Differential Findings of Tc-99m Sestamibi Dual-Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

Objective: In this study, we aimed to compare the results of ultrasonography and Tc-99m sestamibi dual phase parathyroid scintigraphy with postoperative pathology findings in patients with primary hyperparathyroidism. Methods: The study was carried out with 96 patients, who had surgical intervention for primary hyperparathyroidism and followed up in the Endocrinology and Metabolism Clinic, between January 2010-December 2015. Demographic data and preoperative laboratory results of the patients were reviewed. Diagnostic accuracy and compliance were calculated by comparing imaging methods with surgical localization and histopathological evaluation results. Results: Parathyroid adenomas were detected in 75, parathyroid hyperplasia in 12, and parathyroid carcinoma in 5 and suspect pathology results in 4 patients. The mean preoperative calcium (11.25 mg/dl) and parathormone (400.06 pg/ml) levels were determined. Ultrasonography had an estimated diagnostic sensitivity of 58.7% and a specificity of 38.5% in cases with parathyroid adenoma. It was observed that ultrasonography has not any diagnostic significance, and it is not in accordance with histopathological diagnosis (Kappa=-0.018, p=0.851). Diagnostic sensitivity, and specificity of scintigraphy were found to be 58.7%, and 38.5%, respectively. It was observed to be only fairly concordant, and significant according to histopathological diagnosis (Kappa=0.221, p=0.047). Conclusion: Tc-99m MIBI dual-phase parathyroid scintigraphy, a highly sensitive and noninvasive imaging technique, is clearly superior to the ultrasonography in detecting parathyroid adenomas and locating regions correctly.

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Concomitant primary hyperparathyroidism with papillary thyroid carcinoma: The role of dual-phase 99mTc-MIBI parathyroid imaging: case report

Endocrine Abstracts ◽

10.1530/endoabs.56.p269 ◽

2018 ◽

Author(s):

Adina Anghel ◽

Gabriela Vasiliu ◽

Maria Christina Ungureanu ◽

Cristina Preda ◽

Voichita Mogos ◽

...

Keyword(s):

Case Report ◽

Papillary Thyroid Carcinoma ◽

Primary Hyperparathyroidism ◽

Thyroid Carcinoma ◽

Dual Phase ◽

Papillary Thyroid ◽

99Mtc Mibi ◽

Parathyroid Imaging

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Detection of parathyroid adenomas with 4DCT: Towards a true four-dimensional technique

10.21203/rs.3.rs-237831/v1 ◽

2021 ◽

Author(s):

Steven Raeymaeckers ◽

Yannick De Brucker ◽

Tim Vanderhasselt ◽

Nico Buls ◽

Johan De Mey

Keyword(s):

Primary Hyperparathyroidism ◽

Thyroid Tissue ◽

Motion Artifacts ◽

P Value ◽

Normal Thyroid Tissue ◽

Dose Length Product ◽

Normal Thyroid ◽

Parathyroid Adenomas ◽

Parathyroid Lesions ◽

Over Time

Abstract Background. 4DCT is a commonly performed examination in the management of primary hyperparathyroidism, combining three-dimensional imaging with enhancement over time as the fourth dimension. We propose a novel technique consisting of 16 different contrast phases, instead of three or four different phases. The main aim of this study was to see if this protocol allows for the detection of parathyroid adenomas within dose limits. Our secondary aim was examining the enhancement of parathyroid lesions over time.Methods. For this prospective study, we included 15 patients with primary hyperparathyroidism prior to surgery. We obtain a 4DCT with 16 different phases: an unenhanced phase followed by 11 consecutive arterial phases and 4 venous phases. Centered on the thyroid, continuous axial scanning is performed over a fixed 8cm or 16cm coverage volume after start of contrast administration.Results. In all patients an enlarged parathyroid can be demonstrated, mean lesion size is 13.6mm. Mean peak arterial peak enhancement for parathyroid lesions is 384 HU compared to 333 HU for the normal thyroid. No statistical difference could be found. Time to peak (TTP) is significantly earlier for parathyroid adenomas compared to normal thyroid tissue: 30.8s versus 32.3s (p value 0.008). Mean Slope of Increase (MSI) of the enhancement curve is significantly steeper compared to normal thyroid tissue: 29.8% versus 22.2% (p value 0.012). Mean dose length product was 890.7 mGy.cm with a calculated effective dose of 6.7 mSv.Conclusion. We propose a feasible 4DCT scanning-protocol for the detection of parathyroid adenomas. We manage to obtain a multitude of phases, allowing for a dynamic evaluation within an acceptable exposure range when compared to classic helical 4DCT. Our 4DCT protocol may allow for a better visualization of the pattern of enhancement of parathyroid lesions, as enhancement over time curves can be drawn. This way wash-in and wash-out of contrast in suspected lesions can be readily demonstrated. Motion artifacts are less problematic as multiple phases are available.

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The Detection of Preoperative Parathyroid Lesions: The Success of Ultrasonography, Technetium-99m Methoxyisobutylisonitrile Parathyroid Scintigraphy and Spect-CT

Endocrine Practice ◽

10.1016/j.eprac.2021.07.010 ◽

2021 ◽

Author(s):

Ozden Ozdemir Baser ◽

Derya Koseoglu ◽

Zeynep Cetin ◽

Merve Catak ◽

Dilek Berker

Keyword(s):

Parathyroid Scintigraphy ◽

Technetium 99M ◽

Parathyroid Lesions ◽

Technetium 99M Methoxyisobutylisonitrile

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Efficiency of Gamma Probe and Dual-Phase Tc-99m Sestamibi Scintigraphy in Surgery for Patients with Primary Hyperparathyroidism

Clinical Nuclear Medicine ◽

10.1097/01.rlu.0000053406.96478.71 ◽

2003 ◽

Vol 28 (3) ◽

pp. 186-191 ◽

Cited By ~ 2

Author(s):

CENGIZ H. DEMIRKUREK ◽

ISIK ADALET ◽

TARIK TERZIOGLU ◽

SELCUK OZARMAGAN ◽

ALP BOZBORA ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Gamma Probe ◽

Dual Phase ◽

Sestamibi Scintigraphy

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PRE-OPERATIVE LOCALIZATION OF HYPERFUNCTIONING PARATHYROID TISSUE BY PARATHYROID SCINTIGRAPHY

Acta Endocrinologica ◽

10.1530/acta.0.0810298 ◽

1976 ◽

Vol 81 (2) ◽

pp. 298-309 ◽

Cited By ~ 4

Author(s):

P. Burckhardt ◽

A. Bischof-Delaloye ◽

B. Ruedi ◽

B. Delaloye

Keyword(s):

Primary Hyperparathyroidism ◽

False Positive ◽

Parathyroid Tissue ◽

Tubular Reabsorption ◽

Plasma Calcium ◽

Parathyroid Scintigraphy ◽

Biochemical Screening ◽

Parathyroid Adenomas ◽

Positive Results ◽

Positive Focus

ABSTRACT In 22 patients who underwent surgery suspected of primary hyperparathyroidism, the surgical findings were compared with the results obtained by pre-operative parathyroid scanning and biochemical screening. Thirteen of 15 parathyroid adenomas were localized by pre-operative scanning, but in five of them a false positive focus was also described. The technique was less useful in primary hyperplasia. Comparable results were reported by other investigators. In both instances the best results were obtained in patients with high parathyroid activity as measured by plasma calcium, plasma alkaline phosphatase and tubular reabsorption of phosphorus (TRP). Parathyroid scintigraphy was especially helpful in the presence of ectopic adenomas and in patients who had undergone previous parathyroid surgery. Unfortunately, the possibility of false positive results makes it unreliable for the diagnosis of primary hyperparathyroidism.

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