Abstract
We aimed to evaluate the diagnostic and preoperative localization capacity of 99mTc methoxyisobutylnitrile (MIBI) parathyroid scintigraphy and ultrasonography (USG) in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT) as well as the relationship between the success rate of these techniques and biochemical values. In this study, we retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and 5 patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV) were 89.7%, 85.2% and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitancy of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.
Highlights
Primary hyperparathyroidism is a disease characterized by idiopathic, pathological hyper functioning of one or more parathyroid glands, leading to excessive parathyroid hormone (PTH) secretion [1]
A total of 45 enlarged parathyroid glands were found in 39 patients.; 34 patients had a single adenoma while 5 had a multi-gland disease
We found that adenomas were more commonly seen in women, while hyperplasia was more prevalent in men, but these findings were not statistically significant (p >0.05)
Summary
Primary hyperparathyroidism (pHPT) is a disease characterized by idiopathic, pathological hyper functioning of one or more parathyroid glands, leading to excessive parathyroid hormone (PTH) secretion [1]. Submitted: November 2014 / Accepted: December 2014 glands All these imaging methods have had varying rates of success along with a lack of the requisite sensitivity to justify the application of any single imaging modality for routine use before surgical neck exploration [4]. Among these techniques, MIBI parathyroid scintigraphy and USG are the main imaging modalities for the preoperative localization of parathyroid adenomas [5]. We aimed to retrospectively assess the sensitivity of USG, MIBI parathyroid scintigraphy and the combination of both modalities for preoperative localization of enlarged parathyroid glands as well as their relationship with biochemical results for pHPT patients
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