99m Tc-MIBI SPECT/CT Imaging Had High Sensitivity in Accurate Localization of Parathyroids Before Parathyroidectomy for Patients With Secondary Hyperparathyroidism

Ren Fail. 2019 Nov;41(1):885-892. doi: 10.1080/0886022X.2019.1662804.

Abstract

Purpose: Accurate preoperative parathyroid localization is important for successful parathyroidectomy (PTX). The aim of our study was to investigate whether SPECT/CT has enhanced effect in preoperative localization of parathyroids. Methods: In our retrospective cohort study, we evaluated the effects of technetium-99m methoxyisobutylisonitrile-single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) on preoperative parathyroid localization for 645 secondary hyperparathyroidism (SHPT) patients. Among them, 569 successful PTX patients were divided into group A (received 99mTc-MIBI scintigraphy, n = 175) and group B (received 99mTc-MIBI scintigraphy and SPECT/CT imaging, n = 394). Sensitivity, specificity, and consistency of two imaging methods in preoperative localization of parathyroids were compared. Results: Overall sensitivity and consistency were higher in group B, while there was no difference in specificity between the two groups. In group A, the sensitivity of 99mTc-MIBI was 50.00%, 77.11%, 61.76%, and 76.54% in the right upper gland (RU), right lower gland (RL), left upper gland (LU), and left lower gland (LL) subgroups, while the consistency was 52.00%, 76.57%, 61.71%, and 75.43%, respectively. In group B, the sensitivity of 99mTc-MIBI with SPECT/CT was 69.39%, 90.03%, 78.07%, and 84.27%, and the consistency was 69.54%, 88.32%, 78.43%, and 84.26%, respectively. The sensitivity and consistency in lower glands were higher than in upper glands in both groups. Sensitivity for eutopic parathyroid was higher in group B, while there was no difference for ectopic parathyroid. Conclusions: 99mTc-MIBI SPECT/CT can increase the sensitivity and consistency of preoperative localization of eutopic parathyroid glands, and it can accurately locate ectopic parathyroid without sensitivity improvement.

Keywords: Secondary hyperparathyroidism; dual-phase Tc-MIBI scintigraphy; parathyroid; parathyroidectomy; single-photon emission computed tomography/computed tomography imaging.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / diagnostic imaging
  • Hyperparathyroidism, Secondary / surgery*
  • Male
  • Middle Aged
  • Organotechnetium Compounds / administration & dosage
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Glands / surgery
  • Parathyroidectomy*
  • Preoperative Care / methods*
  • Radionuclide Imaging / methods
  • Radiopharmaceuticals / administration & dosage
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, Emission-Computed, Single-Photon / methods*

Substances

  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • technetium 99m methoxyisobutylisonitrile

Grant support

This work was funded by the National Natural Science Foundation of China [81270408, 81570666], International Society of Nephrology (ISN) Clinical Research Program [18–01-0247], Jiangsu Provincial Special Program of Medical Science [BL2014080], Construction Program of Jiangsu Provincial Clinical Research Center Support System [BL2014084], Chinese Society of Nephrology [13030300415], Jiangsu Province Key Medical Personnel Project [RC201162, ZDRCA2016002], Six Major Talents Summit of Jiangsu Province [2010-WS-026].