<sup>99m</sup>Tc‐sestamibi Scintigraphy and Cell Cycle in Parathyroid Glands of Secondary Hyperparathyroidism

Torregrosa, José-Vicente; Fernández‐Cruz, Laureano; Canalejo, Antonio; Vidal, Sergio; Astudillo, E.; Almadén, Yolanda; Pons, F; Rodriguez, Mariano

doi:10.1007/s002680010229

Cited by 65 publications

(42 citation statements)

References 17 publications

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“…The same study found higher degrees of uptake to be correlated with the G 2 /S (active growth) phase. In our present study, MIBI detected hyperplastic glands in 88.8% of the cases, a sensitivity similar to that found previously [10]. There are many important factors that need to be taken into account when analysing false-negative MIBI results.…”

Section: Discussionsupporting

confidence: 74%

“…We obtained similar results in a study of 116 patients, in whom we demonstrated a positive association between PTH levels and MIBI uptake (unpublished data). Moreover, Torregrosa et al [10] showed a positive correlation between MIBI uptake in the parathyroid glands and the phases of the cell cycle. The same study found higher degrees of uptake to be correlated with the G 2 /S (active growth) phase.…”

Section: Discussionmentioning

confidence: 99%

“…When we compare MIBI and ultrasound, the latter has a relatively low cost; however, MIBI is more specific and useful in the cases of recurrent or persistent SHP [4,10]. MIBI is a lipophilic radiotracer that becomes concentrated in cells and inside the mitochondria through active transport and passive diffusion.…”

Section: Discussionmentioning

confidence: 99%

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MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

Custódio¹,

Montenegro²,

Costa³

et al. 2005

Nephrology Dialysis Transplantation

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Background. Although scintigraphy with 99m Tcsestamibi (MIBI) has been used to localize parathyroid glands prior to surgery for hyperparathyroidism, using it to evaluate parathyroid function remains controversial. The purpose of this study was to evaluate the possible association of MIBI uptake with gland weight, histological pattern and proliferative activity of parathyroid cells. Methods. We studied 18 patients with secondary hyperparathyroidism (SHP); mean age 38±3 years, 55% female, mean time on haemodialysis 7.7±0.9 years. All patients had parathyroidectomy (PTx). The weights of the removed glands were estimated, and parathyroid hyperplasia was classified as diffuse (n ¼ 28) or nodular (n ¼ 29). The expression of proliferative cell nuclear antigen (PCNA) was evaluated by immunohistochemistry. Before PTx, all patients underwent MIBI evaluation and were categorized using a 0-3 uptake scoring system. Low uptake (scores of 0 and 1) was seen in 39 glands and high uptake (scores of 2 and 3) in 18. Results. Estimated gland weights, percentage of nodular hyperplasia and PCNA expression were greater in glands with high MIBI scores than in those with low scores (P<0.01). In glands with nodular hyperplasia, PCNA expression was higher (318±66 cells/mm 2 ) than in those with diffuse hyperplasia (104±16 cells/mm 2 ; P<0.001). Conclusions. High MIBI scores were associated with high estimated gland weight, degree of cell proliferation and presence of nodular hyperplasia. MIBI scintigraphy is useful in clinical practice for localizing parathyroid glands, and it could guide the management of SHP by indicating the degree of its severity.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

Custódio¹,

Montenegro²,

Costa³

et al. 2005

Nephrology Dialysis Transplantation

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“…It is well known that glands with nodular growth patterns are heavier and show higher proliferative activity than diffusely hyperplastic glands [17,18]. Torregrosa et al demonstrated that 99m Tc MIBI scintigraphy accurately reflects the functional status of the hyper-plastic parathyroid glands, with higher uptake grades correlating with the active growth phase [19].…”

Section: Discussionmentioning

confidence: 99%

Technetium-99m Sestamibi Scintigraphy Pattern in Patients with Secondary Hyperparathyroidism

Kandeel¹,

Hawary²,

Ebaid³

2010

Arab J. Nephr. Trans

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Introduction: Metabolic bone disease is one of the major complications of end stage renal disease (ESRD). We aimed in this investigation to explore the role of Technetium99m sestamibi ( 99m Tc MIBI) scintigraphy in the preoperative assessment of refractory hyperparathyroidism in hemodialysis (HD) patients. Methods: Dual-phase 99mTc MIBI parathyroid scintigraphy was performed for 23 patients with ESRD who have persistent intact parathyroid hormone (iPTH) levels exceeding 300 pg/ml. Based on scintigraphy results, 13 patients underwent neck exploration during which only glands with positive scintigraphy findings were removed. Results:Among the six patients who had iPTH levels < 800 pg/ml, only one patient had positive scintigraphy findings (16.7%). Among the 17 patients who had iPTH levels ≥ 800 pg/ml, 16 patients had positive scintigraphy findings (94.1%). 99mTc MIBI scan detected 23 positive sites of focal trace uptake in those 17 patients. Partial parathyroidectomy was performed for 13 patients, removing in total 19 glands, while four patients declined surgery. On histological examination, 12 glands showed diffuse hyperplasia, four glands showed nodular hyperplasia and three glands revealed parathyroid adenoma. The three glands with parathyroid adenoma were correctly identified prior to surgery by 99m Tc MIBI scintigraphy. The long-term outcomes of these patients are now being monitored. Conclusion:ESRD patients with iPTH level ≥ 800 pg/ ml are more likely to have positive sites of focal tracer uptake on MIBI scan than patients with lower iPTH levels. Tc MIBI scintigraphy has the ability to correctly identify parathyroid adenoma prior to surgical exploration in these patients.

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“…In the cases presented there were no histological signs of oxyphil cells, and the influence of other factors cannot be excluded. Variability of radiotracer uptake in parathyroid adenomas is another factor reported in addition to oxyphil cell content to which differences in perfusion and metabolic activity, P-glycoprotein expression, and multidrug resistance-related protein expression, and cell cycle may be attributed [7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

False-Negative 99mTc Medi-MIBI Parathyroid Scintigraphies: A Report on the Possible Role of Diagnostic Two-Phase Single-Acquisition CT

et al. 2013

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Introduction Case PresentationA 54-year old male was admitted due to persistently elevated parathyroid hormone (27.4, normal range 1.3-7.6 pmol/L) and free plasma calcium ion (1.72, normal range 1.18-1.32 mmol/L) concentrations in the blood despite medical treatment consistent with primary hyperparathyroidism.A dual-phase parathyroid scintigraphy performed 6 months earlier in another hospital was unable to confirm the diagnosis. The parathyroid scintigraphy was a false-negative result. There were no changes over time in levels of parathyroid hormone and calcium in the blood.After injection of 900 MBq Diagnostic two-phase (bolus injection after 15 sec and 30 sec.) CT single-acquisition (30 sec) of neck and chest was performed after injection of 25 ml and 60 ml Iomeron (140 mg I/ml) 2 hours after injection of 99m Tc Medi-MIBI.Parathyroid scintigraphy gave the impression of increased activity at the lower pole of the right thyroid lobe on early images, still remaining on late images (Figure 1). Low-dose SPECT-CT was not of a quality that convinced the radiologist of the existence of a parathyroid adenoma. Diagnostic CT with contrast enhancement, however, convincingly demonstrated a CT morphological correlate with contrast accumulation in a rounded, approximately 14 mm×5 mm structure situated paravertebrally and paraesophageally behind the lower pole of the right thyroid lobe at the level of the vertebral corpus of C7 (Figure 2).Minimal neck surgery was performed, and an adenoma was removed at the described location. The concentration of parathyroid hormone dropped peroperatively to 4 pmol/L and of free plasma calcium ion to 1.47 mmol/L immediately after removal and to 1.3 pmol/L and 1.17 mmol/L six days after surgery. A histological examination confirmed the presence of a primary parathyroid adenoma (Figure 3). AbstractCase presentations: A 54-year old male was admitted due to persistent elevated parathyroid hormone and calcium concentrations in the blood despite medical treatment consistent with primary hyperparathyroidism. A dualphase parathyroid scintigraphy performed 6 months earlier in another hospital was unable to confirm the diagnosis. There was no change over time in levels of parathyroid hormone and calcium in the blood. In the second case, a 46-year old woman was examined due to the same symptoms and findings; 18 months earlier she also had no retention of tracer on late images. In this case, the patient also had had a CT performed, which showed morphological signs of a parathyroid adenoma. We therefore planned dual-phase parathyroid scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) in the early phase. The low-dose CT was unable to confirm the impression of slight amounts of tracer uptake and retention at the lower right thyroid pole in both cases. Diagnostic in both cases, but still with a low dose, the CT revealed a parathyroid adenoma situated in a common parathyroid location at the lower pole of the right thyroid lobe, where activity retention was seen in lat...

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^99mTc‐sestamibi Scintigraphy and Cell Cycle in Parathyroid Glands of Secondary Hyperparathyroidism

Cited by 65 publications

References 17 publications

MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

Technetium-99m Sestamibi Scintigraphy Pattern in Patients with Secondary Hyperparathyroidism

False-Negative 99mTc Medi-MIBI Parathyroid Scintigraphies: A Report on the Possible Role of Diagnostic Two-Phase Single-Acquisition CT

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