Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

Abstract

A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US ( p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.

Primary Hyperparathyroidism in Neonates and Childhood

“…MIBI scintigraphy appeared to be slightly more sensitive in our series (62%) which is in agreement with studies reported in adults [10, 11]. The high sensitivity of combined Doppler echography and MIBI scintigraphy increased the accuracy of preoperative localization [12].…”

Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy.

“…Worse results are sometimes obtained both in patients with thyroid nodules and in those with ectopic PT tumours (Berczi et al 2002). Staudenherz et al (1997) found different sensitivities in patients with and without thyroid disease (58% vs 71% for US, and 71% vs 91% for SS), while McHenry et al (1996) showed that the thyroid abnormalities have no impact on SS results.…”

“…Moreover, a higher incidence of thyroid tumours in patients with primary HPT has been observed since the 1970s (Kaplan et al 1971). The presence of superimposed thyroid nodules in patients with hyperfunctioning parathyroid (PT) tumour undergoing parathyroidectomy could potentially reduce the accuracy of preoperative localising procedures (Krausz et al 2000, Berczi et al 2002. The aim of this study was to evaluate the sensitivity and positive predictive value (PPV) of high-resolution neck ultrasonography (US) and 99m Tc-pertechnetate subtraction scintigraphy (SS) in patients with proved primary HPT, and to analyse whether the results are dependent or not on coexistent thyroid disease.…”

Tomographie sténopéïque au 99mTc-MIBI dans l’hyperparathyroïdie primaire

“…Une imagerie de localisation préopératoire performante est nécessaire, pour proposer une chirurgie mini-invasive chez ces patients [18][19]. La scintigraphie au MIBI-Tc 99m est la méthode la plus sensible pour localiser les LP [20][21]. Le MIBI, cation monovalent lipophile, est capté par diffusion passive transmembranaire et s'accumule préférentiellement dans les mitochondries [3].…”