Semiquantitative assessment of 99mTc-MIBI uptake in parathyroids of secondary hyperparathyroidism patients with chronic renal failure

Abstract

ObjectiveTo explore the valuably influential factors and improve the diagnostic accuracy and efficiency of 99mTc-methoxyisobutylisonitrile (MIBI) uptake in parathyroids of secondary hyperparathyroidism (SHPT) patients with chronic renal failure (CRF).MethodsThe correlation analysis was performed between clinical indices related to CRF and 99mTc-MIBI uptake intensity TBR (the gray value mean ratio between the parathyroid target and the bilateral neck background, semiquantitatively calculated with ImageJ software). All clinical indices and TBRs were compared by a three- or two-level grouping method of MIBI uptake, which was visually qualitatively assessed. The three-level grouping method comprised slight, medium, and high groups with little, faint, and distinct MIBI concentration in parathyroids, respectively. The two-level grouping method comprised insignificant and significant groups with TBR greater than or less than 0.49–0.71, respectively.ResultsMIBI uptake was significantly positively related to patient age, CRF course, hemodialysis vintage, serum parathyroid hormone (PTH), and alkaline phosphatase (AKP) but was significantly negatively related to serum uric acid (UA). MIBI washout was significantly positively related to patient age but was significantly negatively related to serum phosphorus (P) and calcium (Ca) × P. Oral administration of calcitriol and calcium could significantly reduce the MIBI uptake. MIBI uptake tendency might alter. Such seven indices, namely the MIBI uptake, CRF course, hemodialysis vintage, serum AKP, calcium, cysteine proteinase inhibitor C, and PTH, were comparable between the slight and medium groups but were significantly different between the slight and high groups or between the medium and high groups. The above seven indices plus blood urea nitrogen/creatinine were all significantly different between the insignificant and significant groups. All above significances were with P < 0.05.ConclusionsPatient age, CRF course, hemodialysis vintage, serum PTH, AKP, UA, phosphorus, Ca × P, oral administration of calcitriol and calcium, and parathyroids themselves can significantly influence MIBI uptake in parathyroids of SHPT patients with CRF. The two-level grouping method of MIBI intensity should be adopted to qualitatively diagnose the MIBI uptake.

Tc‐99m‐MIBI SPECT/CT imaging to diagnose secondary hyperparathyroidism after parathyroid forearm transplantation

“…The imaging principle is based on the abundance of mitochondria in hyperfunctioning parathyroid tissue, where MIBI can accumulate 7 . MIBI uptake was significantly positively correlated with patient age, duration of chronic renal failure, years on hemodialysis, serum parathyroid hormone, and alkaline phosphatase, but negatively correlated with serum uric acid 8 …”

“…7 MIBI uptake was significantly positively correlated with patient age, duration of chronic renal failure, years on hemodialysis, serum parathyroid hormone, and alkaline phosphatase, but negatively correlated with serum uric acid. 8 Tc-99m-MIBI duplex imaging is a more commonly used functional imaging diagnostic method for parathyroid disease today, and has unique value compared to other imaging examinations in helping to localize one or more parathyroid lesions, especially for ectopic glands that cannot be identified by ultrasound, with a higher detection rate than ultrasound. A comparative study involving 60 patients demonstrated that early Tc-99m-MIBI SPECT/CT has superior ability to detect parathyroid lesions in Secondary hyperparathyroidism patients compared to ultrasound, dual-phase Tc-99m-MIBI scintigraphy, and delayed Tc-99m-MIBI SPECT/CT.…”

Coincidence or Causality: Parathyroid Carcinoma in Chronic Kidney Disease—Case Report and Literature Review

“…The higher RI may be explained by the lower expression of the P-glycoprotein and multidrug resistance-associated protein 1 (MRP1), which transport drugs and their metabolites across the cell membrane [ 19 , 68 ]. Whether this may apply to PC in SHPT remains unclear, especially as parathyroid MIBI uptake in SHPT is reduced by the administration of calcitriol and calcium, and MIBI uptake and washout correlate with parameters related to CKD (higher uptake and lower washout with longer dialysis vintage and higher PTH and Ca x P product) [ 69 ].…”