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Hyperparathyroidism parathyroid adenoma parathyroid hyperplasia scintigraphy 99mTc sestamibi
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Technetium-99m Sestamibi Scintigraphy Pattern in Patients with Secondary Hyperparathyroidism
Abstract
complications of end stage renal disease (ESRD). We aimed in this investigation to explore the role of Technetium-99m sestamibi (99mTc MIBI) scintigraphy in the pre-operative 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 99mTc 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. Dual-phase 99mTc MIBI scintigraphy has the ability to correctly identify parathyroid adenoma prior to surgical exploration in these patients.
Keywords: Hyperparathyroidism, parathyroid adenoma, parathyroid hyperplasia, scintigraphy, 99mTc sestamibi
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 99mTc 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. Dual-phase 99mTc MIBI scintigraphy has the ability to correctly identify parathyroid adenoma prior to surgical exploration in these patients.
Keywords: Hyperparathyroidism, parathyroid adenoma, parathyroid hyperplasia, scintigraphy, 99mTc sestamibi
