Accuracy of single versus combined use of ultrasonography or computed tomography in the localization of parathyroid adenoma

OBJECTIVE: To assess the accuracy of a single versus combined use of ultrasound (US), or computed tomography (CT) in the localization of diseased parathyroid glands. METHODS: Forty-one patients with hyper-parathyroidism treated surgically between January 2000 to December 2005 at Jordan University Hospital, Amman, Jordan were included in this study. Preoperative ultrasonographic and CT findings were reviewed and compared to the intraoperative and pathologic diagnosis of diseased parathyroid glands. RESULTS: The mean age of patients was 46 years (range 16-70; 15 males and 26 females). Parathyroid adenoma was confirmed in 33 patients and hyperplasia of the parathyroid glands in 8 patients. Preoperative evaluation was carried out in 32 patients (CT scan), and in 23 patients (US). In 18 cases, the diagnosis of parathyroid disease was based on CT findings alone and in 9 patients the diagnosis was based on single US findings. Combined CT and US evaluation was carried out in 14 cases and accurate localization was reached in 12 cases yielding 86% sensitivity and 100% positive predictive value. The independent use of these techniques alone resulted in low (39%) sensitivity for US and high (78%) sensitivity values for the CT. CONCLUSION: Neck CT scan evaluation has almost an equivalent sensitivity to combined CT and neck US in the preoperative localization of diseased parathyroid glands, however the combined use of these techniques provides the best diagnostic accuracy.     

99Tcm-MIBI显像诊断异位甲状旁腺腺瘤合并结节性甲状腺肿1例

患者,女,19岁,因反复发作性游走性大关节疼痛2年,加重伴乏力1月于2001年6月13日收入我院内分泌科.查体:皮肤紧张,甲状腺右叶外侧可扪及2 cm×1.5 cm结节,随吞咽上下移动,质中,无压痛,双膝关节内侧轻压痛,下肢肌力Ⅳ级,余无异常.     

Single-photon emission computed tomography (SPECT). Applications and potential

Single-photon emission computed tomography has received increasing attention as radiopharmaceuticals that reflect perfusion, metabolism, and receptor and cellular function have become widely available. Perfusion single-photon emission computed tomography of the brain provides functional information useful for the diagnosis and management of stroke, dementia, and epilepsy. Single-photon emission computed tomography has been applied to myocardial, skeletal, hepatic, and tumor scintigraphy, resulting in increased diagnostic accuracy over planar imaging because background activity and overlapping tissues interfere far less with activity from the target structure when tomographic techniques are used. Single-photon emission computed tomography is substantially less expensive and far more accessible than positron emission tomography and will become an increasingly attractive alternative for transferring the positron emission tomography technology to routine clinical use. In addition, single-photon emission computed tomography has unique applications that are increasingly finding their way into the routine practice of clinical nuclear medicine.     

甲状旁腺腺瘤引发纤维囊性骨炎X线CT诊断价值

原发性甲状旁腺机能亢进（简称甲旁亢）绝大多数是由孤立性甲状旁腺腺瘤所致,少数由多发甲状旁腺腺瘤、弥漫性甲状旁腺增生或甲状旁腺癌引起。普遍性骨质吸收、骨膜下骨皮质吸收、多发性纤维囊性骨炎及肾结石或肾实质钙质沉着是甲状旁腺机能亢进的重要影像学表现。笔者报告3例经手术病理证实的甲状旁腺腺瘤引发的多发纤维囊性骨炎的X线、CT特征。     

Oliguric glomerulonephritis and parathyroid adenoma

The case is reported of a woman who recovered from acute glomerulonephritis with oliguria of 43 days duration and who subsequently developed hypercalcaemia, treated by parathyroidectomy.     

Validation of single-photon emission computed tomography (SPECT) using thallium-201 in patients with lung cancer

To evaluate the primary site, pulmonary hilar, and mediastinal lesions in patients with lung cancer, thallium-201 using single-photon emission computed tomography (SPECT) was used as a tumor agent. The study population consisted of 7 patients (5 men and 2 women), aged 57 to 82 years (mean 68). Tl-201 tomography imaged positive at the primary site in all patients with lung cancer. The images demonstrated the tumor and/or mediastinal lymph nodes that were greater than 2.0cm. In particular, each tomograms facilitated the identification of the Tl-201 increased uptake in proportion to primary site. The short waiting period after injection with Tl-201 clearly offers a major advantage over alternative tumor imaging agents, such as Ga-67 or radiolabeled monoclonal antibodies. Furthermore, Tl-201 SPECT may be useful to detect the tumor and/or mediastinal lymph nodes in patients with lung cancer.     

Evaluating EMP with computed tomography

Extramedullary plasmacytomas (EMP) of the nasopharynx are rarely associated with osseous destruction, and when destruction does occur, only minimal erosions have been found. More extensive bony involvement and intracranial extension in neoplasms of the head and neck usually suggest the presence of a more aggressive tumor such as carcinoma. We report computed tomographic (CT) findings in a nasopharyngeal EMP showing extensive intracranial involvement and severe bony destruction.     

CT能谱成像对垂体腺瘤质地判断的应用价值

目的探讨CT能谱成像在垂体腺瘤质地判断方面的应用价值。方法收集2011年12月-2013年11月收治的36例垂体腺瘤患者的临床资料,根据术中所见腺瘤质地分为质地软组、质地中等组和质地韧组;患者术前均行头颅磁共振成像（MRI）增强和计算机化断层显像（CT）能谱成像增强扫描检查,对腺瘤组织和额叶白质的能谱衰减曲线及其斜率进行分析和比较。结果36例垂体腺瘤中,质地软组24例,质地中等组8例,质地韧组4例,腺瘤组织CT能谱衰减曲线斜率分别为0．669±0．066、0．333±0．024和0．145±0．049,腺瘤组织与额叶白质的能谱衰减曲线斜率的比值分别为1．355±0．279、0．674±0．057和0．318±0．005,组间比较差异均有统计学意义（P〈0．001）。结论术前CT能谱成像检查有助于对垂体腺瘤质地进行判断,衰减曲线腺瘤斜率及其与额叶白质斜率的比值与垂体腺瘤的质地有关。     

儿童甲状旁腺瘤的诊治

甲状旁腺腺瘤是原发性甲状旁腺功能亢进的主要原因,在儿童中十分罕见,绝大多数病例无遗传性.由于其发病率较低,临床表现多样性,使其误诊率很高.近2年来,我院收治了2例甲状旁腺腺瘤的患儿,现报告如下.     

Combined parathyroid adenoma and an occult papillary carcinoma

Although the pathological association of thyroid and parathyroid disease is common, the association of both parathyroid adenoma and thyroid cancer is rare. We report here a case of a 45-year-old Saudi woman who was diagnosed to have primary hyperparathyroidism due to a single parathyroid adenoma as confirmed biochemically and radiologically. At operation, the adenoma was found to be an intrathyroid and therefore a thyroid lobectomy was performed. Histology of the excised lobe revealed in addition to the intrathyroid parathyroid adenoma a concurrent occult thyroid papillary carcinoma. This interesting association is discussed based on a literature review.     

儿童甲状旁腺瘤的诊治

甲状旁腺腺瘤是原发性甲状旁腺功能亢进的主要原因，在儿童中十分罕见，绝大多数病例无遗传性。由于其发病率较低，临床表现多样性，使其误诊率很高。近2年来，我院收治了2例甲状旁腺腺瘤的患儿，现报告如下。     

Mediastinal parathyroid adenoma: diagnostic and management challenges

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.     

胃淋巴瘤的CT诊断

目的探讨胃淋巴瘤的CT表现特征,提高CT对其的诊断价值。方法对32例经病理证实的胃淋巴瘤的CT表现,包括胃受累的部位、病灶大体形态、侵犯范围、胃壁厚度、浆膜及胃周脂肪间隙受累情况、增强后病灶与周围肌肉的比较、有无坏死、有无其他器官受累、胃周及其他腹部淋巴结情况进行分析。结果本组32例病例大多数发生在胃窦和胃体,胃壁累及范围均大于胃周径的75%,胃壁厚度不均,胃壁最大厚度〉10 mm的有25例（78%）。27例（85%）有一处或一处以上胃周、腹膜后、肝门区、肠系膜淋巴结肿大。20例（61%）病人有腹膜后肾门水平下淋巴结的肿大。24例（75%）病例合并脾肿大。结论胃淋巴瘤的CT表现有一定特征性,有助于其诊断。     

Noninvasive coronary angiography with multislice computed tomography

Context  Multislice computed tomography (MSCT) has recently evolved as a modality for noninvasive coronary imaging. Objective  To assess the accuracy and robustness of MSCT vs the criterion standard of invasive coronary angiography for detection of obstructive coronary artery disease. Design, Setting, and Patients  Prospective, single-center study conducted in a referral center setting in Germany and enrolling 103 consecutive patients (mean age, 61.5 [SD, 9.7] years) from November 2003–August 2004 who were undergoing both invasive coronary angiography and MSCT using a scanner with 16 detector rows. Main Outcome Measures  Blinded results for both modalities compared using the patient as the primary unit of analysis, with supplementary segment- and vessel-based analyses. Results  One thousand three hundred eighty-four segments (1.5 mm diameter) were identified by invasive coronary angiography; nondiagnostic image quality of MSCT was identified for only 88 (6.4%) of these segments, mainly due to faster heart rates. Compared with invasive coronary angiography for detection of significant lesions (>50% stenosis), segment-based sensitivity, specificity, and positive and negative predictive values of MSCT were 95%, 98%, 87%, and 99%, respectively. Quantitative comparison of MSCT and invasive coronary angiography showed good correlation (r = 0.87, P<.001), with MSCT systematically measuring greater-percentage stenoses (bias, +12%). In the patient-based analysis, the area under the receiver operating characteristic curve was 0.97 (95% confidence interval, 0.90-1.00), indicating high discriminative power to identify patients who might be candidates for revascularization (>50% left main artery stenosis and/or >70% stenosis in any other epicardial vessel). Threshold optimization allowed either detection of these patients with 100% sensitivity at a reasonable false-positive rate (specificity, 76.5%; MSCT stenosis, >66%) or optimization of both the sensitivity and specificity (>90%; MSCT stenosis, >76%). Conclusions  Multislice computed tomography provides high accuracy for noninvasive detection of suspected obstructive coronary artery disease. This promising technology has potential to complement diagnostic invasive coronary angiography in routine clinical care.      

涎腺多形性腺瘤的MSCT表现及诊断价值

目的 探讨涎腺多形性腺瘤的MSCT表现特征对提高其术前诊断准确率的价值.方法 回顾性分析本院2011年1月至2012年8月经手术病理证实的47例涎腺多形性腺瘤患者的临床表现、手术情况及MSCT影像特征.结果 47例多形性腺瘤患者中,89.4％ (42/47)为单发,10.6％ (5/47)为单侧多发;59.6％ (28/47)位于腮腺,17.0％(8/47)位于颌下腺,14.9％ (7/47)位于腭部小涎腺,8.5％ (4/47)位于颊部小涎腺;术中见27.7％(13/47)病灶与周围结构有粘连,10.6％ (5/47)包膜不完整,19.1％ (9/47)表面扪及结节.MSCT上涎腺混合瘤多表现为边界清楚、密度均匀的圆形或类圆形肿块或结节,14.9％ (7/47)病例发生囊变,其中6例位于腮腺,以术后复发及多发者最常见,颌下腺及腭部病灶均未见囊变者,增强后95.7％ (45/47)表现为延迟强化(延迟180 s).其中4例发生于硬腭者,由于其解剖结构的特殊,利用三维重组技术行MPR及VR图像后处理,不仅可提高病灶的检出,还可清晰显示病灶的部位、形态、大小及邻近骨质的改变.结论 涎腺多形性腺瘤的MSCT表现具有特征性,发生于硬腭者病灶多较小,应常规应用三维重组技术显示病灶及邻近骨质的改变,提高术前诊断率.