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Title:THE ROLE OF SPECT/CT SCINTIGRAPHY IN LOCALIZATION OF PARATHYROID ADENOMAS
Authors:Rep, Sebastijan (Author)
Hočevar, Marko (Mentor) More about this mentor... New window
Vaupotič, Janja (Mentor) More about this mentor... New window
Files:.pdf RAZ_Rep_Sebastijan_i2016.pdf (1,03 MB)
 
Language:English
Work type:Master's thesis (m2)
Tipology:2.09 - Master's Thesis
Organization:FPŠ - Graduate School
Abstract:Parathyroid scintigraphy is based on the different accumulation and distribution of radiopharmaceutical 99mTc-MIBI (MIBI) in parathyroid and adjacent tissues. Different scintigraphic techniques can be used: subtraction scintigraphy is a combination of MIBI and 99mTc-pertehnetate (pertehnetate) scintigraphy; SPECT can be performed after intravenous injection of MIBI or in the combination with low-dose computerized tomography (SPECT/CT) which allows precise anatomical localization of enlarged parathyroid glands (EPG). The objectives of our study were: to assess diagnostic performance of preoperative localization of EPG (adenomas and hyperplasia) of the early, delayed and combined SPECT/CT and of subtraction scintigraphy in patients with biochemically proven primary hyperparathyroidism (PHP); to determine whether size of EPG, serum parathyroid hormone (PTH), calcium (Ca) and phosphate (P) correlate with successful localization; to assess radiation exposure of patients with early and late SPECT/CT and subtraction scintigraphy The study included 41 patients in whom early, delay SPECT/CT and subtraction scintigraphy were performed. For all scintigraphic methods sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Receiver Operating Characteristic analysis was used to express relationship between scintigraphy results and size of the EPG and serum Ca, P and PTH levels. ImPACT CT Patient Dosimetry Calculator and weighting factors for radiopharmaceuticals (MIBI and pertechnetate) were used for calculating patient expose dose. Sensitivity and specificity were 51.1% and 98.3 for subtraction scintigraphy, 65.1% and 97.5% for early SPECT/CT and 65.1% and 95.5% for delay SPECT/CT. In combined early and delay SPECT/CT sensitivity and specificity were 74.4% and 95.1%.Only size of the EPG correlated with successful localization in our study (AUC of 0.791-0.810). The highest average ED per patient had subtraction scintigraphy (7.37±0.40 mSv), which was statistically significant higher in comparison to combined early and delayed SPECT/CT (6.81±0.44 mSv). The most sensitive and most accurate method of preoperative localization of EPG in patients with PHP is combined early and delayed SPECT/CT. Only size of the EPG correlates with successful localization. The highest radiation exposure is after subtraction scintigraphy.
Keywords:Enlarged parathyroid glands, early SPECT/CT, delayed SPECT/CT, combined SPECT/CT, subtraction scintigraphy, 99mTc-MIBI, 99mTc-pertechnetate, effective dose, serum parathyroid hormone, calcium, phosphate
Year of publishing:2016
Source:Nova Gorica
COBISS_ID:4521979 Link is opened in a new window
URN:URN:SI:UNG:REP:OVRTOLXF
Views:4542
Downloads:202
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Secondary language

Language:Slovenian
Title:VLOGA SPECT/CT SCINTIGRAFIJE PRI LOKALIZACIJI OBŠČITNIČNIH ADENOMOV
Abstract:Scintigrafija obščitnic temelji na različnih akumulacijah in distribuciji radiofarmaka 99mTc-MIBI (MIBI) v obščitnicah in v sosednjih tkivih. Možnih je več različnih scintigrafskih tehnik: odštevna scintigrafija je kombinacija scintigrafije z MIBI in scintigrafije z 99mTc-pertehnetatom (pertehnetatom); SPECT lahko uporabimo samostojno po aplikaciji MIBI ali v kombinaciji z nizko-dozno računalniško tomografijo (SPECT/CT), ki omogoča natančno anatomsko lokalizacijo povečanih obščitnic (PO). Cilji raziskave so bili: oceniti diagnostično uspešnost predoperativne lokalizacije PO (adenom ali hiperplazija) pri zgodnjem, kasnem in kombiniranem SPECT/CT ter odštevni scintigrafiji pri bolnikih z biokemično dokazanim primarnim hiperparatiroidizmom (PHP); ugotoviti če velikost PO, serumski parathormon (PTH), kalcij (Ca) in fosfor (P) korelira z uspešno lokalizacijo; oceniti izpostavljenost sevanju bolnikov pri katerih opravimo zgodni in kasni SPECT/CT ter odštevno scintigrafijo. V raziskavi je sodelovalo 41 bolnikov, pri katerih smo opravili zgodnji in kasni SPECT/CT ter odštevno scintigrafijo. Za vse scintigrafske metode smo izračunali občutljivost, specifičnost, pozitivno in negativno napovedno vrednost ter točnost. ROC analiza je bila uporabljena za oceno odnosa med rezultati scintigrafskih metod in velikostjo PO, serumskih vrednosti Ca, P in PTH. Za izračun sevalne obremenitve bolnikov smo uporabili ImPACT CT kalkulator za dozimetrijo in utežne faktorje za radiofarmake (MIBI & pertehnetat). Občutljivost in specifičnost sta bili 51.1% in 98.3 za odštevno scintigrafijo, 65.1% in 97.5% za zgodnji SPECT/CT in 65.1% in 95.5% za kasni SPECT/CT. Pri kombiniranem zgodnjem in kasnem SPECT/CT sta bili občutljivost in specifičnost 74.4% in 95.1%. Samo velikost PO je korelirala z uspešnostjo lokalizacije v naši raziskavi (AUC 0.791-0.810). Najvišja povprečna efektivna doza na pacienta je bila pri odštevni scintigrafiji (7.37±0.40 mSv), kar je bilo statistično signifikantno višje kot pri kombiniranem zgodnjem in kasnem SPECT/CT (6.81±0.44 mSv). Najbolj občutljiva in najbolj točna metoda predoperativne lokalizacije PO pri bolnikih s PHP je kombinirani zgodnji in kasni SPECT/CT. Samo velikost PO je povezana z uspešno lokalizacijo. Največja izpostavljenost sevanju je po odštevni scintigrafiji.
Keywords:Povečane obščitnice, zgodnji SPECT/CT, kasni SPECT/CT, kombiniran SPECT/CT, odštevana scintigrafija, 99mTc-MIBI, 99mTc-pertechnetate, efektivna doza, serumski parathormon, kalcij, fosfor.


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