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BMC Medical Imaging
Published in: BMC Medical Imaging 1/2020

Open Access 01-12-2020 | Computed Tomography | Research article

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

Authors: Rongqin Zhang, Zhanwen Zhang, Pinbo Huang, Zhi Li, Rui Hu, Jie Zhang, Wanglin Qiu, Ping Hu

Published in: BMC Medical Imaging | Issue 1/2020

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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 albeit weak 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.
Literature
1.
Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H. Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol. 1997;13(2):78–86.PubMed
2.
Trainor D, Borthwick E, Ferguson A. Perioperative management of the hemodialysis patient. Semin Dial. 2011;24(3):314–26.PubMed
3.
Evans M, Methven S, Gasparini A, Barany P, Birnie K, MacNeill S, May MT, Caskey FJ, Carrero JJ. Cinacalcet use and the risk of cardiovascular events, fractures and mortality in chronic kidney disease patients with secondary hyperparathyroidism. Sci Rep. 2018;8(1):2103.PubMedPubMedCentral
4.
Kidney Disease: Improving Global Outcomes CKDMBDWG. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;113:S1–130.
5.
Madorin C, Owen RP, Fraser WD, Pellitteri PK, Radbill B, Rinaldo A, Seethala RR, Shaha AR, Silver CE, Suh MY, et al. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol. 2012;269(6):1565–76.PubMed
6.
Zeng M, Liu W, Zha X, Tang S, Liu J, Yang G, Mao H, Yu X, Sun B, Zhang B, et al. (99m)Tc-MIBI SPECT/CT imaging had high sensitivity in accurate localization of parathyroids before parathyroidectomy for patients with secondary hyperparathyroidism. Ren Fail. 2019;41(1):885–92.PubMedPubMedCentral
7.
Hiramitsu T, Tomosugi T, Okada M, Futamura K, Tsujita M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Pre-operative localisation of the parathyroid glands in secondary hyperparathyroidism: a retrospective cohort study. Sci Rep. 2019;9(1):14634.PubMedPubMedCentral
8.
Schneider R, Waldmann J, Ramaswamy A, Fernandez ED, Bartsch DK, Schlosser K. Frequency of ectopic and supernumerary intrathymic parathyroid glands in patients with renal hyperparathyroidism: analysis of 461 patients undergoing initial parathyroidectomy with bilateral cervical thymectomy. World J Surg. 2011;35(6):1260–5.PubMed
9.
Taterra D, Wong LM, Vikse J, Sanna B, Pekala P, Walocha J, Cirocchi R, Tomaszewski K, Henry BM. The prevalence and anatomy of parathyroid glands: a meta-analysis with implications for parathyroid surgery. Langenbeck's Arch Surg. 2019;404(1):63–70.
10.
Kettle AG, O'Doherty MJ. Parathyroid imaging: how good is it and how should it be done? Semin Nucl Med. 2006;36(3):206–11.PubMed
11.
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;48(7):1084–9.PubMed
12.
Kobylecka M, Plazinska MT, Chudzinski W, Fronczewska-Wieniawska K, Maczewska J, Bajera A, Karlinska M, Krolicki L. Comparison of scintigraphy and ultrasound imaging in patients with primary, secondary and tertiary hyperparathyroidism - own experience. J Ultrason. 2017;17(68):17–22.PubMedPubMedCentral
13.
Zhou J, Lu DY, Xia L, Cheng XJ. Diagnosis performance of (99m)Tc-MIBI and multimodality imaging for hyperparathyroidism. J Huazhong Univ Sci Technol Med Sci. 2017;37(4):582–6.PubMed
14.
Kim YI, Jung YH, Hwang KT, Lee HY. Efficacy of (9)(9)mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy: comparative study with (9)(9)mTc-sestamibi scintigraphy, SPECT, US and CT. Ann Nucl Med. 2012;26(10):804–10.PubMed
15.
Slater A, Gleeson FV. Increased sensitivity and confidence of SPECT over planar imaging in dual-phase sestamibi for parathyroid adenoma detection. Clin Nucl Med. 2005;30(1):1–3.PubMed
16.
Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery. 2000;128(1):29–35.PubMed
17.
Lee JB, Kim WY, Lee YM. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism. Ann Surg Treat Res. 2015;89(6):300–5.PubMedPubMedCentral
18.
Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132(3):359–72.PubMed
19.
Xue J, Liu Y, Ji T, Zhao A, Liang Y, Deng H, Wang Q, Zhang Y, Yang L, Yang A. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun. 2018;39(12):1129–37.PubMedPubMedCentral
20.
Vulpio C, Bossola M, De Gaetano A, Maresca G, Bruno I, Fadda G, Morassi F, Magalini SC, Giordano A, Castagneto M. Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. Head Neck. 2010;32(9):1226–35.PubMed
21.
Yuan LL, Kan Y, Ma DQ, Yang JG. Combined application of ultrasound and SPECT/CT has incremental value in detecting parathyroid tissue in SHPT patients. Diagn Interv Imaging. 2016;97(2):219–25.PubMed
22.
Li P, Liu Q, Tang D, Zhu Y, Xu L, Sun X, Song S. Lesion based diagnostic performance of dual phase (99m)Tc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism. BMC Med Imaging. 2017;17(1):60.PubMedPubMedCentral
23.
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;202(1):180–4.PubMed
24.
Strambu V, Bratucu M, Garofil D, Paic V, Zurzu M, Tigora A, Popa F, Radu P, Costin P. The value of imaging of the parathyroid glands in secondary hyperparathyroidism. Chirurgia. 2019;114(5):541–9.PubMed
25.
Andrade JS, Mangussi-Gomes JP, Rocha LA, Ohe MN, Rosano M, das Neves MC, Santos Rde O. Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-Sestamibi scintigraphy. Br J Otorhinolaryngol. 2014;80(1):29–34.
26.
Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13(6):952–61.PubMedPubMedCentral
27.
Kara M, Tellioglu G, Bugan U, Krand O, Berber I, Seymen P, Eren PA, Ozel L, Titiz I. Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism. Laryngoscope. 2010;120(8):1538–44.PubMed
28.
Li X, Xie X, Wang R, Liu Y, Fu X, Han X. Comparative analysis of calcification features of primary and secondary hyperparathyroidism by 99Tcm-MIBI SPECT/CT imaging. J Third Mil Med Univ. 2014;36(15):1626–9.
29.
Peng S, Li P, Zhang A, Liu Q, Xu L, Sun X, Huang G, Song S. Importance of 99Tcm-MIBI SPECT/CT fusion imaging in primary and secondary hyperparathyroidism. Int J Radiat Med Nucl Med. 2018;42(3):195–200.
30.
Liang XX, Li F, Gao F, Liu Y, Qiao XH, Zhang Z, Du LF. The value of the model and quantitative parameters of contrast-enhanced ultrasound in judging the severity of SHPT. Biomed Res Int. 2016;2016:6064526.PubMedPubMedCentral
31.
Yeh SM, Hwang SJ, Chen HC. Treatment of severe metastatic calcification in hemodialysis patients. Hemodial Int. 2009;13(2):163–7.PubMed
32.
Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int. 2006;69(11):1945–53.PubMed
33.
Shantouf R, Kovesdy CP, Kim Y, Ahmadi N, Luna A, Luna C, Rambod M, Nissenson AR, Budoff MJ, Kalantar-Zadeh K. Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2009;4(6):1106–14.PubMedPubMedCentral
34.
Lomashvili KA, Garg P, Narisawa S, Millan JL, O'Neill WC. Upregulation of alkaline phosphatase and pyrophosphate hydrolysis: potential mechanism for uremic vascular calcification. Kidney Int. 2008;73(9):1024–30.PubMedPubMedCentral
35.
Delbeke D, Coleman RE, Guiberteau MJ, Brown ML, Royal HD, Siegel BA, Townsend DW, Berland LL, Parker JA, Zubal G, et al. Procedure guideline for SPECT/CT imaging 1.0. J Nucl Med. 2006;47(7):1227–34.PubMed
36.
Greenspan BS, Dillehay G, Intenzo C, Lavely WC, O'Doherty M, Palestro CJ, Scheve W, Stabin MG, Sylvestros D, Tulchinsky M. SNM practice guideline for parathyroid scintigraphy 4.0. J Nucl Med Technol. 2012;40(2):111–8.PubMed
37.
Thomas DL, Bartel T, Menda Y, Howe J, Graham MM, Juweid ME. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 2009;34(10):651–5.PubMed
38.
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;139(4):433–7.PubMed
39.
Yamaguchi S, Yachiku S, Hashimoto H, Kaneko S, Nishihara M, Niibori D, Shuke N, Aburano T. Relation between technetium 99m-methoxyisobutylisonitrile accumulation and multidrug resistance protein in the parathyroid glands. World J Surg. 2002;26(1):29–34.PubMed
40.
Taieb D, Hindie E, Grassetto G, Colletti PM, Rubello D. Parathyroid scintigraphy: when, how, and why? A concise systematic review. Clin Nucl Med. 2012;37(6):568–74.PubMed
41.
Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using (9)(9)mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med. 2012;26(10):794–803.PubMed
42.
Zhao Y, Wang Q. Bone uptake of Tc-99m MIBI in patients with hyperparathyroidism. Ann Nucl Med. 2014;28(4):349–55.PubMed
Metadata
Title
Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism
Authors
Rongqin Zhang
Zhanwen Zhang
Pinbo Huang
Zhi Li
Rui Hu
Jie Zhang
Wanglin Qiu
Ping Hu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2020
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-020-00490-3

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