Assessment of the integrated role of myocardium perfusion gated SPECT study in patient with parathyroid adenoma by 99mTc-sestamibi

Document Type: Original Article

Author

Zagazig University, Zagazig, Egypt

Abstract

Introduction: The purpose of this study is to assess the integrated role of scintigraphy by Tc99m MIBI in diagnosis of parathyroid adenoma and its impacts on the myocardium, and to evaluate whether myocardium perfusion gated SPECT study could be a complementary routine workup for patient with positive parathyroid adenoma on Tc99m MIBI parathyroid scan. Methods: Rest myocardium perfusion gated SPECT study was performed on the same day of parathyroid scintigraphy, the stress study were completed on the next day for complete assessment of the myocardium perfusion and LV functions. Results: Population included 30 patients; 56% were positive for parathyroid adenoma and compared to 44% negative for parathyroid adenoma, the latter was considered as control group, the gated SPECT EF was normal in 62.5% and abnormal 37.5%. Myocardial perfusion was abnormal in 43.75%, the overall hemodynamic disorder  including EF abnormalities as well as the perfusion defects in the study group were 62.5% compared to  27.5% in the controlled group with statically significant relationship (P value=0.03). Conclusion: The risk of premature cardiovascular death in p HPT is a serious problem and the present study indicates that scintigraphically detected  parathyroid adenoma has an impact on the overall hemodynamic of the myocardium and the complementary role of rest/ stress two days protocol  Tc99m MIBI myocardium perfusion gated SPECT study may be  promising , but its usage as routine workup specially in patient with positive parathyroid adenoma and have high risk warranted further evaluation and reassessment.

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Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. 2000 Dec 21;343(25):1863-75.

Solomon BL, Schaaf M, Smallridge RC. Psychologic symptoms before and after parathyroid surgery. Am J Med. 1994 Feb;96(2):101-6.

Hedbäck G, Tisell LE, Bengtsson BA, Hedman I, Oden A. Premature death in patients operated on for primary hyperparathyroidism. World J Surg. 1990 Nov-Dec;14(6):829-36.

Nuzzo V, Tauchmanovà L, Fonderico F, Trotta R, Fittipaldi MR, Fontana D, Rossi R, Lombardi G, Trimarco B, Lupoli G. Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism. Eur J Endocrinol. 2002 Oct;147(4):453-9.

Neunteufl T, Heher S, Prager G, Katzenschlager R, Abela C, Niederle B, Stefenelli T. Effects of successful parathyroidectomy on altered arterial reactivity in patients with hypercalcaemia: results of a 3-year follow-up study. Clin Endocrinol (Oxf). 2000 Aug;53(2):229-33.

Dominiczak AF, Lyall F, Morton JJ, Dargie HJ, Boyle IT, Tune TT, Murray G, Semple PF. Blood pressure, left ventricular mass and intracellular calcium in primary hyperparathyroidism. Clin Sci (Lond). 1990 Feb;78(2):127-32.

Wermers RA, Khosla S, Atkinson EJ, Grant CS, Hodgson SF, O'Fallon WM, Melton LJ 3rd. Survival after the diagnosis of hyperparathyroidism: a population-based study. Am J Med. 1998 Feb;104(2):115-22.

Moure D, Larrañaga E, Domínguez-Gadea L, Luque-Ramírez M, Nattero L, Gómez-Pan A, Marazuela M. 99mTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration. Surgery. 2008 Sep;144(3):454-9.

Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med. 2005 Oct;35(4):266-76.

Sciagrà R. The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene. Eur J Nucl Med Mol Imaging. 2007 Jul;34(7):1107-22.

Nakajima K.  Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function. Ann Nucl Med. 2010 Apr;24(3):125-35.

Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55.

Moure D, Larrañaga E, Domínguez-Gadea L, Luque-Ramírez M, Nattero L, Gómez-Pan A, Marazuela M. 99mTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration. Surgery. 2008 Sep;144(3):454-9. 

Ogino K, Burkhoff D, Bilezikian JP. The hemodynamic basis for the cardiac effects of parathyroid hormone (PTH) and PTH-related protein. Endocrinology. 1995 Jul;136(7):3024-30.

Glasser SP, Arnett DK, McVeigh GE, Finkelstein SM, Bank AJ, Morgan DJ, Cohn JN. Vascular compliance and cardiovascular disease: a risk factor or a marker? Am J Hypertens. 1997 Oct;10(10 Pt 1):1175-89.

Marini C, Giusti M, Armonino R, Ghigliotti G, Bezante G, Vera L, Morbelli S, Pomposelli E, Massollo M, Gandolfo P, Minuto F, Sambuceti G. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2010 Dec;37(12):2256-63.

Ogard CG, Søndergaard SB, Vestergaard H, Jakobsen H, Nielsen SL. Myocardial perfusion defects and the left ventricular ejection fraction disclosed by scintigraphy in patients with primary hyperparathyroidism. World J Surg. 2005 Jul;29(7):914-6.