Preoperative localization of parathyroid lesions

Summary

The aim of our study was to assess retrospectively the value of ^99mTc-MIBI SPECT in the localization of parathyroid lesions in primary hyperparathyroidism and to determine the impact of PTH level, age, sex, characteristics of the lesions and thyroid nodules on the sensitivity of imaging. Patients, methods: Fifty nine patients who were cured after the resection of 60 lesions (50 adenomas, 9 hyperplasias and 1 carcinoma, 9 of them in ectopy) were selected. ^99mTcO₄-, early and late ^99mTc-MIBI planar images (n = 59), ^99mTc-MIBI SPECT (n = 58) and ultrasound (n = 50) performed preoperatively were analyzed. The imaging results were compared to surgical and histological findings and correlated to different factors suspected of influencing the imaging's sensitivity. Results: Sensitivity of double phase ^99mTc-MIBI/^99mTcO₄- scintigraphy was higher than that of early or late scintigraphy alone. SPECT increased the sensitivity of scintigraphy from 85% to 92% and was useful to confirm doubtful foci and to localize ectopic lesions. Ultrasound (US) had the lowest sensitivity (56%) and the highest rate of false-positive results (n = 10), but identified 2 adenomas which were not detected by scintigraphy. Combining all imaging modalities, sensitivity reached 96%. Better sensitivities were observed when age < 69 years, preoperative PTH level ≥155 pg/ml, weight of the gland ≥0.80 g and in the absence of thyroid nodules. US was more influenced by these factors than scintigraphy. Conclusion: Combination of US, double-phase ^99mTc- MIBI/^99mTcO₄- planar scintigraphy and SPECT is the most accurate method for the detection of parathyroid lesions and should be performed before minimally invasive surgery, especially when PTH level is low, in older patients and in cases of multinodular goiter.

Zusammenfassung

Ziel der Studie war eine retrospektive Beurteilung der ^99mTc-MIBI-SPECT in der Lokalisationsdiagnostik von Nebenschilddrusenadenomen bei primarem Hyperparathyroidismus sowie der Beeinflussung der Sensitivitat durch die Faktoren PTH-Konzentration, Lebensalter, Geschlecht, Lokalisation und Gewicht der Lasion sowie koexistente Schilddrusenknoten. Patienten, Methoden: Bei 59 Patienten wurden insgesamt 60 Lasionen (50 Adenome, 9 Hyperplasien, 1 Karzinom, davon 9 Ektopien) operativ entfernt. Praoperativ waren planare ^99mTc-MIBI/ ^99mTcO₄-. Zwei-Phasen-Szintigraphien (n = 59), eine ^99mTc-MIBI-SPECT (n = 58) sowie Sonographien (n = 50) durchgefuhrt worden. Die Resultate wurden mit den chirurgisch-pathologischen Befunden verglichen und mit den moglichen Einflussfaktoren korreliert. Ergebnisse: Die Sensitivitat der planaren Sequenzszintigraphie war hoher als die der fruhen oder spaten Einzelaufnahme. Die SPECT erhohte die Sensitivitat der planaren Szintigraphie von 85 auf 92%, erlaubte fragwurdige Herde zu bestatigen sowie ektope Drusen besser zu lokalisieren. Die Sonographie zeigte mit 56% die geringste Sensitivitat und die hochste Anzahl falsch positiver Resultate (n = 10), fand jedoch zwei Adenome, die szintigraphisch nicht nachweisbar waren. Die Kombination aller Methoden erreichte eine Sensitivitat von 96%. Eine hohere Sensitivitat zeigte sich <69 Jahre, PTH ≥155 pg/ml, einem Drusengewicht ≥0,8g und beim Fehlen von Schilddrusenknoten. Die Sonographie wurde starker von diesen Faktoren beeinflusst als die Szintigraphie. Schlussfolgerungen: Die Kombination von Sonographie, planarer Szintigraphie und SPECT ist die sicherste Methode zum Nachweis pathologischen Nebenschilddrusengewebes und sollte praoperativ, insbesondere bei gering erhohtem PTH-Spiegel, alteren Patienten, und koexistenten Schilddrusenknoten eingesetzt werden.

Keywords

Hyperparathyroidism - parathyroid scintigraphy - SPECT - ^99mTc-sestamibi - preoperative localization - PTH

Schlüsselwörter

Hyperparathyroidismus - Nebenschilddrüsenszintigraphie - SPECT - ^99mTc- sestamibi - präoperative Lokalisation - PTH

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