Objective:To study the clinical value of Technetium-99m sestamibi myocardial perfusion single photon emission computed tomography(SPECT) in diabetes with suspected coronary artery diseases.Methods:Seventy-eight diabet...Objective:To study the clinical value of Technetium-99m sestamibi myocardial perfusion single photon emission computed tomography(SPECT) in diabetes with suspected coronary artery diseases.Methods:Seventy-eight diabetic patients complicated with cardiac symptoms or electrocardiogram(ECG) abnormalities and suspected coronary heart disease hospitalized in the department of endocrinology from January,2008 to December,2008 were investigated.Technetium-99m sestamibi myocardial perfusion SPECT was performed in all patients.Exercise stress test was done in 35 cases(group A).Adenosine stress test was done in 43 cases(group B).Results:The positive rates in the two groups were 54.29%(19/35) and 53.48%(23/43),respectively.There was no statistic difference between the 2 groups(P>0.05).The abnormality rates in male and female groups were 63.04% and 28.13%,respectively(P<0.01).Eighty-six segments of perfusion abnormality were detected in 38 positive patients.Four segments of fixed defect were found in 4 cases.Conclusion:As non-invasive method,myocardial perfusion SPECT can play an important role in the treatment of diabetes with suspected coronary artery disease.展开更多
Objective To evaluate the application of 99Tcm-sestamibi dual-phase parathyroid scintigraphy in the preoperative localization in patients with primary hyperparathyroidism and to compare the diagnostic efficacy of vari...Objective To evaluate the application of 99Tcm-sestamibi dual-phase parathyroid scintigraphy in the preoperative localization in patients with primary hyperparathyroidism and to compare the diagnostic efficacy of various imaging modalities. Methods Ninety-two consecutive patients, diagnosed as hyperparathyroidism and presented with hypercalcaemia as the predominant symptom, were included. All the patients underwent dual-phase parathyroid scintigraphy using 99Tcm-sestamibi and parathyroid ultrasound scan. Among them, 48 patients underwent parathyroid computed tomography (CT). All patients were referred for parathyroidectomy. Results 99Tcm-sestamibi dual-phase parathyroid scintigraphy revealed the diagnostic sensitivity of 76.5%, 80%, 75% and 33.3% for the subgroup of single adenomas, multiple adenomas, ectopic parathyroid and parathyroid hyperplasia respectively. The specificity was 100% for all leisons. 99Tcm-sestamibi dual-phase parathyroid scintigraphy was proved to be superior to the other imaging modalities (ultrasound and CT) in terms of the preoperative diagnostic accuracy. The lesion weight was found to be an underlying factor leading to the false negative result. Conclusion 99Tcm-sestamibi dual-phase parathyroid scintigraphy was found to have higher diagnostic accuracy in comparison with other imaging modalities and is recommended preoperatively in order to reduce the sugery time and unnecessary neck exploration.展开更多
Background: The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data...Background: The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in “MIBI-negative”-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in “MIBI-negative”-patients. The positive predictive value of a “positive” MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.展开更多
Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased fro...Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.展开更多
An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The i...An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The implications of increased LHR in patients undergoing stress technetium- 99m(tc- 99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc- 99m sestamibi MPI. Methods: We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc- 99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79(exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography(study population). The average LHR of these 79 subjects was compared to 79 patients(control population) with normal scans(exercise=50, adenosine=29, male=34, female=45, mean age=60 years). Results: The mean LHR(± SE) in subjects with normal scans was 0.30± 0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32± 0.01 and pharmacological stress was 0.31± 0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39± 0.01(p=0.000) and for adenosine was 0.39± 0.02(p=0.000). Conclusion: An elevated LHR in patients undergoing exercise or pharmacological tc- 99m MPI correlates with multi-vessel CAD.展开更多
文摘Objective:To study the clinical value of Technetium-99m sestamibi myocardial perfusion single photon emission computed tomography(SPECT) in diabetes with suspected coronary artery diseases.Methods:Seventy-eight diabetic patients complicated with cardiac symptoms or electrocardiogram(ECG) abnormalities and suspected coronary heart disease hospitalized in the department of endocrinology from January,2008 to December,2008 were investigated.Technetium-99m sestamibi myocardial perfusion SPECT was performed in all patients.Exercise stress test was done in 35 cases(group A).Adenosine stress test was done in 43 cases(group B).Results:The positive rates in the two groups were 54.29%(19/35) and 53.48%(23/43),respectively.There was no statistic difference between the 2 groups(P>0.05).The abnormality rates in male and female groups were 63.04% and 28.13%,respectively(P<0.01).Eighty-six segments of perfusion abnormality were detected in 38 positive patients.Four segments of fixed defect were found in 4 cases.Conclusion:As non-invasive method,myocardial perfusion SPECT can play an important role in the treatment of diabetes with suspected coronary artery disease.
文摘Objective To evaluate the application of 99Tcm-sestamibi dual-phase parathyroid scintigraphy in the preoperative localization in patients with primary hyperparathyroidism and to compare the diagnostic efficacy of various imaging modalities. Methods Ninety-two consecutive patients, diagnosed as hyperparathyroidism and presented with hypercalcaemia as the predominant symptom, were included. All the patients underwent dual-phase parathyroid scintigraphy using 99Tcm-sestamibi and parathyroid ultrasound scan. Among them, 48 patients underwent parathyroid computed tomography (CT). All patients were referred for parathyroidectomy. Results 99Tcm-sestamibi dual-phase parathyroid scintigraphy revealed the diagnostic sensitivity of 76.5%, 80%, 75% and 33.3% for the subgroup of single adenomas, multiple adenomas, ectopic parathyroid and parathyroid hyperplasia respectively. The specificity was 100% for all leisons. 99Tcm-sestamibi dual-phase parathyroid scintigraphy was proved to be superior to the other imaging modalities (ultrasound and CT) in terms of the preoperative diagnostic accuracy. The lesion weight was found to be an underlying factor leading to the false negative result. Conclusion 99Tcm-sestamibi dual-phase parathyroid scintigraphy was found to have higher diagnostic accuracy in comparison with other imaging modalities and is recommended preoperatively in order to reduce the sugery time and unnecessary neck exploration.
文摘Background: The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in “MIBI-negative”-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in “MIBI-negative”-patients. The positive predictive value of a “positive” MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.
文摘Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.
文摘An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The implications of increased LHR in patients undergoing stress technetium- 99m(tc- 99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc- 99m sestamibi MPI. Methods: We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc- 99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79(exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography(study population). The average LHR of these 79 subjects was compared to 79 patients(control population) with normal scans(exercise=50, adenosine=29, male=34, female=45, mean age=60 years). Results: The mean LHR(± SE) in subjects with normal scans was 0.30± 0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32± 0.01 and pharmacological stress was 0.31± 0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39± 0.01(p=0.000) and for adenosine was 0.39± 0.02(p=0.000). Conclusion: An elevated LHR in patients undergoing exercise or pharmacological tc- 99m MPI correlates with multi-vessel CAD.
