Factors That Affect the Sensitivity of Imaging Modalities in Primary Hyperparathyroidism

Background. Cervical ultrasound, 99mTc-sestamibi single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT), and cervical CT are routinely used in preoperative localization of primary hyperparathyroidism (PHPT). However, false-negative imaging results are also frequently encountered in clinical practice. Exploring the factors that affect the sensitivity of these imaging modalities is important for the surgical management of PHPT patients. Methods. Clinical data of 352 PHPT patients hospitalized in our center from January 2011 to December 2015 were retrospectively collected to evaluate the sensitivity of 3 imaging modalities in the preoperative localization of parathyroid lesions. The ROC curve analysis was used to explore the clinical factors affecting the sensitivity of localization, and the cut-point(s) of related factors were determined. Results. 99mTc-MIBI SPECT/CT has the highest sensitivity among the localization modalities commonly used, reaching 91.1% (86.0%–94.8%). When the lengths of parathyroid lesions were ≤1.3 cm, the sensitivity of neck ultrasonography significantly decreased, while the sensitivity of 99mTc-MIBI SPECT/CT decreased with parathyroid lesions ≤1.3 cm or serum PTH≤252 pg/ml. 99mTc-MIBI SPECT/CT was less effective in localizing the hyperplasia lesions. Neck ultrasonography combined with 99mTc-MIBI SPECT/CT can effectively improve the accuracy of preoperative localization of parathyroid lesions to 96.2% (92.7%–98.1%). Conclusions. Small parathyroid lesion and mild elevation of serum PTH would reduce the accuracy of parathyroid localization in PHPT patients.

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An Unusual Case of Primary Hyperparathyroidism: Case Report of a Bifocal Intrathyroidal Parathyroid Carcinoma

Ear Nose & Throat Journal ◽

10.1177/0145561320977466 ◽

2020 ◽

pp. 014556132097746

Author(s):

Maxime Damien ◽

Alexandra Rodriguez ◽

Pierre Kleynen ◽

Didier Dequanter ◽

Cyril Bouland

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Parathyroid Carcinoma ◽

Photon Emission ◽

Parathyroid Tissue ◽

Emission Computed Tomography ◽

Thyroid Lobe ◽

Imaging Results ◽

Pet Ct ◽

Left Thyroid Lobe

Intrathyroidal parathyroid carcinoma is an extremely rare cause of primary hyperparathyroidism. We reported a 51-year old woman who presented symptoms of hypercalcemia. 99mTc sestamibi single-photon emission computed tomography/computed tomography (CT) revealed a large hypermetabolic nodule in the left thyroid lobe suggestive of hyperfunctioning parathyroid tissue. 11C-methionine positron emission tomography/computed tomography (PET/CT) and 18F-fluorocholine PET/CT confirmed the nodule in the left thyroid lobe and also revealed a hypermetabolic activity on the posterior surface of the lower left pole. The patient underwent a total thyroidectomy and parathyroidectomy, and a diagnosis of bifocal intrathyroidal parathyroid carcinoma was confirmed. We present the first reported case of bifocal intrathyroidal carcinoma and discuss the discordant imaging results.

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Single Center Experience in the Surgical Management of Primary Hyperparathyroidism

Clinical and Experimental Otorhinolaryngology ◽

10.21053/ceo.2019.01361 ◽

2020 ◽

Vol 13 (3) ◽

pp. 285-290

Author(s):

Berat Demir ◽

Adem Binnetoglu ◽

Akın Sahin ◽

Dilek Gogas Yavuz

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Imaging Modalities ◽

Neck Exploration ◽

Preoperative Imaging ◽

Emission Computed Tomography ◽

Laboratory Values ◽

Ectopic Parathyroid ◽

Pathology Reports

Objectives. As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years.Methods. One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease.Results. Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma.Conclusion. Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.

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Accuracy of Dual Phase Single-Photon Emission Computed Tomography/Computed Tomography in Primary Hyperparathyroidism: Correlation with Serum Parathyroid Hormone Levels

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2015.06.002 ◽

2016 ◽

Vol 67 (2) ◽

pp. 115-121 ◽

Cited By ~ 4

Author(s):

Wade Koberstein ◽

Christopher Fung ◽

Kristy Romaniuk ◽

Jonathan T. Abele

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Predictive Value ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Dual Phase ◽

Parathyroid Adenomas ◽

Ectopic Parathyroid ◽

Serum Pth

Purpose The objectives of this study were: 1) to determine the accuracy of dual-phase 99mTc -methoxyisobutylisonitrile (MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of parathyroid adenomas in the setting of primary hyperparathyroidism; 2) to determine the accuracy of localization for ectopic glands; and 3) to assess the relationship between accuracy and serum parathyroid hormone (PTH) levels. Methods Eighty-eight patients who underwent 99mTc-MIBI SPECT/CT imaging for primary hyperparathyroidism at our institution over a 27-month period were retrospectively assessed. The preoperative SPECT/CT results were compared to intraoperative findings (within 1 year of imaging). The relationship between serum PTH level (within 3 months) and SPECT/CT accuracy was then evaluated. Results Accuracy indices for the retrothyroid subgroup were sensitivity 86.7%, specificity 96.4%, positive predictive value 98.1%, negative predictive value 77.1%, and accuracy 89.8%. Accuracy indices for ectopic parathyroid adenomas were sensitivity 81.5%, specificity 100%, positive predictive value 100%, negative predictive value 92.4%, and accuracy 94.3%. For the overall group, SPECT/CT demonstrated a sensitivity of 85.1% and a PPV of 98.7%. SPECT/CT correctly identified the abnormal parathyroid gland in 60% of patients with a normal serum PTH (<6.9 pmol/L), 73% between 6.9-9.9 pmol/L, 86% between 10.0-14.9 pmol/L, 100% between 15.0-19.9 pmol/L, 88% between 20.0-24.5 pmol/L, and 100% of patients with a PTH greater than 25.0 pmol/L. Conclusions Dual-phase 99mTc- MIBI with SPECT/CT is an accurate and reliable means to correctly localize both retrothyroid and ectopic parathyroid adenomas for the purpose of surgical planning. The accuracy of SPECT/CT increases with increasing serum PTH levels.

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Differential Diagnostic Value of Parathyroid 99mTc-MIBI SPECT/CT in MIBI Uptake Lesion

10.21203/rs.3.rs-54808/v1 ◽

2020 ◽

Author(s):

Ri Sa ◽

Danyan Liu ◽

Sen Hou ◽

Hongguang Zhao ◽

Feng Guan

Keyword(s):

Computed Tomography ◽

Differential Diagnosis ◽

Single Photon ◽

Photon Emission ◽

Nodular Goiter ◽

Multivariable Logistic Regression Analysis ◽

Emission Computed Tomography ◽

Pathological Findings ◽

Serum Pth ◽

Mibi Spect

Abstract Background: To investigate the role of parathyroid technetium-99m-hexakis2-methoxy-2-methylpropylisonitrile (99mTc-MIBI) single photon emission computed tomography/ computed tomography (SPECT/CT) combined with the serum calcium (Ca) and serum parathyroid hormone (PTH) in the differential diagnosis of MIBI uptake lesion. Methods: 201 patients with MIBI uptake lesion on parathyroid 99mTc-MIBI SPECT/CT from January 2015 to July 2019 were enrolled in this study. All patients who underwent surgical resection were classified into two groups: primary hyperparathyroidism (PHPT) and non-PHPT in terms of the pathological findings. Radiological performance of 99mTc-MIBI SPECT/CT, serum Ca and serum PTH were comparable between the two groups.Results: 201 patients (135 females; median age, 53.0 years; age range, 29 – 79 years) were included. Pathological findings were as follows: PHPT was in 126 (62.7%) patients, including parathyroid adenoma in 106 patients, parathyroid cancer in 12 patients and parathyroid hyperplasia in 8 patients, while non-PHPT were in 75 (37.3%) patients, including thyroid adenoma in 14 patients, thyroid papillary cancer in 15 patients and thyroid nodular goiter in 46 patients. In the following multivariable logistic regression analysis, serum Ca and diameter of the shortest axis of the lesion were the independent factors for differentiating PHPT from non-PHPT. In receiver operating characteristic (ROC) analyses, the cut-off value of serum Ca differentiating PHPT from non-PHPT was 2.6 mmol/L, yielding the area under the ROC curve (AUC) of 0.931, sensitivity of 85.7%, specificity of 89.2%; the cut-off value of diameter of the shortest axis of the lesion was 20.4mm, yielding AUC of 0.728, sensitivity of 62.2%, specificity of 87.1%.Conclusion: Parathyroid 99mTc-MIBI SPECT/CT combined with serum Ca and serum PTH contributed to the differential diagnosis of PHPT from non-PHPT, evenly can assist the determination of the specific pathology of MIBI uptake lesion before surgery.

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The Value of 99mTc-MIBI SPECT/CT in the Postoperative Assessment of Patients with Differentiated Thyroid Carcinoma

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211108154028 ◽

2021 ◽

Vol 17 ◽

Author(s):

Berna Okudan ◽

Bedri Seven ◽

Nedim C.M. Gülaldı ◽

Mustafa Çapraz ◽

Yusuf Açıkgöz

Keyword(s):

Computed Tomography ◽

Thyroid Carcinoma ◽

Single Photon ◽

Lung Metastases ◽

Photon Emission ◽

Differentiated Thyroid Carcinoma ◽

Whole Body ◽

Emission Computed Tomography ◽

99Mtc Mibi ◽

Mibi Spect

Background: The therapeutic approaches of differentiated thyroid carcinoma (DTC) are surgery, ablation therapy with the postoperative use of radioiodine-131 (131I), and thyroid-stimulating hormone (TSH) suppression therapy. After the surgical therapy, the patient should be assessed for remnants/metastases. Objective: The purpose of this research was to investigate the role of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in the postoperative management of patients with DTC. Methods: The study comprised 22 DTC patients (13 women, 9 men; mean age 46.55 ± 13.27 y) who underwent a total thyroidectomy previously. All patients were investigated for thyroid remnants/metastases by 99mTc-MIBI SPECT/CT, posttherapy 131I whole-body scan (WBS) and ultrasound (US). Serum TSH, thyroglobulin and anti-Tg antibody levels were measured. Results of imaging modalities and laboratory measurements were compared with each other. Results: 99mTc-MIBI SPECT/CT, 131I WBS and US respectively demonstrated thyroid remnants in 15 (68.18%), 22 (100%) and 14 (63.63%) of the all patients and metastatic lymph nodes in 8 (100%), 6 (75%) and 6 (75%) of the 8 patients with lymph node metastases. 99mTc-MIBI SPECT/CT also demonstrated lung metastases in 2 patients (9.09% of all patients). The same result was obtained with 131I WBS. Conclusion : The findings of this study show that 99mTc-MIBI SPECT/CT can be effective for detecting metastases in patients with DTC who underwent surgery prior to 131I therapy.

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Preoperative localization of parathyroid lesions

Nuklearmedizin ◽

10.3413/nukmed-0108 ◽

2008 ◽

Vol 47 (04) ◽

pp. 158-162 ◽

Cited By ~ 16

Author(s):

E. Mirallié ◽

T. Carlier ◽

H. Abbey-Huguenin ◽

F. Aubron ◽

F. Kraeber-Bodéré ◽

...

Keyword(s):

Thyroid Nodules ◽

Accurate Method ◽

Sex Characteristics ◽

Double Phase ◽

Imaging Results ◽

Parathyroid Lesions ◽

99Mtc Mibi ◽

The Impact ◽

Pth Level ◽

Mibi Spect

SummaryThe aim of our study was to assess retrospectively the value of 99mTc-MIBI SPECT in the localization of parathyroid lesions in primary hyperparathyroidism and to determine the impact of PTH level, age, sex, characteristics of the lesions and thyroid nodules on the sensitivity of imaging. Patients, methods: Fifty nine patients who were cured after the resection of 60 lesions (50 adenomas, 9 hyperplasias and 1 carcinoma, 9 of them in ectopy) were selected. 99mTcO4-, early and late 99mTc-MIBI planar images (n = 59), 99mTc-MIBI SPECT (n = 58) and ultrasound (n = 50) performed preoperatively were analyzed. The imaging results were compared to surgical and histological findings and correlated to different factors suspected of influencing the imaging's sensitivity. Results: Sensitivity of double phase 99mTc-MIBI/99mTcO4- scintigraphy was higher than that of early or late scintigraphy alone. SPECT increased the sensitivity of scintigraphy from 85% to 92% and was useful to confirm doubtful foci and to localize ectopic lesions. Ultrasound (US) had the lowest sensitivity (56%) and the highest rate of false-positive results (n = 10), but identified 2 adenomas which were not detected by scintigraphy. Combining all imaging modalities, sensitivity reached 96%. Better sensitivities were observed when age < 69 years, preoperative PTH level ≥155 pg/ml, weight of the gland ≥0.80 g and in the absence of thyroid nodules. US was more influenced by these factors than scintigraphy. Conclusion: Combination of US, double-phase 99mTc- MIBI/99mTcO4- planar scintigraphy and SPECT is the most accurate method for the detection of parathyroid lesions and should be performed before minimally invasive surgery, especially when PTH level is low, in older patients and in cases of multinodular goiter.

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

BMC Medical Imaging ◽

10.1186/s12880-021-00616-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruigang Lu ◽

Wei Zhao ◽

Li Yin ◽

Ruijun Guo ◽

Bojun Wei ◽

...

Keyword(s):

Parathyroid Hormone ◽

Retrospective Study ◽

Primary Hyperparathyroidism ◽

Diagnostic Performance ◽

Preoperative Localization ◽

Clinical Value ◽

Parathyroid Adenomas ◽

Parathyroid Lesions ◽

Primary Hyperthyroidism ◽

Mibi Spect

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.

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99mTc-MIBI SPECT in primary hyperparathyroidism

Nuklearmedizin ◽

10.3413/nukmed-0057 ◽

2008 ◽

Vol 47 (01) ◽

pp. 01-07 ◽

Cited By ~ 4

Author(s):

N. Thoma ◽

M. Dietlein ◽

D. Moka ◽

W. Eschner ◽

M. Faust ◽

...

Keyword(s):

Vitamin D ◽

Primary Hyperparathyroidism ◽

Vitamin D Deficiency ◽

Statistical Significance ◽

Negative Influence ◽

Normal Vitamin ◽

Planar Images ◽

99Mtc Mibi ◽

Mibi Spect ◽

Spect Images

SummaryAim of the study was to analyse the influence of a concomitant vitamin D deficiency on the results of 99mTc-MIBI studies in patients (pts) with primary hyperparathyroidism (pHPT). Patients, methods: Between January 1998 and May 2004, 71 pts with pHPT had undergone operation after a 99mTc-MIBI study of whom 54 pts (76%) had normal values of 25-OH-vitamin D3 and 17 pts (24%) had vitamin D deficiency. Results of a dual-phase 99mTc-MIBI protocol with SPECT were compared with histopathology. Results: In 54 pts with normal vitamin D values late SPECT images identified more lesions (n = 51, sensitivity 91%) than early planar (n = 45, sensitivity 82%) or late planar images (n = 50, sensitivity 88%). In 17 pts with vitamin D deficiency late SPECT images identified more lesions (n = 13, sensitivity 72%) than early planar (n = 10, sensitivity 56%) or late planar images (n = 10, sensitivity 56%) too. In pts with vitamin D deficiency the sensitivity of a 99mTc-MIBI SPECT study was lower than in those with normal vitamin D status (72% vs. 91%) and dependent on the value for PTH. However, the results did not reach statistical significance: early planar: p = 0.1625; late planar: p = 0.0039; 99mTc-MIBI SPECT: p = 0.1180. Conclusion: The likelihood of a pathological 99mTc-MIBI study being obtained in pts with pHPT is dependent on the parathyroid hormone level. However, a negative influence of a low vitamin D level on the scintigraphic detection rate of a parathyroid adenoma could not be proven which may be due to the low number of pts with vitamin D deficiency.

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