imaging. Thus, the sensitivity and specificity of tetrofosmin imaging were 95% (19/20) and 95% (19/20); US, 85% (17/20) and 94% (16/17); initial CT, 85% (17/20) and 94% (16/17); and initial MRI, 88% (17/20) and 94% (16/17), respectively. The P/T uptake ratio at 2 hours after tetrofosmin injection was correlated with the serum concentration of intact PTH (rs=0.47, p<0.05) and the resected tumor weight (rs=0.53, p<0.05). CONCLUSION: 99mTc-tetrofosmin scintigraphy is useful for localization of parathyroid adenoma. Tetrofosmin uptake depends on the tumor weight and serum intact PTH levels.     

A case of papillary carcinoma of the thyroid associated with parathyroid adenoma without hyperparathyroidism.

A rare occurrence of the association of parathyroid adenoma in a case of thyroid papillary carcinoma is described. The patient was incidentally found to have parathyroid adenoma which was preoperatively diagnosed to be a metastatic lymph node. Analysis of her serum obtained before operation showed an elevation of serum parathyroid hormone (PTH) concentration without hypercalcemia. Since the association of hyperparathyroidism is high in patients with thyroid diseases, examination of not only serum levels of calcium and PTH but also careful interpretation of computed tomography (CT) and/or nuclear magnetic imaging (MRI) is necessary in the diagnosis of co-existing asymptomatic hyperparathyroidism.     

磁共振成像在甲状旁腺腺瘤诊断中的应用

目的探讨甲状旁腺腺瘤的MRI表现特点。方法40例经手术病理证实的病例进行MRI平扫及增强扫描。结果肿瘤常见于颈下部气管食管隐窝区,颈动脉鞘内侧,也可位于上纵隔; 呈卵圆型,有完整的包膜。可出现坏死、液化及囊性变; MRI表现T1WI呈等、等高及等低信号,T2WI上呈高信号,坏死、囊变区信号明显增高,增强扫描后肿瘤明显强化。结论MRI具有较高的软组织分辨能力及三维、多参数成像功能,对甲状旁腺腺瘤的诊断更具优越性、敏感性和准确性。     

Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging

OBJECTIVE: To present first-line thoracic surgery made possible by localization studies in three patients with ectopic parathyroid adenomas. DESIGN AND METHODS: Three patients with ectopic parathyroid tissue in the mediastinum were examined by ultrasound, technetium-99m sestamibi scintigraphy, computed tomography (CT), and venous catheterization with measurement of parathyroid hormone. Without previous cervical exploration, video-assisted thoracic surgery (VATS) was used in all cases to avoid the need for thoracic open surgical procedures. RESULTS AND CONCLUSIONS: The mediastinal parathyroid glands were all detected at scintigraphy, and CT and venous catheterization were helpful in anatomic and functioning characterization. All pathologic glands were successfully resected, with only one minor complication. VATS can safely remove a deep mediastinal parathyroid adenoma and avoid more aggressive open approaches. In an experienced referral center, systematic and sophisticated imaging studies may accurately identify and localize rare ectopic parathyroid adenomas, and avoid cervical surgery.     

A Pilot Comparison of 18F-fluorocholine PET/CT,Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies

We compared ¹⁸F-fluorocholine hybrid positron emission tomography/X-ray computed tomography (FCH-PET/CT) with ultrasonography (US) and scintigraphy in patients with hyperparathyroidism and discordant, or equivocal results of US and ¹²³I/^99mTc-sesta-methoxyisobutylisonitrile (sestaMIBI) dual-phase parathyroid scintigraphy. FCH-PET/CT was performed in 17 patients with primary (n = 11) lithium induced (n = 1) or secondary hyperparathyroidism (1 dialyzed, 4 renal-transplanted).The reference standard was based on results of surgical exploration and histopathological examination. The results of imaging modalities were evaluated, on site and by masked reading, on per-patient and per-lesion bases.In a first approach, equivocal images/foci were considered as negative. On a per-patient level, the sensitivity was for US 38%, for scintigraphy 69% by open and 94% by masked reading, and for FCH-PET/CT 88% by open and 94% by masked reading. On a per-lesion level, sensitivity was for US 42%, for scintigraphy 58% by open and 83% by masked reading, and for FCH-PET/CT 88% by open and 96% by masked reading. One ectopic adenoma was missed by the 3 imaging modalities. Considering equivocal images/foci as positive increased the accuracy of the open reading of scintigraphy or of FCH-PET/CT, but not of US. FCH-PET/CT was significantly superior to US in all approaches, whereas it was more sensitive than scintigraphy only for open reading considering equivocal images/foci as negative (P = 0.04). FCH uptake was more intense in adenomas than in hyperplastic parathyroid glands. Thyroid lesions were suspected in 9 patients. They may induce false-positive results as in one case of oncocytic thyroid adenoma, or false-negative results as in one case of intrathyroidal parathyroid adenoma. Thyroid cancer (4 cases) can be visualized with FCH as with ^99mTc-sestaMIBI, but the intensity of uptake was moderate, similar to that of parathyroid hyperplasia.This pilot study confirmed that FCH-PET/CT is an adequate imaging tool in patients with primary or secondary hyperparathyroidism, since both adenomas and hyperplastic parathyroid glands can be detected. The sensitivity of FCH-PET/CT was better than that of US and was not inferior to that of dual-phase dual-isotope ¹²³I/^99mTc-scintigraphy. Further studies should evaluate whether FCH could replace ^99mTc-sestaMIBI as the functional agent for parathyroid imaging, but US would still be useful to identify thyroid lesions.     

Effect of somatostatin on parathyroid hormone and calcitonin secretion.

This study evaluated the effect of somatostatin on immunoreactive parathyroid hormone (iPTH) and calcitonin (iCT) secretion in vivo in rats and monkeys and on iPTH secretion in vitro by normal bovine parathyroid tissue and by a human parathyroid adenoma. Somatostatin infusion promptly (within 0.5 h) suppressed both iPTH and iCT in both species studied in vivo, the suppression being progressive during the infusion period. In in vitro studies, somatostatin caused significant dose-related decreases in basal, low Ca-stimulated, and high Ca-suppressed PTH secretion from normal bovine parathyroid tissue and from basal and low Ca-stimulated PTH secretion from a human parathyroid adenoma. Therefore, somatostatin 1) suppresses both PTH and CT secretion in vivo; 2) acts directly on the parathyroid cell and presumably directly on the C-cell also; 3) acts upon normal and adenomatous parathyroid tissue; 4) suppresses basal, low Ca-stimulated and high Ca-suppressed PTH secretion; and 5) has a dose-related effect. The possible role of somatostatin in the physiological control of PTH and CT secretion (and therefore in Ca homeostasis), and in the pathogenesis of abnormalities of Ca homeostasis, requires further evaluation.     

Spontaneous hematoma of a parathyroid adenoma

A patient with long-standing, asymptomatic, primary hyperparathyroidism developed pain in the anterior neck area, with cough, dysphagia and increasing shortness of breath. This led to respiratory insufficiency, which required endotracheal intubation and respirator assistance. During the ensuing hours the patient developed an area of ecchymosis on the anterior chest. Chest x-ray showed widening of the superior mediastinum, and CT scan showed a large mass with a fluid level. Surgery revealed a large hematoma originating from a mediastinal parathyroid adenoma with a hemorrhagic infarct. Serum calcium, previously elevated, decreased to normal with the onset of neck pain, and the patient remains normocalcemic. Previous reported cases of this rare complication of parathyroid adenomas are reviewed. Hemorrhagic infarct of a parathyroid adenoma may present with a rapidly enlarging mediastinal mass, and/or hypercalcemic crisis. Surgical removal of the infarcted adenoma can return the serum calcium to normal.