Abstract
BackgroundSecondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT.MethodsSixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH).ResultsA total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US, early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99mTc-MIBI scintigraphy (P < 0.001). Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P < 0.05). The Spearman correlation results showed a significant albeit weak association between calcification and both serum PTH and ALP (P = 0.002).ConclusionThe ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.
Highlights
Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail
Our results show that early 99mTc-MIBI SPECT/computed tomography (CT) was superior to the other modalities in detecting parathyroid lesions in SHPT patients
We found that the 99mTc-MIBI uptake of some hyperplastic parathyroid glands on early 99mTc-MIBI SPECT/CT was slightly higher than the background uptake but lower than the thyroid uptake and that further clearance in delayed SPECT/CT caused false-negative results on delayed SPECT/CT
Summary
Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. Obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. Secondary hyperparathyroidism (SHPT) is a complex disease due to increased parathyroid hormone (PTH) production, which affects the metabolism of calcium and phosphorus and causes further abnormal PTH secretion, usually leading to 4-gland hyperplasia [1]. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) suggested parathyroidectomy to treat severe SHPT when drug regimens fail [4], and total parathyroidectomy has shown a minimum risk of postoperative relapse (0–4%) [5]. The incidence of ectopic and supernumerary glands in patients with end-stage renal disease has been reported to be 17.5–39.3% and 6.3–37%, respectively [7,8,9]. Preoperative imaging and accurate localization are critical to a successful operation
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