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

Zhang, Rongqin; Zhang, Zhanwen; Huang, Pinbo; Li, Zhi; Hu, Rui; Zhang, Jie; Qiu, Wanglin; Hu, Ping

doi:10.1186/s12880-020-00490-3

Cited by 30 publications

(24 citation statements)

References 39 publications

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“…Their diagnostic accuracy is similar or even superior to second-line localization methods like CT or MRI [ 110–112 ]. Parathyroid scintigraphy uses technetium ( 99m Tc) setamibi (MIBI) as radiopharmaceutical to evaluate enlarged or ectopic parathyroid glands and its combination with CT (SPECT/CT) guarantees more sensitivity in parathyroid evaluation during SHPT [ 108 , 113 ].…”

Section: Introductionmentioning

confidence: 99%

A roadmap to parathyroidectomy for kidney transplant candidates

Cianciolo

Tondolo

Barbuto

et al. 2022

Clinical Kidney Journal

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Chronic kidney disease Mineral and Bone Disorder may persist after successful kidney transplantation. Persistent hyperparathyroidism has been identified in up to 80% of patients throughout the first year after kidney transplantation. International Guidelines lack strict recommendations about the management of persistent hyperparathyroidism. However, it is associated with adverse graft and patients’ outcomes such as higher fracture risk and an increased risk of all-cause mortality and allograft loss. Secondary hyperparathyroidism may be treated medically (vitamin D, phosphate binders and calcimimetics) or surgically (parathyroidectomy). Guideline recommendations suggest medical therapy first but do not clarify optimal PTH targets or indications and timing of parathyroidectomy. There are no clear guidelines or long-term studies about the impact of hyperparathyroidism therapy. Parathyroidectomy is more effective than medical treatment although associated to increased short term risks. Ideally, parathyroidectomy should be performed before kidney transplantation to prevent persistent hyperparathyroidism and improve graft outcomes. We now propose a roadmap for the management of secondary hyperparathyroidism in patients eligible for kidney transplantation that includes the indications and timing (pre- or post-kidney transplantation) of parathyroidectomy, the evaluation of parathyroid gland size and the integration of parathyroid gland size in the decision-making process by a multidisciplinary team of nephrologists, radiologists and surgeons.

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Section: Introductionmentioning

confidence: 99%

A roadmap to parathyroidectomy for kidney transplant candidates

Cianciolo

Tondolo

Barbuto

et al. 2022

Clinical Kidney Journal

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“…При обнаружении атипично расположенных ОЩЖ ДТ данных методов визуализации существенно снижается: УЗИ -36,7%, сцинтиграфия -30%, МСКТ -47,8%, а сочетание методов -63,3% [19]. ОФЭКТ/КТ показывает наибольшую ДТ -87-90% по сравнению с традиционными методами визуализации ОЩЖ (сцинтиграфия -59%; УЗИ -65%) у пациентов с ВГПТ [20][21]. ДТ ОФЭКТ/КТ для обнаружения типично расположенных ОЩЖ -89,5%, а для атипично расположенных -90,0% [21].…”

Section: Discussionunclassified

“…ОФЭКТ/КТ показывает наибольшую ДТ -87-90% по сравнению с традиционными методами визуализации ОЩЖ (сцинтиграфия -59%; УЗИ -65%) у пациентов с ВГПТ [20][21]. ДТ ОФЭКТ/КТ для обнаружения типично расположенных ОЩЖ -89,5%, а для атипично расположенных -90,0% [21]. Сочетание ОФЭКТ/КТ со сцинтиграфией позволяет увеличить ДТ до 72,12%, а с УЗИ -до 79,39% [22].…”

Section: Discussionunclassified

Persistence of secondary hyperparathyroidism after parathyroidectomy in a patient with chronic kidney disease: a case report

et al. 2021

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This is a clinical case of surgical treatment of persistence of secondary hyperparathyroidism (SHPT) in a patient with chronic kidney disease after previous parathyroidectomy. Programmed hemodialysis started in 2014, and in 2016 SHPT was diagnosed. In November 2018, indications for surgical treatment were presented in one of the clinics. According to scintigraphy, an increase in the functional activity of all four parathyroid glands (PTG) was observed, according to ultrasound data, the localization of the right lower, left upper and lower PTG was established. Removal of 3x PTG was performed without revision of the thymus horns (11.2018), while in the postoperative period, an adequate decrease in parathyroid hormone was not observed. After additional examination, according to ultrasound, scintigraphy and computer tomography of the neck with intravenous enhancement, it was found that both lower PTGs are located in the upper horns of the thymus. In July 2020, a repeated surgical intervention was performed in the volume of the right lower and left lower parathyroidectomy with a positive intraoperative test. Remission of SHPT was achieved. At present, no consensus has been reached on the extent of surgery for SHPT, since no statistically significant differences were found in the incidence of persistence / recurrence of SHPT. A complete assessment of the results of preoperative imaging techniques is required when planning surgery. Intraoperative monitoring of parathyroid hormone is an effective technique for assessing the radicality of surgical treatment.

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“…С другой стороны, по данным сцинтиграфии определяют степень патологической активности и автономии клеток гиперплазированных ПЩЖ, а также (как и у пациентов с дефицитом витами на D) признаки развития нодулярной формы гипер плазии, что может предоставить дополнительную аргументацию в пользу решения о выполнении ПТЭ [29]. Отчасти этот принцип основан на том, что при диффузной гиперплазии измененные ПЩЖ визуализируются по данным планарной сцинти графии лишь в 40-50% случаев, а при ОЭКТ/КТв 60-70% [30]. В случае четкой визуализации обра зований ПЩЖ по данным сцинтиграфии (Grade 2) у этих пациентов велика вероятность отсутствия эффекта дальнейшей медикаментозной тера пии ГПТ, в связи с чем должна быть рассмотре на ПТЭ [31].…”

Section: пациенты с хбпunclassified

The Role of Scintigraphy and Hybrid Single-Photon Emission Tomography in Comparison with Laboratory Data in a Comprehensive Examination of Patients with Secondary Hyperparathyroidism

Prokina¹,

Аншелес

Tarasov

et al. 2022

Vestn. rentgenol. radiol.

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Objective: to estimate the possibilities and determine the diagnostic value of scintigraphy and single-photon emission computed tomography combined with computed tomography (SPECT/CT) in the assessment of the functional state of parathyroids in comparison with laboratory data in patients with secondary hyperparathyroidism (SHPT). Material and methods. The study consistently included 64 patients with the established diagnosis of SHPT due to the acquired vitamin D deficiency or with terminal chronic kidney disease (CKD), with the presence of ultrasound data and laboratory tests of calcium-phosphoric exchange indicators. Neck and mediastum nuclear study with 99mTc-methoxy-isobutyl-isonitrile (MIBI) was performed in the planar two-phase scintigraphy mode according to the standard protocol with an estimation of parathyroid visualization intensity, as well as in SPECT/CT performed 1 hour after MIBI injection. Results. In the group of patients with CKD as a cause of SHPT (n = 14), the most pronounced increase of parathyroid hormone (PTH) level (210.8 ± 103.0 vs. 107.0 ± 40.2 pg/ml in patients with vitamin D deficiency (n = 50, p < 0.001)) and phosphorus (mean 1.39 ± 0.51 mmol/l), as well as excess of normal levels of alkaline phosphatase (407.7 ± 338.1 units/l) were noted. In patients with vitamin D deficiency, impaired parathyroids according to SPECT/CT data was visualized in 8 % of cases, and in patients with CKD in 14.3 %. No significant differences in the mean levels of vitamin D in patients with (n = 46) and without (n = 4) modified parathyroids according to scintigraphy were detected: 26.06 ± 13.19 vs. 25.82 ± 18.80 ng/ml, respectively (p = 0.97). Differences in PTH and calcium levels were not observed: 91.3 ± 39.2 vs. 89.2 ± 29.5 pg/ml (p = 0.90), 2.53 ± 0.21 vs. 2.58 ± 0,15 mmol/l (p = 0.64), respectively. Conclusion. The neck SPECT/CT is a key method of topical imaging of impaired parathyroids in preoperative preparation of patients with SHPT caused by CKD. The method may have a diagnostic value in treatment-resistant patients with vitamin D deficiency and upper-normal PTH and calcium levels in terms of detection of the nodular form of parathyroid hyperplasia. The implementation of SPECT/CT after 1 hour after MIBI injection increases the sensitivity of the study.

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

Cited by 30 publications

References 39 publications

A roadmap to parathyroidectomy for kidney transplant candidates

A roadmap to parathyroidectomy for kidney transplant candidates

Persistence of secondary hyperparathyroidism after parathyroidectomy in a patient with chronic kidney disease: a case report

The Role of Scintigraphy and Hybrid Single-Photon Emission Tomography in Comparison with Laboratory Data in a Comprehensive Examination of Patients with Secondary Hyperparathyroidism

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