MIBIシンチをシンチを 中心中心 にに

1 MIBI -MIBI - 2 )) P (cinaclcet) . 1 90% 1 90% PTH PTH (intact PTH whole PTH) C Ca P P Ca 200mg PTH C P PTH Ca P D PEIT D PEIT D . PTH D PTH D D (25-OH D) Ca [NET] = Ca-( )[]() (Ca 2+) (5- ) Ca 13mg/dl ( ) 30-40mgg 80%, 90%) 80%, 90%)

2 5 8 5 3 3 MEN Type 1 60% 1 1. HliHyperplasia3. Hyperplasia4. I HyperplasiaIIA AdenomaIIB (minimally invasive parathyroidectomy) US low echo mass - Doppler Doppler CT low density mass 16 MDCT MPR 16 MDCT MPR MRI T1 T2 STIR T1 T1 ( )PTHi 262(pg/ml)Ca (mg/dl) USlongitudinal transverseCa (mg/dl) PTH-I (pg/ml)

3 6 6 class III follow PTH PTH D2a CT MPR(2-3mm ) artifact CT CT CT 60 Ca ( )P ( )PTH-I (12-65)ALP 415 (101-360) MIBI MIBI CT(MPR 2mm /slice)C (/s ce)VR : feeder 4 4 70.

4 MIBI CT MPR mm/slice)CT MPR mm/slice) D VR 60 60 12 12 D VR 30 30 , . CT (axial)CT (axial) 3D VR image feeder TlTc Tl-Tc Tl-Tc subtraction scintigraphyTl-Tc subtraction scintigraphyTl-201Tc-99mSubtracted imageTl201 Tc99m Subtracted imageT+PTPT + P-T = P Sensitivity MIBI (70-80%)MIBI MIBI Tc-99m MIBI (methoxyisobutylisonitrile.

5 Sestamibi) 2 ( ) ( ) (MIBI) 96% 10-20 mCi (370-740 MBq) ( ) 10-20 (early image) 120-180 (delayed image) (+ ) SPECT ( ) delayed image (> 500mg) False positive: False positive: False negative: K SPECT/CT fusion image Tc-99m MIBI meta-analysis (6331 Tc-99m MIBI meta-analysis (6331 sensitivity specificity -2000 3152 3152 1.)

6 : 82 (26%) 2332 (74%)2 4060 2225 50 2. : 40-60 2225 50 - 3. Ca (mg/dl): 11 < 38%, 11-12 37%, 12-14 21%, > 14 4%,,,4. (g): < 35%, - 1 29%, 1- 5 31%, > 5 5%5 : 54% 35% 11%5. : 54%, 35%, 11%6. 84%, 11%, 2%, 2%, 1%7. : 170/ 3152 ( )MEN I 121, MEN IIA 18, HPT 318. :Ca 95% Ca 2% Ca 3%Ca 95%, Ca 2%, Ca 3%9. :Ca 82%, Ca 6%, Ca 12%10. : 84%, 8%, 8%MIBI positive hyperfunctioning glandpypggPTH 262 (pg/ml) Ca (mg/dl)the longest diameter 23 mmlftleft upperMIBI earlyUSyDopplerdelayedDoppler28yrs., fPrimary hyperparathyroidismearly delayedAdenomaMIBIA denoma 540 (mg/dl)USCa (mg/dl) PTH-I (pg/ml)USlongitudinal transverseMIBI- SPECT (coronal)learlydelayed earlydelayedearly delayed EarlyDelayedEarly Delayed delayed image MIBI US CT50.

7 Hashimoto s thyroiditis ( ) ( )MIBI planar SPECTpUS MIBI MIBI (1040 mg ) US 40 , . MIBI . MIBI .49yrs, female, MIBI positive gland at back aspect of lower pole of the left lobe. ppDelayed MIBI scan MIBI SPECT /CT 60 60 CT MIBI planar MIBI SPECT coronal imagesSPECT/CT fusion MPRSC/CusoMIBI superimpose excellent70.

8 MIBI CT MPR mm/slice)CT MPR mm/slice) DVR D VR MIBI/CT fusion MPR imagesMIBI superimpose fair60 , .. VR US US MIBI scanCTSPECT/CT fusionCT SPECT/CT fusion MIBI superimpose . good - feeding artery SPECT/CT work station fusion fusion Fusion minimally invasive surgery