Parathyroid nuclear scan. A focused review on the technical and biological factors affecting its outcome

Kannan, Subramanian; Milas, Mira; Neumann, Donald R.; Parikh, Rikesh T.; Siperstein, Allan; Licata, Angelo A.

doi:10.11138/ccmbm/2014.11.1.025

Cited by 10 publications

(8 citation statements)

References 22 publications

(15 reference statements)

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“…Similarly, among the patients having positive scan 62.2% (n=23) had serum calcium level greater than 12.3 mg/dL as opposed to 37.8 % (n=14) in those with lower level. Among 18 false negative cases, five (27.7 %) had The degree of hypercalcaemia in primary hyperparathyroidism seems to be closely related to defective regulation of PTH secretion, metabolic rate and elevated membrane potential rather than increased mass of parathyroid tissue (5). Indeed, in some patient hypercalcaemia may be surprisingly increased despite only modest glandular enlargement.…”

Section: Resultsmentioning

confidence: 99%

Sestamibi Positive Vs Negative Scan In Primary Hyperparathyroidism; A Clinical Dilemma

Rahman¹,

Haque²,

Sharmin³

2016

Bangladesh J. Nuclear Med.

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Objectives: In primary hyperthyroidism Tc-99m Sestamibi (MIBI) scanning is commonly used for localization of abnormal parathyroid gland and the reported sensitivity is very high. However, false negative scan remain a problem. We examined whether serum calcium and parathormone (PTH) level have any impact in the sensitivity of MIBI scan.Study design: A retrospective review of 55 patients with primary hyperparathyroidism who underwent MIBI scan from January 2012 to December 2014 were included in this study. All patients underwent parathyroid surgery followed by histopathological confirmation. Results Conclusion:Lower calcium and PTH level significantly correlate with reduced sensitivity of MIBI scan. Although we did not find the best cut-off level of serum calcium and PTH level that can predict a positive scan.

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Section: Resultsmentioning

confidence: 99%

Sestamibi Positive Vs Negative Scan In Primary Hyperparathyroidism; A Clinical Dilemma

Rahman¹,

Haque²,

Sharmin³

2016

Bangladesh J. Nuclear Med.

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“…In a study on the factors affecting MIBI localization, Kannan et al found that higher serum calcium and serum PTH levels were associated with a higher likelihood of a positive scan (5). For this reason, we used preoperative PTH values as one criteria to match +LT and −LT patients.…”

Section: Discussionmentioning

confidence: 99%

Does levothyroxine administration impact parathyroid localization?

Ayers

Tobin

Sippel

et al. 2015

Journal of Surgical Research

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Background Proper localization is crucial in performing minimally invasive parathyroidectomy for primary hyperparathyroidism (PHPT). Ultrasonography (US) and Tc-99m sestamibi (MIBI) scintigraphy are common methods used for localization. As the appearance and activity of the thyroid gland may impact parathyroid localization, the purpose of this study was to determine how exogenous use of the thyroid hormone, levothyroxine (LT), affects parathyroid localization. Methods Adult patients with non-familial PHPT who underwent initial parathyroidectomy from 2000 to 2014 were retrospectively identified. Levothyroxine (+LT) and non-levothyroxine (-LT) patients were matched 1:3 based on age, gender, goiter status, and preoperative parathyroid hormone levels. Subgroup analysis was performed on patients previously treated with radioactive iodine and patients undergoing single adenoma resection. Results Of the 1,737 patients that met inclusion criteria, 286 were on LT at the time of their parathyroid localization scan. Use of LT not did impact the percentage of correct MIBI localization scans when compared to −LT patients (p=0.83). Interestingly, use of LT significantly hindered localization by US in comparison to the −LT group (48.4 vs 62.2%, p<0.01). When examining only patients where a single upper gland was removed, the +LT group was less likely to have a correct US compared to the −LT group (50 vs. 72.8%, p<0.01). However, there was no difference in US accuracy for patients who only had a single lower gland removed (p=0.51). Conclusions Exogenous levothyroxine is associated with impaired parathyroid localization with US but not MIBI. Surgeons should be aware of localization efficiency for this subset of patients in the era of personalized medicine and cost effectiveness.

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“…Based on this assumption, MIBI uptake within the parathyroid gland could be related to cell types like chief cells with high metabolic activity and/or oxyphil cell with many mitochondria. However, clear cell and adipose cell thought to have no significant role in MIBI uptake [5][6] . In this study the overall sensitivity of MIBI scan was 67.2% which is low compare to other reported sensitivity of 75-80% 1 .…”

Section: Discussionmentioning

confidence: 99%

Association of Histological Findings with Tc-99m Sestamibi Parathyroid Imaging in Hyperfunctional Parathyroid Gland

Rahman¹,

Haque²,

Jahan³

et al. 2017

J. Natl Inst. Neurosci Bangladesh

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Background: Hyperthyroidism is a relatively common disorder that results from increased production of parathormone. Tc-99m sestamibi (MIBI) scanning is used for localization of abnormal parathyroid gland, with high reported sensitivities. However, there exists a group of patients in whom MIBI scan is either equivocal or negative. Objectives: The aim of this study was to see association of the histological features of pathologic parathyroid gland with MIBI scan in hyperfunctional parathyroid gland. Methodology: This retrospective study was conducted with primary hyperthyroidism who underwent MIBI scan. The data were collected from the record from January 2012 to December 2014 for a period of two years. All patients underwent parathyroid surgery followed by histopathological examination. According to oxyphil cell distribution patients are divided in three groups. Group I comprised of >25.0% oxyphil cell; group II included the 25 to 75% oxyphil cell and group III included >75% of oxyphil cell. Result: A total 56 patients with hypercalcaemia and high serum parathyroid hormone (PTH) level were studied. Mean age was 41.3(±19.8) years with a range of 21 to 63 years. MIBI scan was true positive in 34(60.7%) cases and false negative in 22(39.3%) cases. In group I MIBI scan was true positive in 4(36.3%) cases and false negative in 7(63.7%) cases. In group II MIBI scan showed positive in 17(62.9%) cases and negative in 10(37.1%) cases. In group III out of 18 patients 13(72.2%) showed MIBI scan positive whereas, 5(27.8%) showed negative scan. The sensitivity was 36.3% in group I whereas, 62.9% and 72.2% in group II and group III respectively. Conclusion: Based on these findings, it could be say that Tc-99m setamibi uptake correlate with parathyroid oxyphil cell content, and false negative scan can occur with parathyroid glands containing predominantly clear cell.

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Parathyroid nuclear scan. A focused review on the technical and biological factors affecting its outcome

Abstract: Conclusion.Clinicians should be aware of technical and biological factors that could result in negative scan in parathyroid nuclear scintigraphy.

Cited by 10 publications

References 22 publications

Sestamibi Positive Vs Negative Scan In Primary Hyperparathyroidism; A Clinical Dilemma

Sestamibi Positive Vs Negative Scan In Primary Hyperparathyroidism; A Clinical Dilemma

Does levothyroxine administration impact parathyroid localization?

Association of Histological Findings with Tc-99m Sestamibi Parathyroid Imaging in Hyperfunctional Parathyroid Gland

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