Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism

Abstract

Background Primary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas. Methods A total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated. Results In this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; χ2 = 26.224, 18.227 respectively, P < 0.001). The differences between US + Tc-99m MIBI SPECT/CT and Tc-99m MIBI SPECT/CT-alone were statistically significant (χ2 = 33.410, 21.587 respectively, P < 0.001), yet there were no significant differences in the sensitivity or accuracy between US + Tc-99m MIBI SPECT/CT and US-alone (χ2 = 0.866, 0.187 respectively, P = 0.352 and 0.665). Conclusions US shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.

A Prospective Comparative Study of Using Ultrasonography, 4D-CT and Parathyroid Dual-Phase Scintigraphy with SPECT in Patients with Primary Hyperparathyroidism

“…SPECT/CT demonstrated 93% sensitivity, 4D-CT 93% sensitivity, and ultrasonography 73% sensitivity. These numbers are in concordance with the results of the two meta-analyses [1,15] and with the later studies [18][19][20]. On the other hand, our sample size is too small for further subgroup analyses.…”

“…We show an ectopic adenoma in Figure 3, and a syndromic (MEN) hypercalcemia patient in Figure 2. In a recent study consisting of 107 patients, SPECT was superior to US to detect ectopic disease, even though they found US superior to SPECT in detecting adenomas preoperatively [20]. Anecdotally, studies have shown that larger parathyroid adenomas are associated with lower vitamin D levels, which are more likely to be detected by 99m Tc-MIBI-SPECT/CT [23].…”

Clinical, Biochemical, and Sonographic Factors Influencing Performance of Parathormone Washout Measurement vs. 99mTc-MIBI Scintigraphy in the Preoperative Diagnostics of Parathyroid Adenomas

“…The sensitivity and specificity of ultrasonography is estimated to be 69-90% and 90-98%, respectively. For MIBI, similarly wide ranges have been reported (68-95%) [5]. The combination of both methods shows better performance (sensitivity and specificity 90-100%), while the highest diagnostic accuracy (97%) was achieved using the parathormone (PTH) concentration measurement in the washout from the ultrasound-guided biopsy (PTHw) of the suspected lesion [6].…”

Four-Dimensional Computed Tomography for Parathyroid Adenoma Localization: A Pre-Operative Imaging Protocol

“…USG has historically had favorable specificity and accuracy in adenoma detection, with published rates up to 93% and 88%, respectively. 21 It poses no radiation risk, and is lower cost compared to SES and 4D CT (which can be up to 6 times the cost of USG). 22,23 However, it is limited by patient body habitus, skill of the ultrasonographer, and concomitant thyroid disease.…”