Differential Findings of Tc-99m Sestamibi Dual-Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

Cheon, Miju; Choi, Joon Young; Chung, Jae-Hoon; Lee, Ji Young; Cho, Sook Kyung; Yoo, Jang; Park, Soo Bin; Lee, Kyung-Han; Kim, Byung‐Tae

doi:10.1007/s13139-011-0103-y

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…On the other hand, the retention of 99m Tc-MIBI is associated with the efflux rate of 99m Tc-MIBI from cells. A pioneering study with a small cohort of parathyroid carcinomas showed a lower washout grade of 99m Tc-MIBI from malignant parathyroid lesions than that from benign ones (17). Our study, with relatively larger samples, further indicated a significant difference of RI between malignant and benign parathyroid lesions.…”

Section: Discussionsupporting

confidence: 54%

Semi-quantitative analysis of 99mTc-sestamibi retention level for preoperative differential diagnosis of parathyroid carcinoma

Zhang¹,

Sun²,

Rui³

et al. 2019

Quant. Imaging Med. Surg.

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Background: To investigate the role of 99m Tc-labeled sestamibi (99m Tc-MIBI) retention level in the assessment of malignant potential of parathyroid lesions. Methods: Twenty patients with parathyroid carcinomas and forty controls with benign parathyroid lesions who underwent preoperatively 99m Tc-MIBI dual-phase planar and SPECT/CT imaging were retrospectively enrolled in this study. The mean and peak of retention index (RI mean and RI peak) were measured for evaluating the retention level of 99m Tc-MIBI in the parathyroid lesions. Diagnostic accuracies of RI for differentiating malignant parathyroid lesions from benign ones were assessed by receiver operating characteristic analyses (area under the curve; AUC). Results: RI peak (AUC =0.87, P<0.001) and RI mean (AUC =0.78, P<0.001) showed significant difference between the malignant and benign lesions. The diagnostic sensitivity, specificity, positive and negative predictive values, accuracy of RI peak were respectively 80.0%, 85.0%, 72.7%, 89.5% and 83.3% when its cutoff value was −19.03%. In addition, the level of serum parathyroid hormone (PTH) slightly correlated with RI peak (r=0.260, P=0.044) or RI mean (r=0.281, P=0.029). Conclusions: Parathyroid carcinomas have higher retention level of 99m Tc-MIBI than benign parathyroid lesions. RI peak may contribute to preoperative differential diagnosis of parathyroid carcinoma.

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Section: Discussionsupporting

confidence: 54%

Semi-quantitative analysis of 99mTc-sestamibi retention level for preoperative differential diagnosis of parathyroid carcinoma

Zhang¹,

Sun²,

Rui³

et al. 2019

Quant. Imaging Med. Surg.

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“…Patients with a confirmed parathyroid cancer usually have a higher concentration of PTH in blood serum. This is consistent with our observations and with findings in subject literature [8,[16][17][18].…”

Section: Discussionsupporting

confidence: 94%

“…The findings were evaluated using a four-point visual scale based on the comparison of tracer accumulation in the submandibular gland and thyroid gland as opposed to the parathyroid. The high uptake of radiotracer in the delayed phase and small difference in radioactivity between early and delayed uptake were among the combinations of different factors that proved useful in determining the highest possible positive predictive value for detecting a neoplastic lesions [8].…”

Section: Discussionmentioning

confidence: 99%

Semi-quantitative method for the assessment of focal lesions in parathyroid scintigraphy with relation to histopathology: a prospective study

et al. 2017

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BBACKGROUND:The aim of this paper was to analyse our own semi-quantitative method of assessing focal lesions localised in pre-operative diagnostic scintigraphy of primary hyperparathyroidism (PHPT) using 99m Tc-MIBI with washout and comparing these data with the result of the histopathological examination (HP). MATERIAL AND METHODS:A total of 40 (37 female, 3 male, average age 58.7 years) patients with a suspicion of PHPT were enrolled for prospective analysis. Dual phase planar and SPECT/CT examination with 99m Tc-MIBI were performed. The tumour to background ratios in the 10 th and 120 th minute were calculated (TBR10 and TBR120) on the basis of the planar acquisition.PTH, ionised calcium and phosphate levels were measured.Parathyroid surgery alone or combined with subtotal/total thyreoidectomy was conducted in 23 (57.5%) and 17 (42.5%) patients, respectively. A HP was performed in all patients. RESULTS:Average concentration of PTH in the whole group was 243.95 pg/ml. There was a statistically significant correlation between medians of PTH concentration and parathyroid histopathological results (p = 0.01). A total of 45 lesions of increased uptake were found in 32 (80.0%) and 34 (85%) patients in the early phase and the delayed phase, respectively.The post-operative material contained 20 (44.5%) parathyroid adenomas, 11 (24.5%) cases of hyperplasia, 2 (4.4%) cancers, 4 (8.9%) cases of normal parathyroid tissue, 2 (4.4%) lymph nodes and 6 (13.3%) cases of thyroid gland tissue.The medians of TBR10 and TBR120 for lesions examined in the HP were respectively: 3.64 and 2.59 for adenoma; 3.08 and 2.18 for hyperplasia; 7.7 and 5.5 for parathyroid cancer, 4.89 and 3.16 for normal tissue and 5.26 and 2.95 for lymph nodes or thyroid gland tissue.A high correlation coefficient of TBR10 to TBR120 in the parathyroid adenoma and parathyroid hyperplasia groups was observed with r = 0.867 and r = 0.964, respectively. The ρr correlation coefficient of TBR10 to TBR120 for normal parathyroid was 0.4.There was a statistically significant association between the HP and TBR10 medians (p = 0.047), but not between histopathology and TBR120 medians (p = 0.840

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“…[ 13 – 15 ] However, 99m Tc-MIBI SPECT/CT has not previously been fully validated for the detection of parathyroid carcinoma, though 99m Tc-MIBI-avid lesions both in early and delayed images may indicate benign adenoma. [ 16 ] In the present study, 99m Tc-MIBI SPECT/CT showed all the primary parathyroid carcinoma lesions, but planar imaging missed the primary lesion in case 2, giving a false negative result.…”

Section: Discussioncontrasting

confidence: 47%

99mTc-MIBI single photon emission computed tomography/computed tomography for the incidental detection of rare parathyroid carcinoma

Shao

Zhou

et al. 2018

Medicine

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This study aimed to evaluate the characteristics of parathyroid carcinoma and to validate the diagnostic value of 99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography/x-ray computed tomography (SPECT/CT) for differentiating between parathyroid carcinoma and hyperparathyroidism. Four consecutive patients with suspected primary hyperparathyroidism were enrolled in this study and underwent 99mTc-MIBI SPECT/CT, ultrasonography, enhanced CT, and MRI. Serum parathyroid hormone (PTH) and calcium were measured. All primary and recurrent lesions showed high focal uptake on 99mTc-MIBI image, whereas metastatic lymph nodes gave false negative results. The serum PTH was 165.14 ± 90.26 pmol/L, which declined rapidly after surgery. One patient with a persistently high PTH (147.5 pmol/L) after surgery presented with multiple lymphadenopathy in the neck. Higher expression of chromogranin A (CgA) further confirmed parathyroid carcinoma as a rare endocrine tumor. Parathyroid carcinoma is thus usually diagnosed incidentally based on nonspecific multiorgan symptoms of hypercalcemia and hyperparathyroidism. 99mTc-MIBI SPECT/CT may help to localize the parathyroid carcinoma, while MRI is valuable for detecting metastasis. Serum PTH and CgA serve as circulating biomarkers in parathyroid carcinoma, and raised levels of PTH and CgA together with locoregional lymphadenopathy may indicate parathyroid carcinoma. Further studies are needed.

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Differential Findings of Tc-99m Sestamibi Dual-Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

Abstract: For Tc-99m MIBI dual-phase parathyroid scintigraphy, uptake grade on delayed images and washout were significantly useful diagnostic criteria for differentiating benign from malignant parathyroid lesions, along with age and parathyroid hormone serum concentration.

Cited by 17 publications

References 22 publications

Semi-quantitative analysis of 99mTc-sestamibi retention level for preoperative differential diagnosis of parathyroid carcinoma

Semi-quantitative analysis of 99mTc-sestamibi retention level for preoperative differential diagnosis of parathyroid carcinoma

Semi-quantitative method for the assessment of focal lesions in parathyroid scintigraphy with relation to histopathology: a prospective study

99mTc-MIBI single photon emission computed tomography/computed tomography for the incidental detection of rare parathyroid carcinoma

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