Diagnosis performance of 99mTc-MIBI and multimodality imaging for hyperparathyroidism

Abstract

This study aimed to examine the diagnosis performance of Tc-methoxyisobutylisonitrisonitrile (Tc-MIBI) and multimodality imaging [ultrasound, single-photon emission computed tomography/computed tomography (SPECT/CT)] for hyperparathyroidism (HPT). From Nov. 2009 to Dec. 2015, clinical data of a total of 43 HPT patients (16 males and 27 females; 26-70 years old, average age: 51.60±10.66 years old) were retrospectively analyzed. Among them, 19 patients with primary hyperparathyroidism (PHPT) underwent Tc-MIBI planar imaging, 24 [15 with PHPT and 9 with secondary hyperparathyroidism (SHPT)] underwent SPECT/CT hybrid imaging, and 41 (33 with PHPT and 8 with SHPT) had neck ultrasound imaging. Final diagnosis was determined by pathological examination after surgery. The positive rate was compared between different imaging modalities, and the correlation analysis was conducted between imaging results and lesion size or serum parathyroid hormone (PTH) level. The results showed that the total positive rates ofTc-MIBI imaging, ultrasound, and the two combined imaging in the 43 HPT cases were 90.70% (39/43), 58.54% (24/41), and 100% (41/41), respectively. According to lesion numbers, the positive rates were 79.10% (53/67), 53.23% (33/62), and 88.71% (55/62), respectively. SPECT/CT hybrid images were positive in all the 24 patients who underwent this examination. The mean maximum diameters of the lesions in Tc-MIBI positive and negative patients were 1.96±0.95 cm and 1.36±0.67 cm respectively, with statistically significant difference noted (P=0.03). The T/NT ofTc-MIBI imaging at the early phase was correlated positively with serum PTH level (r=0.40, P=0.01). The T/NT of Tc-MIBI imaging at both the early phase and the delay phase was correlated positively with lesion size (r=0.51, and r=0.45, respectively; P<0.01 for both). It was concluded that Tc-MIBI imaging presents significant value for location diagnosis of HPT, especially when combined with SPECT/CT hybrid imaging or ultrasound. TheTc-MIBI uptake correlates positively with serum PTH level and lesion size.

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

“…Li et al [11] reported that 8.05 mm was the optimal cut-off value in lesions diameter for predicting 99m Tc-MIBI SPECT/CT positive in SHPT. Zhou et al [24] reported that the average maximum diameter of 99m Tc-MIBI SPECT/CT positive lesions was 19.6 ± 9.5 mm in hyperparathyroidism. NMDG refered to true positive lesions, while MIBI positive included ture positive and false positive lesions.…”

Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism

“…When combined with singlephoton emission computed tomography/computed tomography (SPECT/CT), functional and anatomical, the sensitivity of scintigraphy is increased. Multiple studies have reported that dual-phase 99m Tc-MIBI scintigraphy is superior to US, especially when combined with SPECT/CT, in patients with HPT [12][13][14], but these studies did not distinguish SHPT from PHPT for statistical analysis. For PHPT, several investigations have reported that 99m Tc-MIBI SPECT/CT is superior to dual-phase 99m Tc-MIBI scintigraphy [11,15,16].…”

“…The image was considered positive on visual analysis when it met one of the following criteria: (1) abnormal 99m Tc-MIBI uptake was observed on both early and delayed imaging; (2) abnormal 99m Tc-MIBI uptake was observed on either early or delayed imaging. The image was considered negative when abnormal 99m Tc-MIBI uptake was observed on neither early nor delayed imaging [13].…”

Diagnosis performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT in preoperative localization of parathyroid gland in secondary hyperparathyroidism

“…Different from the above anatomical imaging, technetium-99m methoxyisobutylisonitrile ( 99m Tc-MIBI) scintigraphy is a functional exploration and regarded as the best preoperative localizing method for patients with PHPT or SHPT [6] and when combined with single photon emission computed photography/ computed photography (SPECT/CT), functional and anatomical, the sensitivity of scintigraphy can be able to increase. Multiple studies have reported 99m Tc-MIBI scintigraphy superior to US especially combined with SPECT/CT in patient with hyperparathyroidism [13][14][15], but these studies do not separate SHPT from primary hyperparathyroidism (PHPT) for statistics and analysis. For PHPT, several investigations had reported 99m Tc-MIBI SPECT/CT superior to scintigraphy [16][17][18], although the other study did not find SPECT/CT superior to scintigraphy [19].…”