The key role of 99mTc-MIBI SPECT/CT in the diagnosis of parathyroid adenoma: a case report

Abstract

SUMMARYThe concomitant occurrence of primary hyperparathyroidism (PHPT) due to parathyroid adenoma and papillary thyroid carcinoma (PTC) is not common. The co-occurrence of parathyroid tumors and thyroid diseases can lead to misdiagnosis owing to mutual interference of imaging in the early period of disease. The most commonly used imaging techniques for the preoperative localization of parathyroid and thyroid adenomas are technetium-99m sestamibi ( 99m Tc-MIBI) scintigraphy and ultrasonography of the neck. Recently, 99m Tc-MIBI single-photon emission computed tomography associated with computed tomography scintigraphy (SPECT/CT) has been used to detect PHPT, and its diagnostic value is being evaluated. Herein, we report a patient with an unusual co-occurrence of parathyroid adenoma and multiple thyroid diseases, including papillary thyroid carcinoma, thyroid adenoma and lymphocytic thyroiditis, which were localized with 99m Tc-MIBI SPECT/CT and confirmed surgically. We suggest that 99m Tc-MIBI SPECT/CT can play an important role in the diagnosis of parathyroid and thyroid lesions. Arch Endocrinol Metab. 2015;59(3):265-9

The role of combined techniques of scintigraphy and SPECT/CT in the diagnosis of primary hyperparathyroidism

“…It depends on symptoms, laboratory findings, and imaging. [2–5] The preoperative and postoperative evaluation of phosphocalcic, lipid, and purine metabolism is of major interest.…”

“…The sensitivity of this method for the diagnosis of parathyroid adenoma is between 50% and 86%. [5–8] The principle consists of the distinct kinetics that Techentium sestamibi has in thyroid and parathyroid glands, revealing hyperfunctioning parathyroid glands in delayed phase. This method is appreciated for simplicity of the technique and low cost.…”

Parathyroid Carcinoma: Case Report and Literature Review

“…It also allows the evaluation of deeper areas of the body and mediastinum to determine invasion of surrounding tissues such as the esophagus and trachea and have better anatomical references for planning the surgery [6]. Single-photon emission computed tomography (SPECT-CT) is advantageous over flat imaging because it provides useful anatomical information, which improves overall diagnostic confidence, even though its diagnostic value in parathyroid carcinoma is still being evaluated [13][14][15]. The cytological study is not recommended through aspiration puncture with a fine needle as it has been shown to be not very profitable and there is a potential risk of tumor dissemination secondary to the procedure [6].…”