Diagnosis performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT in preoperative localization of parathyroid gland in secondary hyperparathyroidism

Abstract Background: Secondary hyperparathyroidism (SHPT) usually need parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of ultrasonography, dual-phase 99m Tc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT in patients with SHPT. Methods: Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively with ultrasonography, dual-phase 99m Tc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy rate were determined for each method. Spearman correlation analysis was used to analyze the correlation of the hyperplastic parathyroid calcification with serum alkaline phosphatase (AKP) and parathyroid hormone (PTH). Results: 229 lesions in 60 patients were pathological confirmed to be parathyroid hyperplasia with 209 lesions in typical sites, 15 lesions in upper mediastinum and 5 lesions in the thyroid. 88.33% (53/60) patients had four lesions. US, early and delayed SPECT/CT had significantly higher sensitivity and accuracy rate (P < 0.001) than did dual-phase 99m Tc-MIBI scintigraphy. Furthermore, early SPECT/CT had significantly higher sensitivity (χ2 = 17.521, P < 0.001, χ2 = 35.027, P < 0.001) and accuracy rate (χ2 = 11.076, P = 0.001, χ2 = 16.289, P < 0.001) than did US and delayed SPECT/CT. In ectopic hyperplastic parathyroid, the sensitivity of early SPECT/CT (90%) was significantly higher than US (55%) and dual-phase planar (50%) (P = 0.039 and P = 0.039). Spearman correlation results showed a significant linear association between the calcification and serum PTH (r = 0.398, P = 0.002) and AKP (r = 0.415, P = 0.002). Conclusion: The ability of early SPECT/CT to detect hyperplastic parathyroid in patients with SHPT is superior to US, 99m Tc-MIBI scintigraphy and delayed SPECT/CT, and dual-phase SPECT/CT is not essential. Calcification of parathyroid gland is related to the levels of PTH and AKP and may help provide an evidence for the identification of SHPT.

Download Full-text

Diagnosis performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT in preoperative localization of parathyroid gland in secondary hyperparathyroidism

10.21203/rs.2.22081/v1 ◽

2020 ◽

Author(s):

Rongqin Zhang ◽

Zhanwen Zhang ◽

Huang Pinbo ◽

Zhi Li ◽

Rui Hu ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Parathyroid Gland ◽

Serum Alkaline Phosphatase ◽

Dual Phase ◽

Spearman Correlation ◽

Accuracy Rate ◽

99Mtc Mibi ◽

Serum Pth ◽

Mibi Scintigraphy ◽

Higher Sensitivity

Abstract ObjectiveSecondary hyperparathyroidism (SHPT) usually need parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT in patients with SHPT.MethodsSixty patients with SHPT who were undergoing dialysis were evaluated preoperatively with ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy rate were determined for each method. Spearman correlation analysis was used to analyze the correlation of the hyperplastic parathyroid calcification with serum alkaline phosphatase (AKP) and parathyroid hormone (PTH). Results229 lesions in 60 patients were pathological confirmed to be parathyroid hyperplasia with 209 lesions in typical sites, 15 lesions in upper mediastinum and 4 lesions in the thyroid. 88.33% (53/60) patients had four lesions. US, early and delayed SPECT/CT had significantly higher sensitivity and accuracy rate (P < 0.001) than did dual-phase 99mTc-MIBI scintigraphy. Furthermore, early SPECT/CT had significantly higher sensitivity (χ2 = 17.521, P < 0.001, χ2 = 35.027, P < 0.001) and accuracy rate (χ2 = 11.076, P = 0.001, χ2 = 16.289, P < 0.001) than did US and delayed SPECT/CT. In ectopic hyperplastic parathyroid, the sensitivity of early SPECT/CT (90%) was significantly higher than US (55%) and dual-phase planar (50%) (P = 0.039 and P = 0.039). Spearman correlation results showed a significant linear association between the calcification and serum PTH (r = 0.398, P = 0.002) and AKP (r = 0.415, P = 0.002).ConclusionThe ability of early SPECT/CT to detect hyperplastic parathyroid in patients with SHPT is superior to US, 99mTc-MIBI scintigraphy and delayed SPECT/CT, and dual-phase SPECT/CT is not essential. Calcification of parathyroid gland is a special sign of SHPT and correlated with serum PTH and AKP.

Download Full-text

Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism

10.21203/rs.2.22081/v4 ◽

2020 ◽

Author(s):

Rongqin Zhang ◽

Zhanwen Zhang ◽

Pinbo Huang ◽

Zhi Li ◽

Rui Hu ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Diagnostic Performance ◽

Serum Alkaline Phosphatase ◽

Parathyroid Glands ◽

Dual Phase ◽

Spearman Correlation ◽

99Mtc Mibi ◽

Mibi Scintigraphy ◽

Mibi Spect ◽

Higher Sensitivity

Abstract Background: Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT.Methods: Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH).Results: A total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US, early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99mTc-MIBI scintigraphy (P < 0.001). Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P < 0.05). The Spearman correlation results showed a significant linear association between calcification and both serum PTH and ALP (P = 0.002).Conclusion: The ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.

Download Full-text

Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, and early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism

10.21203/rs.2.22081/v3 ◽

2020 ◽

Author(s):

Rongqin Zhang ◽

Zhanwen Zhang ◽

Pinbo Huang ◽

Zhi Li ◽

Rui Hu ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Diagnostic Performance ◽

Serum Alkaline Phosphatase ◽

Parathyroid Glands ◽

Dual Phase ◽

Spearman Correlation ◽

99Mtc Mibi ◽

Mibi Scintigraphy ◽

Mibi Spect ◽

Higher Sensitivity

Abstract Background: Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, and early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT.Methods: Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, and early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH).Results: A total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US and early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy (P < 0.001) than dual-phase 99mTc-MIBI scintigraphy. Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (χ2 = 17.521, P < 0.001, χ2 = 35.027, P < 0.001) and accuracy (χ2 = 11.076, P = 0.001, χ2 = 16.289, P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P = 0.039 and P = 0.039). The Spearman correlation results showed a significant linear association between calcification and both serum PTH (r = 0.398, P = 0.002) and ALP (r = 0.415, P = 0.002).Conclusion: The ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.

Download Full-text

Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism

BMC Medical Imaging ◽

10.1186/s12880-020-00490-3 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Rongqin Zhang ◽

Zhanwen Zhang ◽

Pinbo Huang ◽

Zhi Li ◽

Rui Hu ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Parathyroid Gland ◽

Diagnostic Performance ◽

Dual Phase ◽

99Mtc Mibi ◽

Mibi Scintigraphy ◽

Mibi Spect

Download Full-text

Parathyroidectomia: treatment of secondary hyperparathyroidism. Causes and prophylaxis of disease relapse

Acta medica Lituanica ◽

10.6001/actamedica.v18i4.1870 ◽

2011 ◽

Vol 18 (4) ◽

pp. 170-174

Author(s):

V. BEIŠA ◽

K. LAGUNAVIČIUS ◽

A. BEIŠA ◽

K. STRUPAS

Keyword(s):

Parathyroid Hormone ◽

Surgical Treatment ◽

Secondary Hyperparathyroidism ◽

Parathyroid Gland ◽

Ultrasound Examination ◽

Single Photon ◽

Photon Emission ◽

Parathyroid Glands ◽

Emission Computed Tomography ◽

Mibi Scintigraphy

Background. The growing number of haemodialysis patients and the increasing their life expectancy within the past few years have resulted in a rise of long-term haemodialysis-associated complications. The aim of the paper is to present a case study of a successful surgical treatment of secondary hyperthyroidism and assess the causes of the disease. Materials and methods. A 63-year-old male patient had been on haemodialysis for 18 years; he had undergone parathyroidectomy for secondary hyperparathyroidism 10 years ago. The relapse of the disease was suspected when the patient developed the onset of pruritus and muscle pain. The following tests were performed: biochemical markers of plasma calcium and parathyroid hormone, thyroid ultrasound examination, parathyroid gland 99 mTc MIBI scintigraphy, single photon emission computed tomography of the neck and mediastinum. Results. Elevated calcium (2.73 mmol/l serum) and parathyroid hormone (1352 pg/ml blood plasma) levels were found. Ultrasound examination, 99 mTc MIBI scintigraphy and SPECT revealed parathyroid adenoma of the left inferior thyroid section. The patient underwent surgery in 2011. Remnants of the previously resected parathyroid gland were removed, and an accessory parathyroid gland was found within the thymus; this gland was removed, and partial autotransplantation was performed. The level of the parathyroid hormone decreased to 24 pg/ml during the day after surgery. The histological examination of the removed tissues was performed. Conclusions. Accessory parathyroid glands are usually found within the thymus; therefore, any type of surgical treatment of secondary hyperparathyroidism should include thymectomy. Keywords: parathyroid glands, secondary hyperparathyroidism, haemodialysis, parathyroidectomy

Download Full-text

Dual-phase 99mTc-MIBI scintigraphy to assess calcimimetic effect in patients on haemodialysis with secondary hyperparathyroidism

Nuclear Medicine Communications ◽

10.1097/mnm.0b013e3283305df6 ◽

2009 ◽

Vol 30 (11) ◽

pp. 890-894 ◽

Cited By ~ 5

Author(s):

David Fuster ◽

José-Vicente Torregrosa ◽

Beatriz Domenech ◽

Oriol Solà ◽

Gloria Martín ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Dual Phase ◽

99Mtc Mibi ◽

Mibi Scintigraphy

Download Full-text

Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study

Clinical Oral Investigations ◽

10.1007/s00784-021-03826-7 ◽

2021 ◽

Author(s):

W. Leontiev ◽

E. Magni ◽

C. Dettwiler ◽

C. Meller ◽

R. Weiger ◽

...

Keyword(s):

Multivariate Analysis ◽

Ex Vivo ◽

Predictive Values ◽

Composite Restorations ◽

Significant Difference ◽

Identification Technique ◽

Illumination Method ◽

Sensitivity Specificity ◽

Entire Procedure ◽

Higher Sensitivity

Abstract Objectives The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. Materials and methods Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. Results The sensitivity (84%, CI 81–86%), specificity (94%, CI 93–96%), PPV (92%, CI 90–94%), and NPV (90%, CI 88–91%) of FIT was significantly higher than that of CONV (47%, CI 44–50%; 82%, CI 79–84%; 66%, CI 62–69%, and 69%, CI 68–71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. Conclusions FIT is more reliable for detecting composite restorations than the conventional illumination method. Clinical relevance FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

Download Full-text

Differential regulation of PHEX expression in bone and parathyroid gland by chronic renal insufficiency and 1,25-dihydroxyvitamin D3

AJP Renal Physiology ◽

10.1152/ajprenal.00321.2003 ◽

2004 ◽

Vol 286 (4) ◽

pp. F739-F748 ◽

Cited By ~ 12

Author(s):

Angela J. Brewer ◽

Lucie Canaff ◽

Geoffrey N. Hendy ◽

Harriet S. Tenenhouse

Keyword(s):

Renal Insufficiency ◽

Parathyroid Gland ◽

Chronic Renal Insufficiency ◽

Control Diet ◽

Protein Abundance ◽

Dihydroxyvitamin D3 ◽

Dihydroxyvitamin D ◽

Phex Gene ◽

Rat Tibia ◽

Serum Pth

Mutations in the PHEX gene are responsible for X-linked hypophosphatemia, a renal phosphate-wasting disorder associated with defective skeletal mineralization. PHEX is predominantly expressed in bones and teeth and in the parathyroid gland of patients with chronic renal failure and tertiary hyperparathyroidism. The purpose of the present study was to examine the effects of renal insufficiency and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] on the regulation of PHEX expression in rat tibia and parathyroid gland. In rats fed a high-phosphate (Pi) diet, ⅚ nephrectomy elicited a significant increase in the serum parathyroid hormone (PTH) concentration that was associated with a significant increase in the abundance of PHEX mRNA and protein in the tibia and a significant increase in PHEX mRNA in the parathyroid gland. In contrast, 1,25(OH)2D3 administration to intact rats fed a control diet elicited a significant decrease in the serum PTH concentration that was accompanied by a significant decrease in PHEX mRNA and protein abundance in the tibia and a significant decrease in PHEX mRNA in the parathyroid gland. In addition, the increases in serum PTH levels and PHEX mRNA in the tibia and parathyroid gland in ⅚ nephrectomized rats fed a high-Pi diet were blunted by 1,25(OH)2D3. Serum PTH concentration was positively and significantly correlated with tibial PHEX mRNA and protein abundance. In summary, we demonstrate that PHEX expression in the tibia and parathyroid gland is increased by chronic renal insufficiency and decreased by 1,25(OH)2D3 administration and suggest that PTH status may play an important role in mediating these changes in PHEX expression.

Download Full-text

New screening tool for neonatal nutritional risk in China: a validation study

BMJ Open ◽

10.1136/bmjopen-2020-042467 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042467

Author(s):

Mei Zhou ◽

Yuwei Li ◽

Huaying Yin ◽

Xianhong Zhang ◽

Yan Hu

Keyword(s):

Validation Study ◽

Head Circumference ◽

Predictive Value ◽

Screening Tool ◽

Nutritional Risk ◽

Risk Level ◽

Spearman Correlation ◽

Nutrition Risk ◽

Sensitivity Specificity ◽

Nutritional Risk Screening

ObjectiveA neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.DesignProspective validation study.Setting and participantsIn total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.Main outcome measuresWe evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.ResultsThe sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.ConclusionThe validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.Trial registration numberChiCTR2000033743.

Download Full-text