Evaluation of Conventional Imaging Techniques on Preoperative Localization in Primary Hyperparathyroidism

Mesut Ozkaya; Umut Elboga; Ertan Sahin; Ebuzer Kalender; Hakan Korkmaz; Hasan Deniz Demir; Y. Zeki Celen; Suna Erkılıç; Avni Gökalp; Göktürk Maralcan

doi:10.17305/bjbms.2015.207

Authors

Mesut Ozkaya Department of Endocrinology, Gaziantep University, Gaziantep, Turkey.
Umut Elboga Department of Nuclear Medicine, Gaziantep University, Gaziantep, Turkey.
Ertan Sahin Department of Nuclear Medicine, Namik Kemal University, Tekirdag, Turkey
Ebuzer Kalender Department of Nuclear Medicine, Gaziantep University, Gaziantep, Turkey.
Hakan Korkmaz Department of Endocrinology, Gaziantep University, Gaziantep, Turkey.
Hasan Deniz Demir Department of Nuclear Medicine, Gaziantep University, Gaziantep, Turkey
Y. Zeki Celen Department of Nuclear Medicine, Gaziantep University, Gaziantep, Turkey.
Suna Erkılıç Department of Pathology, Gaziantep University, Gaziantep, Turkey.
Avni Gökalp Department of Surgery, Gaziantep University, Gaziantep, Turkey.
Göktürk Maralcan Department of Surgery, Gaziantep University, Gaziantep, Turkey.

DOI:

https://doi.org/10.17305/bjbms.2015.207

Keywords:

Hyperparathyroidism, MIBI parathyroid scintigraphy, USG, iPTH, calcium

Abstract

We aimed to evaluate the diagnostic and preoperative localization capacity of ^99mTc methoxyisobutylnitrile (MIBI) parathyroid scintigraphy and ultrasonography (USG) in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT) as well as the relationship between the success rate of these techniques and biochemical values. In this study, we retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and 5 patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV) were 89.7%, 85.2% and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitancy of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.

Citations

Downloads

Download data is not yet available.

References

Del Rio P, Cataldo S, Sommaruga L, Arcurı M.F, Massa M, Sianesi M. Localization of pathological gland’s site in primary hyperparathyroidism: ten years experience with MIBI scintigraphy. G Chir 2008;29(4):186-189.

Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000;343 (25):1863–1875. http://dx.doi.org/10.1056/NEJM200012213432508

Satava RM, Beahrs OH, Scholz DA. Success rate of cervical exploration for hyperparathyroidism. Arch Surg 1975;110(5):625–628. http://dx.doi.org/10.1001/archsurg.1975.01360110171028

Doppman JL. Preoperative localization of parathyroid tissue in primary hyperparathyroidism. In: Bilzekian JP, editor.The Parathyroids. New York: Raven Press, Ltd; 1994. P. 553–565.

Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 2007;188:1706–1715. http://dx.doi.org/10.2214/AJR.06.0938

Hendy GN. Molecular mechanisms of primary hyperparathyroidism. Rev Endocr Metab Disord 2000;1(4):297–305. http://dx.doi.org/10.1023/A:1026518502081

Henry JF, Iacobone M, Mirallie E, Deveze A, Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyrodism. Surgery 2001;130(6):999 –1004. http://dx.doi.org/10.1067/msy.2001.119112

Jacobson SR, Van Heerden JA, Farley DR, , Grant CS, Thompson GB, Mullan BP,et al. Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or the use of the gamma probe. World J Surg 2004;28:1127–1131. http://dx.doi.org/10.1007/s00268-004-7469-2

Profanter C, Wetscher GJ, Gabriel M, Sauper T, Rieger M, Kovacs P. CT-MIBI image fusion: a new preoperative localization technique for primary, recurrent and persistent hyperparathyroidism. Surgery 2004;135(2):157– 162. http://dx.doi.org/10.1016/S0039-6060(03)00396-9

Neumann DR, Esselstyn CB Jr, Go RT, Wong CO, Rice TW, Obuchowski NA. Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. Am J Roentgenol 1997;169(6):1671–1674. http://dx.doi.org/10.2214/ajr.169.6.9393188

Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands. Clin Endocrinol (Oxf) 2002;57(2):241–249. http://dx.doi.org/10.1046/j.1365-2265.2002.01583.x

Barczynski M, Golkowski F, Konturek A, Buziak-Bereza M, Cichon S, Hubalewska-Dydejczyk A, et al. Technetium-99m-sestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas in directing surgical approach. Clin Endocrinol (Oxf) 2006;65(1):106–113. http://dx.doi.org/10.1111/j.1365-2265.2006.02556.x

Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Comparison of technetium-99m MIBI, technetium-99m tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med 1998;39(2):320–324.

Gotthardt M, Lohmann B, Behr TM, Bauhofer A, Franzius C, Schipper ML, et al. Clinical value of parathyroid scintigraphy with technetium-99m methoxyisobutylisonitrile: discrepancies in clinical data and a systematic metaanalysis of the literature. World J Surg 2004;28(1):100–107. http://dx.doi.org/10.1007/s00268-003-6991-y

De Feo ML, Colagrande S, Biagini C, Tonarelli A, Bisi G, Vaggelli L,et al. Parathyroid glands: Combination of (99m) Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214(2):393–402. http://dx.doi.org/10.1148/radiology.214.2.r00fe04393

Torregrosa JV, Fernandez-Cruz L, Canalejo A, Vidal S, Astudillo E, Almaden Y, et al. (99m)Tc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg 2000;24(11):1386–1390. http://dx.doi.org/10.1007/s002680010229

Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med 2005;35(4):266–276. http://dx.doi.org/10.1053/j.semnuclmed.2005.06.001

Pons F, Torregrosa JV, Fuster D. Biological factors influencing parathyroid localization. Nucl Med Commun 2003;24(2):121-124. http://dx.doi.org/10.1097/00006231-200302000-00003

Rodriquez J, Parrilla P. Localization studies in persistent or recurrent hyperparathyroidism. In: Clark OH, Duh QY, Kebebew E, editors. Textbook of endocrine surgery. Philadelphia: Elsevier Saunders; 2005. P. 430-438.

Lane MJ, Desser TS, Weigel R J, et al. Use of colour and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas. A JR Am J Roentgenol 1998;171:819-823. http://dx.doi.org/10.2214/ajr.171.3.9725323

Biertho LD, Kim C, Wu HS, Unger P, Inabnet WB. Relationship between sestamibi uptake, parathyroid hormone assay, and nuclear morphology in primary hyperparathyroidism. J Am Coll Surg 2004;199(2):229-233. http://dx.doi.org/10.1016/j.jamcollsurg.2004.04.013

Hung GU, Wang SJ, Lin WY. Tc-99m MIBI parathyroid scintigraphy and intact parathyroid hormone levels in hyperparathyroidism. Clin Nucl Med 2003;28(3):180-185. http://dx.doi.org/10.1097/01.RLU.0000053529.71776.37

Ambrosoni P, Heuguerot C, Olaizola I, Acuña G, Fajardo L, Petraglia A, et al. Can we use 99mTc-MIBI in functional studies of the parathyroid gland? Nephrol Dial Transplant 1998;13(3):33–36. http://dx.doi.org/10.1093/ndt/13.suppl_3.33

Melloul M, Paz A, Koren R, Cytron S, Feinmesser R, Gal R, et al. 99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med 2001;28(2):209–213. http://dx.doi.org/10.1007/s002590000406

Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ,et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med 1998;39(8):1441–1444.

Parikshak M, Castillo ED, Conrad MF, Talpos GB. Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Am Surg 2003;69(5):393-398.

Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 1998;186(3):293–304. http://dx.doi.org/10.1016/S1072-7515(98)00016-7

Rubello D, Casara D, Pelizzo MR. Optimization of peri-operative procedures. Nucl Med Commun 2003;24(2):133–140. http://dx.doi.org/10.1097/00006231-200302000-00005

Hindie E, Ugur O, Fuster D, O'Doherty M, Grassetto G, Ureña P, et al. EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 2009;36(7):1201–1216. http://dx.doi.org/10.1007/s00259-009-1131-z

Bhansali A, Masoodi SR, Bhadada S, Mittal BR, Behra A, Singh P. Ultrasonography in detection of single and multiple abnormal parathyroid glands in primary hyperparathyroidism: comparison with radionuclide scintigraphy and surgery. Clin Endocrinol (Oxf) 2006; 65(3): 340–345. http://dx.doi.org/10.1111/j.1365-2265.2006.02601.x

Lo CY, Lang BH, Chan WF, Kung AW, Lam KS. A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. Am J Surg 2007;193(2):155–9. http://dx.doi.org/10.1016/j.amjsurg.2006.04.020