Dijagnostičke metode za bolesti paratireoidnih žlijezda

Sanja Kusačić Kuna, Hrvojka Tomić Brzac, Draško Pavlović, Sanda Ćosić Jelisavac, Zdenka Bence Žigman, Dražen Huić

Bolesti paratireoidnih žlijezda često dovode do oštećenja bubrega poput primarnog hiperparatireoidizma ili se javljaju kao posljedica insuficijencije bubrega u sekundarnom i tercijarnom hiperparatireoidizmu. Bolesnici razvijaju hiperkalcemiju s povišenom razinom PTH, a većina ima smanjenu mineralnu gustoću kostiju uz deformitete, bolove i sklonost prijelomima, ali i oštećenje bubrežne funkcije, nefrokalcinozu ili nefrolitijazu uz opstruktivnu uropatiju. Cilj izvješća je predstaviti nuklearno-medicinske metode u dijagnostici i liječenju bolesnika s poremećajima paratireoidnih žlijezda. Najčešće korištene slikovne metode u dijagnostici jesu ultrazvuk visoke rezolucije s obojenim doplerom, zatim SPECT/CT scintigrafija u kombinaciji s kompjutoriziranom tomografijom s tehnecij-99m sestamibijem (Tc-99m-MIBI), te po potrebi PET/CT s fluor 18-kolinom. Ultrazvuk može biti praćen ciljanom citološkom punkcijom, a iz punktata se može odrediti i razina PTH koji također služi za potvrdu dijagnoze u slučaju da citološka analiza ne pokaže pravo podrijetlo epitelnih stanica iz punktata. U odjelima nuklearne medicine određuju se i laboratorijski parametri, odnosno razina PTH u serumu, važna u praćenju bolesnika. Najčešće se koriste kombinacije nekoliko različitih slikovnih metoda za određivanje veličine, položaja i odnosa paratireoidnih žlijezdi s okolnim strukturama, a u radu su prezentirane glavne indikacije te prednosti i ograničenja svake od metoda uz slikovni materijal.

Diseases of the parathyroid glands often lead to kidney damage, as in primary hyperparathyroidism, or occur as a consequence of renal insufficiency, as in secondary or tertiary hyperparathyroidism. Most patients exhibit the symptomatology of hypercalcemia with high serum calcium values as well as high PTH level, and majority of them have reduced bone density, pain, bone changes and fractures, as well as nephrolithiasis, nephrocalcinosis, obstructive uropathy, or other renal damage. The aim of this report is to present nuclear medicine imaging methods for the diagnosis and management of patients with parathyroid disorders. The most commonly used imaging methods are high-resolution ultrasonography with color Doppler imaging, SPECT/CT scintigraphy combined with computed tomography with technetium-99m sestamibi (Tc-99m-MIBI), and, if needed, positron emission tomography/computed tomography (PET/CT) with fluor 18-choline. Ultrasound can be followed by ultrasonographically guided fine-needle aspiration biopsy (US-FNAB) that is performed for cell aspiration, and PTH level from the punctate can also be determined. Laboratory findings (PTH level) important for monitoring in the follow-up of patients are also measured in the nuclear medicine department. Combinations of several different imaging tests are sometimes used to determine the size, location, and relationship of the parathyroid glands with the surrounding structures. The imaging material of the enlarged parathyroid glands will be presented, and the main objective is to discuss the values and limitations of each method as well as imaging pitfalls in parathyroid imaging.