Limitations of Tc99m‐MIBI‐SPECT Imaging Scans in Persistent Primary Hyperparathyroidism

Witteveen, Janneke; Kievit, J.; Stokkel, Marcel P. M.; Morreau, Hans; Romijn, Johannes A.; Hamdy, Neveen A. T.

doi:10.1007/s00268-010-0818-4

Cited by 42 publications

(31 citation statements)

References 52 publications

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“…Moreover, these limitations also apply to MIBI-SPECT as seen in our cohort and as demonstrated by other authors with sensitivities of 67-86 % [13][14][15][16]. In addition, the diagnostic work-up is impeded in patients with concomitant nodular goiter, which is endemic in the German population [17,18].…”

Section: Discussionmentioning

confidence: 62%

Preoperative ¹¹C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

et al. 2015

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Section: Discussionmentioning

confidence: 62%

Preoperative ¹¹C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

et al. 2015

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“…In a retrospective study, Witteveen et al (19) reported that 99m Tc-sestamibi SPECT imaging was of limited value in the reoperative setting of hyperparathyroidism in 19 consecutive patients, as compared with the performance of 99m Tc-sestamibi SPECT in 23 control patients with sporadic hyperparathyroidism due to single-gland disease who underwent scanning before initial surgery. Thus, good performance of a technique before primary operation does not necessarily ensure good performance also in the reoperative setting.…”

Section: Discussionmentioning

confidence: 99%

Planar Scintigraphy with ¹²³I/^99mTc-Sestamibi, ^99mTc-Sestamibi SPECT/CT, ¹¹C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?

et al. 2013

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All patients with primary hyperparathyroidism should undergo localization studies before reoperation, but it is not known which method is most accurate. The purpose of this prospective study was to compare the performance of planar scintigraphy with 123 I/ 99m Tc-sestamibi, 99m Tc-sestamibi SPECT (SPECT/CT), 11 C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism. Methods: Twenty-one patients referred for reoperation of persistent hyperparathyroidism were included and investigated with 123 I/ 99m Tc-sestamibi, SPECT/CT (n 5 19), 11 C-methionine PET/CT, and SVS (n 5 18) before reoperation. All patients had been operated on 1-2 times previously because of hyperparathyroidism. The results of the localization studies were compared with operative findings, histology, and biochemical cure. Results: Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%-79%) for 123 I/ 99m Tc-sestamibi, 19% (95% CI, 5%-42%) for SPECT/CT, 65% (95% CI, 43%-84%) for 11 C-methionine PET/CT, and 40% (95% CI, 19%-65%) for SVS (P , 0.01 for 123 I/ 99m Tc-sestamibi vs. SPECT/ CT). The corresponding accuracy for the correct quadrant or more specific site was 48% (95% CI, 27%-69%) for 123 I/ 99m Tc-sestamibi, 14% (95% CI, 3%-36%) for SPECT/CT, 61% (95% CI, 39%-80%) for 11 C-methionine PET/CT, and 25% (95% CI, 9%-49%) for SVS (P , 0.02 for 123 I/ 99m Tc-sestamibi vs. SPECT/CT). In the 3 patients not cured, preoperative 123 I/ 99m Tc-sestamibi and SPECT/CT remained negative, SVS was false predictive in all, and 11 C-methionine PET/CT in 1. 11 C-methionine PET/CT accurately revealed the pathologic gland in 4 of 8 (50%) patients with a negative 123 I/ 99m Tc-sestamibi scan result, all of whom were biochemically cured after reoperation. Conclusion: Planar scintigraphy with 123 I/ 99m Tc-sestamibi performs well in complicated primary hyperparathyroidism and is recommended as first-line imaging before reoperation. 11 C-methionine PET/CT provides valuable additional information if 123 I/ 99m Tc-sestamibi scan results remain negative. 99m Tc-sestamibi SPECT/CT and SVS provide no additional information, compared with the combined results of 123 I/ 99m Tcsestamibi and 11 C-methionine PET/CT imaging.Key Words: primary hyperparathyroidism; persistent; reoperation; 123 I/ 99m Tc-sestamibi; SPECT-CT; 11 C-methionine PET/CT; selective venous sampling; PTH Nucl Med 2013; 54:739-747 DOI: 10.2967/jnumed.112.109561 Pri mary hyperparathyroidism is a common endocrine disease, with a peak incidence in women aged 50-60 y (1). It is explained by a single parathyroid adenoma in 80%-85% of patients, double adenomas in about 4%, and parathyroid hyperplasia in 15%-20% of cases. Parathyroid carcinoma is...

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“…As initially described, the first imaging study is usually US, together with nuclear medicine imaging. However, in patients with persistent PHPT, the 99m Tc-MIBI sensitivity has been show to decline from 80%, before initial surgery, to 50% (12,31). If localization is not obtained with US and 99m Tc-MIBI scan, additional imaging studies should be performed.…”

Section: Availability Of Rapid Pth Assaymentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

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Limitations of Tc99m‐MIBI‐SPECT Imaging Scans in Persistent Primary Hyperparathyroidism

Cited by 42 publications

References 52 publications

Preoperative ¹¹C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

Preoperative ¹¹C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

Planar Scintigraphy with ¹²³I/^99mTc-Sestamibi, ^99mTc-Sestamibi SPECT/CT, ¹¹C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?

Imaging of the parathyroid glands in primary hyperparathyroidism

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Limitations of Tc99m‐MIBI‐SPECT Imaging Scans in Persistent Primary Hyperparathyroidism

Cited by 42 publications

References 52 publications

Preoperative 11C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

Preoperative 11C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

Planar Scintigraphy with 123I/99mTc-Sestamibi, 99mTc-Sestamibi SPECT/CT, 11C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?

Imaging of the parathyroid glands in primary hyperparathyroidism

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Preoperative ¹¹C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

Preoperative ¹¹C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

Planar Scintigraphy with ¹²³I/^99mTc-Sestamibi, ^99mTc-Sestamibi SPECT/CT, ¹¹C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?