Double-Phase Tc-99m Sestamibi Scintigraphy in the Preoperative Location of Lesions Causing Hyperparathyroidism

Blanco, Isabel; Carril, J.M.; Banzo, Ignacio; Quirce, R.; Gutiérrez, C; Uriarte, Isabel; Montero, Alfonso; Vallina, N K

doi:10.1097/00003072-199805000-00005

Cited by 53 publications

(21 citation statements)

References 24 publications

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“…However, sensitivity is influenced by the size of lesions, which is a significant feature for diagnosis in young children. For Jones et al [8], the sensitivity was 92% for lesions of up to 500 mg, moreover it was 50% for lesions smaller than 500 mg, and had a better sensitivity for detecting adenomas (92%) and hyperplasias (62%) as reported by Blanco et al [9]. …”

Section: Discussionmentioning

confidence: 89%

Primary Hyperparathyroidism in Neonates and Childhood

Mallet¹

2008

Horm Res Paediatr

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Objectives: Primary hyperparathyroidism (HP1) in childhood is thought to be extremely rare. Its exact incidence remains unknown, as do the characteristics of HP1. A retrospective study collection was conducted on cases supplied by members of the Working Group on Calcium Metabolism throughout France over a 20-year period (1984–2004), since the availability of the intact parathormone (iPTH) radioimmunoassay. Results: 55 cases were collected of which 11 were neonates. Among the 44 children and adolescents, there were 18 male and 26 female patients, ranging in age from 6 to 18 (mean 13) years. 83% were symptomatic and 43% had nephrolithiasis. Symptoms were associated with high serum calcium and inappropriate iPTH levels. Ultrasonography and technetium-labelled methoxyisobutylisonitrile scintigraphy are useful tools for the preoperative localization of adenomas, particularly in adolescents. Intraoperative iPTH assays are effective in minimizing invasive parathyroidectomy. All patients, except neonates, underwent surgery: 29 adenomas and 11 hyperplasias were found. Two multiple endocrine neoplasias (MENs) were subsequently discovered. Since the calcium-sensing receptor (CaSR) mutation was reported, the form of management in neonates has become more medical (intravenous diphosphonates) than surgical. On follow-up no recurrence was observed except for MEN. Conclusion: These national results reflect HP1 epidemiology. HP1 is a rare entity and appears to be a severe disease in terms of symptoms with regard to management. The use of molecular biology tests could be useful not only in neonatal cases (CaSR mutation) but also prior to surgery in children (MEN mutation).

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Section: Discussionmentioning

confidence: 89%

Primary Hyperparathyroidism in Neonates and Childhood

Mallet¹

2008

Horm Res Paediatr

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“…Different techniques were used in performing PT scintigraphy, both with 99m Tc-sestamibi alone (12,29,30) and 99m Tc-sestamibi in conjunction with 123 I or 99m Tcpertechnetate for thyroid image subtraction (9,26,27), with similar results. Dual phase imaging with single-photon emission computer tomography (SPECT) seems to be a promising procedure for the detection of hyperfunctioning PT tissue, both increasing the sensitivity of 99m Tc-sestamibi scintigraphy and appearing particularly useful in localizing mediastinal glands (38,39).…”

Section: Discussionmentioning

confidence: 90%

Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

Lumachi

Zucchetta

Marzola

et al. 2000

European Journal of Endocrinology

145

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Objective: To evaluate the usefulness of the combination of 99m Tc-sestamibi/ 99m Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. Design and Methods: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18±78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. Results: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant P , 0X05Y Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly P , 0X05Y Fisher exact test) influenced only the US sensitivity. Conclusions: When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.

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“…This methodology requires 2 sets of images, one at 5-15 min (early) and one at 2-3 h (delayed). Investigations have reported good results (11,16,17), similar in accuracy to the subtraction method, although few direct comparison studies have been reported (18)(19)(20).…”

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confidence: 92%

Comparison of SPECT/CT, SPECT, and Planar Imaging with Single- and Dual-Phase 99mTc-Sestamibi Parathyroid Scintigraphy

Lavely¹,

Goetze²,

Friedman³

et al. 2007

Journal of Nuclear Medicine

282

178

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Various methodologies for 99m Tc-sestamibi parathyroid scintigraphy are in clinical use. There are few direct comparisons between the different methods and even less evidence supporting the superiority of one over another. Some reports suggest that SPECT is superior to planar imaging. The addition of CT to SPECT may further improve parathyroid adenoma localization. The purpose of our investigation was to compare hybrid SPECT/CT, SPECT, and planar imaging and to determine whether dual-phase imaging is advantageous for the 3 methodologies. Methods: Scintigraphy was performed on 110 patients with primary hyperparathyroidism and no prior neck surgery. Of these, 98 had single adenomas and are the subject of this review. Planar imaging and SPECT/CT were performed at 15 min and 2 h after injection. Six image sets (early and delayed planar imaging, SPECT, and SPECT/CT) and combinations of the 2 image sets were reviewed for adenoma localization at 13 possible sites. Each review was scored for location and certainty of focus by 2 reviewer groups. Surgical location served as the standard. Sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, and k-values were determined for each method. Results: The overall k-coefficient (certainty of adenoma focus) between reading groups was 0.68 (95% confidence interval, 0.66-0.70). The highest values were for dualphase studies that included SPECT/CT. Dual-phase planar imaging, SPECT, and SPECT/CT were statistically significantly superior to single-phase early or delayed imaging in sensitivity, area under the curve, and positive predictive value. Neither single-phase nor dual-phase SPECT was statistically superior to dual-phase planar imaging. Early-phase SPECT/CT in combination with any delayed imaging method was superior to dualphase planar imaging or SPECT for sensitivity, area under the curve, and positive predictive value. Conclusion: Early SPECT/ CT in combination with any delayed imaging method was statistically significantly superior to any single-or dual-phase planar or SPECT study for parathyroid adenoma localization. Localization with dual-phase acquisition was more accurate than with singlephase 99m Tc-sestamibi scintigraphy for planar imaging, SPECT, and SPECT/CT.

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Double-Phase Tc-99m Sestamibi Scintigraphy in the Preoperative Location of Lesions Causing Hyperparathyroidism

Cited by 53 publications

References 24 publications

Primary Hyperparathyroidism in Neonates and Childhood

Primary Hyperparathyroidism in Neonates and Childhood

Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

Comparison of SPECT/CT, SPECT, and Planar Imaging with Single- and Dual-Phase 99mTc-Sestamibi Parathyroid Scintigraphy

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