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C-11-Methionin-PET/CT zur Lokalisation von Nebenschilddrüsenadenomen

Localization of parathyroid adenomas with C11-methionine PET-CT

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Zusammenfassung

Hintergrund

Die präoperative Lokalisationsdiagnostik von Nebenschilddrüsenadenomen beim primären Hyperparathyreoidismus (pHPT) ermöglicht eine fokussierte unilaterale Operation. Zur Standarddiagnostik zählen die Sonographie und Technetium-99m-Sestamibi-Szintigraphie. Das neueste Verfahren zur Darstellung hyperfunktioneller Nebenschilddrüsen stellt die C-11-Methionin-Positronenemissionstomographie/Computertomographie (PET/CT) dar.

Methodik

Es wurde eine selektive Literaturrecherche in PubMed mit den Stichworten „primary hyperparathyroidism and methionine“, „primary hyperparathyroidism and PET“, „parathyroid adenomas and methionine“ und „parathyroid adenomas and PET“ durchgeführt.

Ergebnisse

Mithilfe des Methionin PET/CT gelingt es in 79–91 % solitäre Nebenschilddrüsenadenome nachzuweisen. Vorteile des Verfahrens sind eine hohe Sensitivität auch bei Rezidiveingriffen oder gleichzeitig bestehenden Knotenstrumen sowie eine exakte anatomische Zuordnung auch von atypisch gelegenen Adenomen. Eine vollständige Darstellung einer Mehrdrüsenerkrankung gelingt dagegen nur selten. Als ungünstig zu bewerten sind derzeit noch die eingeschränkte Verfügbarkeit der Methode und die vergleichsweise hohen Kosten.

Schlussfolgerung

Durch das Methionin-PET/CT ist bei der Mehrzahl der untersuchten Patienten mit pHPT eine exakte Lokalisation solitärer Nebenschilddrüsenadenome möglich. Eine Indikation zur Durchführung besteht vor allem bei präoperativ negativer Standarddiagnostik und bei Rezidiveingriffen.

Abstract

Background and objectives

In primary hyperparathyroidism (pHPT) preoperative localization of parathyroid adenomas enables focussed unilateral parathyroidectomy. Ultrasound and sestamibi scintigraphy are the recommended standard procedures for primary diagnostics of pHPT and C-11 methionine positron emission tomography computed tomography (Met-PET/CT) is the latest technique for localization of hyperfunctioning parathyroid glands.

Methods

This review presents the results of Met-PET/CT on the basis of a selective literature search using the keywords “primary hyperparathyroidism and methionine”, “primary hyperparathyroidism and PET”, “parathyroid adenomas and methionine” and “parathyroid adenomas and PET”.

Results

Localization of single gland adenomas can be achieved with Met-PET/CT in 79–91 % of cases. The advantages of this procedure are a high sensitivity even in operations for recurrencies or concomitant thyroid nodules and an accurate detection even with atypical localizations. In multiglandular disease a localization of more than one hyperfunctioning gland remains difficult. Potential limitations of the method include the restricted availability and the relatively high costs of Met-PET/CT.

Conclusions

Using Met-PET/CT hyperfunctioning parathyroid glands can be exactly localized in most patients with pHPT. Indications for this procedure are mostly when preoperative standard tests are negative and in parathyroid surgery for recurrencies.

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Danksagung

Die Autoren danken allen Mitarbeitern und Kollegen der Kliniken für Allgemein- und Viszeralchirurgie und Nuklearmedizin des Universitätsklinikums Ulm, die sich mit der klinischen Anwendung des Met-PET/CT beim primären Hyperparathyreoidismus beschäftigt haben. Besonderer Dank gilt Herrn Dr. Clemens Maier-Funk, Frau Dagmar Ohlhauser, Herrn Dr. Martin Gottstein und Frau Dr. Janet Bampoe Addo für ihr großes Engagement bei der Durchführung und Auswertung der PET/CT-Aufnahmen.

Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Weber erhielt Vortragshonorare der Firma Genzyme GmbH und ein Forschungsstipendium der B. Braun-Stiftung. M. Luster erhielt Vortragshonorare der Firmen Genzyme GmbH, Bayer HealthCare AG, Sanofi Aventis, Merck und AstraZeneca. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    T. Weber

  2. Klinik für Nuklearmedizin, Universitätsklinikum, Marburg, Deutschland

    M. Luster

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  1. T. Weber
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  2. M. Luster
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Correspondence to T. Weber.

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Weber, T., Luster, M. C-11-Methionin-PET/CT zur Lokalisation von Nebenschilddrüsenadenomen. Chirurg 85, 601–606 (2014). https://doi.org/10.1007/s00104-013-2695-5

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  • DOI: https://doi.org/10.1007/s00104-013-2695-5

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