99mTc-MIBI SPECT/CT imaging contribution in the diagnosis of patients with hyperparathyroidism

Document Type: Original Article

Authors

Institute of Pathophysiology and Nuclear Medicine "Acad Isak S. Tadzer", Faculty of Medicine, Ss Cyril and Methodius University, Skopje, Macedonia

Abstract

Introduction: Hyperparathyroidism is presented with increased parathyroid hormone (PTH) secretion due to hyperfunctioning of one or more of the four parathyroid glands. Primary hyperparathyroidism (p-HPT) can be due to parathyroid adenoma, hyperplasia or carcinoma of the parathyroid gland. Secondary hyperparathyroidism (s-HPT) is usually a response to hypocalcaemia and consecutive hyperplasia of the glands. Our aim was to compare the efficacy of 99mTc-methoxyisobutylisonitrile (MIBI) SPECT/CT in identification of the location of the lesion(s) in cases of HPT by comparing these results with the findings of ultrasound (US) and planar scintigraphy.
Methods: Forty one consecutive patients (54±17 age, 12 males and 29 females) with primary or secondary hyperparathyroidism were included. All patients were examined by US and afterwards patients underwent conventional double-phase 99mTc-MIBI scintigraphy combined with neck SPECT/CT procedure. Planar images (early and delayed), US and SPECT/CT image sets were evaluated for adenoma localization at the neck and thorax. Regions of interest (ROIs), equal sized, were selected and compared, over the hyperfunctioning parathyroid tissue (accumulated impulses-counts value) and over the contralateral lobe of the thyroid gland (control counts value).
Results:The ultrasonography detected 24 positive findings. The late phase of planar scan detected 26 positive findings. SPECT/CT presented with bigger detection rate than late planar phase or US (75.6%, 63.4%, 61.5%) and with higher sensitivity (100%, 83.8%, 77.4%), respectively.
Conclusion: The SPECT/CT study seems reliable, sensitive and with added value in diagnosing hyperparathyroidism as a complementary method to planar scintigraphy. US as compatible method, should be performed prior the scintigraphy protocols.

Keywords

Main Subjects


  1. Cordellat IM. Hyperparathyroidism: primary or secondary disease? Reumatol Clin. 2012 Sep-Oct;8(5):287-91.
  2. Gopinath P, Mihai R. Hyperparathyroidism. Surgery.2011;29:451–458.
  3. Bilezikian JP, Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med. 2004 Apr 22;350(17):1746-51.
  4. Sukan A, Reyhan M, Aydin M, Yapar AF, Sert Y, Canpolat T, Aktas A. Preoperative evaluation of hyperparathyroidism: the role of dual-phase parathyroid scintigraphy and ultrasound imaging. Ann Nucl Med. 2008 Feb;22(2):123-31.
  5. Coakley AJ, Kettle AG, Wells CP, O'Doherty MJ, Collins RE. 99Tcm sestamibi--a new agent for parathyroid imaging. Nucl Med Commun. 1989 Nov;10(11):791-4.
  6. Bergenfelz A, Tennvall J, Valdermarsson S, Lindblom P, Tibblin S. Sestamibi versus thallium subtraction scintigraphy in parathyroid localization: a prospective comparative study in patients with predominantly mild primary hyperparathyroidism. Surgery. 1997 Jun;121(6):601-5.
  7. Mazzeo S, Caramella D, Lencioni R, Molea N, De Liperi A, Marcocci C, Miccoli P, Iacconi P, Bossio GB, Viacava P, Lazzeri E, Bartolozzi C. Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions. AJR Am J Roentgenol. 1996 Jun;166(6):1465-70.
  8. Tziakouri C, Eracleous E, Skannavis S, Pierides A, Symeonides P, Gourtsoyiannis N. Value of ultrasonography, CT and MR imaging in the diagnosis of primary hyperparathyroidism. Acta Radiol. 1996 Sep;37(5):720-6.
  9. Purcell GP, Dirbas FM, Jeffrey RB, Lane MJ, Desser T, McDougall IR, Weigel RJ. Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi. Arch Surg. 1999 Aug;134(8):824-8; discussion 828-30.
  10. Ahuja AT, Wong KT, Ching AS, Fung MK, Lau JY, Yuen EH, King AD. Imaging for primary hyperparathyroidism--what beginners should know. Clin Radiol. 2004 Nov;59(11):967-76.
  11. Hetrakul N, Civelek AC, Stagg CA, Udelsman R. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery. 2001 Dec;130(6):1011-8.
  12. Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med. 1992 Oct;33(10):1801-7.
  13. O'Doherty MJ, Kettle AG, Wells P, Collins RE, Coakley AJ. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med. 1992 Mar;33(3):313-8.
  14. Leslie WD, Dupont JO, Bybel B, Riese KT. Parathyroid 99mTc-sestamibi scintigraphy: dual-tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging. 2002 Dec;29(12):1566-70.
  15. Chen CC, Holder LE, Scovill WA, Tehan AM, Gann DS. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT. J Nucl Med. 1997 Jun;38(6):834-9.
  16. Noda S, Onoda N, Kashiwagi S, Kawajiri H, Takashima T, Ishikawa T, Yoshida A, Higashiyama S, Kawabe J, Imanishi Y, Tahara H, Inaba M, Osawa M, Hirakawa K. Strategy of operative treatment of hyperparathyroidism using US scan and (99m)Tc-MIBI SPECT/CT. Endocr J. 2014;61(3):225-30.
  17. Giordano A, Rubello D, Casara D. New trends in parathyroid scintigraphy. Eur J Nucl Med. 2001 Sep;28(9):1409-20.
  18. Perez-Monte JE, Brown ML, Shah AN, Ranger NT, Watson CG, Carty SE, Clarke MR. Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT. Radiology. 1996 Oct;201(1):85-91.
  19. Yang J, Hao R, Yuan L, Li C, Yan J, Zhen L. Value of dual-phase (99m)Tc-sestamibi scintigraphy with neck and thoracic SPECT/CT in secondary hyperparathyroidism. AJR Am J Roentgenol. 2014 Jan;202(1):180-4.
  20. Carty SE, Worsey J, Virji MA, Brown ML, Watson CG. Concise parathyroidectomy: the impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay. Surgery. 1997 Dec;122(6):1107-14; discussion 1114-6.
  21. Civelek AC, Ozalp E, Donovan P, Udelsman R. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery. 2002 Feb;131(2):149-57.
  22. Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, Dackiw AP, Tufano RP, Zeiger MA, Ziessman HA. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007 Jul;48(7):1084-9.
  23. Thrall J, Ziessman H. Medicina Nuclear. 2nd ed. Rio de Janeiro: Guanabara Koogan S.A.; 2003. p. 28–31
  24. Junior FAM, Guiberteau MJ. Essentials of Nuclear Medicine Imaging. 5th ed. London, U.K.: Saunders Elsevier; 2006. p. 85–181.
  25. Tublin ME, Pryma DA, Yim JH, Ogilvie JB, Mountz JM, Bencherif B, Carty SE. Localization of parathyroid adenomas by sonography and technetium tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med. 2009 Feb;28(2):183-90.
  26. Eslamy HK, Ziessman HA. Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics. 2008 Sep-Oct;28(5):1461-76.
  27. Schachter PP, Issa N, Shimonov M, Czerniak A, Lorberboym M. Early, postinjection MIBI-SPECT as the only preoperative localizing study for minimally invasive parathyroidectomy. Arch Surg. 2004 Apr;139(4):433-7.
  28. Neumann DR, Obuchowski NA, Difilippo FP. Preoperative 123I/99mTc-sestamibi subtraction SPECT and SPECT/CT in primary hyperparathyroidism. J Nucl Med. 2008 Dec;49(12):2012-7.
  29. Hasegawa BH, Wong KH, Iwata K, Barber WC, Hwang AB, Sakdinawat AE, Ramaswamy M, Price DC, Hawkins RA. Dual-modality imaging of cancer with SPECT/CT. Technol Cancer Res Treat. 2002 Dec;1(6):449-58.
  30. Patton JA, Townsend DW, Hutton BF. Hybrid imaging technology: from dreams and vision to clinical devices. Semin Nucl Med. 2009 Jul;39(4):247-63.