Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism

Abstract

Localization of parathyroid adenomas for treatment of primary hyperparathyroidism can be challenging. This retrospective study compared single-photon emission computed tomography/computed tomography (SPECT/CT), 4D-CT, and US studies in detection of adenomas prior to surgery. A retrospective chart review was performed on all consecutive patients with parathyroid adenoma presenting to an urban tertiary care medical center. A total of 58 patients (45 female, 13 male) underwent surgery for parathyroid adenoma. Patients aged 28 to 80 years (mean: 58.8) with parathyroid hormone levels ranging from 42 to 424 pg/mL (mean: 168). All patients underwent preoperative SPECT/CT with 20 mCi technetium-99m MIBI (99m Tc-MIBI). Fifty-three patients had additional US imaging and 14 patients had 4D-CT scans. Additionally, 34 patients had injection of 20 mCi 99m Tc-MIBI on the day of surgery. Pathological correlation was performed. Comparing SPECT/CT versus 4D-CT resulted in sensitivity (77% vs 80%), specificity (71% vs 75%), and accuracy (77% vs 79%). Ultrasound was less sensitive with similar specificity (44%, 86%, respectively). Combination of SPECT/CT and 4D-CT increased sensitivity to 88%, specificity to 100%, and accuracy to 89%. Combining SPECT/ CT with US resulted in sensitivity of 85%, specificity of 83%, and accuracy of 85%. Intraoperative localization substantially improved in patients who received preoperative injections. The SPECT/CT remains the best imaging modality for preoperative localization of parathyroid adenomas with high sensitivity. Combining SPECT/CT with US resulted in increased sensitivity and accuracy. For suspicion of ectopic cases or suspicion of unidentifiable adenoma with negative scintigraphy, addition of 4D-CT is recommended. Intraoperative localization and adjunctive imaging may improve surgical management of patients with hyperparathyroidism.

The role of 99mTc-MIBI SPECT/CT in patients with secondary hyperparathyroidism: comparison with 99mTc-MIBI planar scintigraphy and ultrasonography

“…The procedures of 99m Tc-MIBI scintigraphy includes planar scintigraphy, SPECT and SPECT/CT. Most studies compared the sensitivitiy of 99m Tc-MIBI scintigraphy and US in primary hyperparathyroidism [7][8][9][10]. However, few studies compared the sensitivity of 99m Tc-MIBI scintigraphy and US in SHPT [11,12].…”

Konventionelle nuklearmedizinische Bildgebung bei Hyperparathyreoidismus

“…Die präoperative Bildgebung bei pHPT im Rahmen der Lokalisationsdiagnostik ist entscheidend für die individuelle Auswahl des geeigneten Operationsverfahrens (minimalinvasive Vorgehensweise im Gegensatz zur konventionellen bilateralen Exploration aller 4 Nebenschilddrüsen) [7]. Vorteile einer minimalinvasiven Vorgehensweise nach exakter Lokalisationsdiagnostik sind ▪ die verkürzte Operationsdauer, ▪ ein kleinerer Schnitt, ▪ verkürzte Liegedauer, ▪ weniger postoperative Schmerzen und ▪ niedrige Raten an postoperativer Hypokalzämie [5].…”

“…Bei bis zu 16 % der Fälle besteht eine ektope Lage, von denen die häufigste der Bereich des Thymus ist. Etwa 1-2 % der Nebenschilddrüsenadenome können intrathorakal/mediastinal liegen [4], [5], [6]. Tc-Sestamibi NSAID nonsteroidal anti-inflammatory Drug (nichtsteroidales Antiphlogistikum) NSD Nebenschilddrüse PET-CT Positronenemissionstomografie ("positron emission tomography") Pgp P-Glykoprotein pHPT primärer Hyperparathyreoidismus PHT Parathormon sHPT sekundärer Hyperparathyreoidismus SPECT Einzelphotonen-Emissionscomputertomographie ("single photon emission computed tomography") tHPT tertiärer Hyperparathyreoidismus Merke Laborchemisch ist eine Hyperkalzämie bei gleichzeitig erhöhtem PTH-Wert kennzeichnend für einen pHPT [7].…”

Benefit of diverse surgical approach on short-term outcomes of MEN1-related hyperparathyroidism

“…High-resolution US is useful to understand the anatomic relation between parathyroid glands and the adjacent thyroid gland. Although US alone is not enough for preoperative evaluation due to its low sensitivity and specificity 24 , a combination of 99m Tc-MIBI SPECT/CT and US has been a popular method for preoperative localisation of PHPT.…”