Advertisement

Annals of Nuclear Medicine

, Volume 26, Issue 10, pp 794–803 | Cite as

Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis

  • Carmelo CaldarellaEmail author
  • Giorgio Treglia
  • Alfredo Pontecorvi
  • Alessandro Giordano
Original article

Abstract

Objective

Parathyroid scintigraphy using 99mTc-MIBI is not currently considered a valuable diagnostic tool for the localization of involved glands in patients with secondary hyperparathyroidism (SHPT). However, published data about its diagnostic accuracy are discordant and a meta-analysis about this topic is still lacking. The aim of our study is to meta-analyze the published data about the diagnostic performance of 99mTc-MIBI parathyroid scintigraphy in patients with SHPT.

Methods

A comprehensive computer literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through September 2011 and regarding the diagnostic accuracy of 99mTc-MIBI parathyroid scintigraphy in patients with SHPT was carried out. Only articles in English language in which at least 10 patients with SHPT underwent planar 99mTc-MIBI parathyroid scintigraphy were selected. Pooled sensitivity, pooled specificity and area under the ROC curve on a per lesion-based analysis were calculated to measure the diagnostic accuracy of 99mTc-MIBI parathyroid scintigraphy in SHPT patients.

Results

Twenty-four studies comprising 471 patients were included in this meta-analysis. The pooled sensitivity and specificity of 99mTc-MIBI parathyroid scintigraphy in detecting hyperplastic glands in SHPT patients were 58 % [95 % confidence interval (95 % CI) 52–65 %] and 93 % (95 % CI 85–100 %), respectively, on a per lesion-based analysis. Area under ROC curve was 0.75.

Conclusions

In patients with SHPT and diffuse or nodular hyperplasia, planar parathyroid scintigraphy using 99mTc-MIBI has demonstrated an inadequate diagnostic accuracy. Therefore, it should not be considered as a first-line diagnostic imaging method in the pre-surgical detection of hyperplastic parathyroid glands.

Keywords

Parathyroid scintigraphy Secondary hyperparathyroidism Meta-analysis Diagnostic accuracy 

Notes

Conflict of interest

None.

References

  1. 1.
    Krubsack AJ, Wilson SD, Lawson TL, Kneeland JB, Thorsen MK, Collier BD, et al. Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors. Surgery. 1989;106:639–44.PubMedGoogle Scholar
  2. 2.
    Casara D, Rubello D, Cauzzo C, Pelizzo MR. 99mTc-MIBI radio-guided minimally invasive parathyroidectomy: experience with patients with normal thyroids and nodular goiters. Thyroid. 2002;12:53–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med. 1992;33:1801–7.PubMedGoogle Scholar
  4. 4.
    Oksüz MO, Dittmann H, Wicke C, Müssig K, Bares R, Pfannenberg C, et al. Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol. 2011;17:297–307.PubMedGoogle Scholar
  5. 5.
    Bandeira FA, Oliveira RI, Griz LH, Caldas G, Bandeira C. Differences in accuracy of 99mTc-sestamibi scanning between severe and mild forms of primary hyperparathyroidism. J Nucl Med Technol. 2008;36:30–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Fine EJ. Parathyroid imaging: its current status and future role. Semin Nucl Med. 1987;17:350–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Giordano A, Rubello D, Casara D. New trends in parathyroid scintigraphy. Eur J Nucl Med. 2001;28:1409–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Lai EC, Ching AS, Leong HT. Secondary and tertiary hyperparathyroidism: role of preoperative localization. ANZ J Surg. 2007;77:880–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Périé S, Fessi H, Tassart M, Younsi N, Poli I, Guily JL, et al. Usefulness of combination of high-resolution ultrasonography and dual-phase dual-isotope iodine 123/technetium Tc 99m sestamibi scintigraphy for the preoperative localization of hyperplastic parathyroid glands in renal hyperparathyroidism. Am J Kidney Dis. 2005;45:344–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Papanikolaou V, Vrochides D, Imvrios G, Papagiannis A, Gakis D, Ouzounidis N, et al. Tc-99m sestamibi accuracy in detecting parathyroid tissue is increased when combined with preoperative laboratory values: a retrospective study in 453 Greek patients with chronic renal failure who underwent parathyroidectomy. Transplant Proc. 2008;40:3163–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Kebebew E, Duh QY, Clark OH. Tertiary hyperparathyroidism: histologic patterns of disease and results of parathyroidectomy. Arch Surg. 2004;139:974–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Fjeld JG, Erichsen K, Pfeffer PF, Clausen OP, Rootwelt K. Technetium-99m-tetrofosmin for parathyroid scintigraphy: a comparison with sestamibi. J Nucl Med. 1997;38:831–4.PubMedGoogle Scholar
  13. 13.
    Gallowitsch HJ, Mikosch P, Kresnik E, Gomez I, Lind P. Technetium 99m tetrofosmin parathyroid imaging. Results with double-phase study and SPECT in primary and secondary hyperparathyroidism. Invest Radiol. 1997;32:459–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 1998;39:320–4.PubMedGoogle Scholar
  15. 15.
    Giordano A, Marozzi P, Meduri G, Ficola U, Calcagni ML, Vaccaro A, et al. Quantitative comparison of technetium-99m tetrofosmin and thallium-201 images of the thyroid and abnormal parathyroid glands. Eur J Nucl Med. 1999;26:907–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PN, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol. 2006;6:9.PubMedCrossRefGoogle Scholar
  17. 17.
    Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.PubMedCrossRefGoogle Scholar
  18. 18.
    Chesser AM, Carroll MC, Lightowler C, Macdougall IC, Britton KE, Baker LR. Technetium-99m methoxy isobutyl isonitrile (MIBI) imaging of the parathyroid glands in patients with renal failure. Nephrol Dial Transplant. 1997;12:97–100.PubMedCrossRefGoogle Scholar
  19. 19.
    Pons F, Torregrosa JV, Vidal-Sicart S, Sabater L, Fuster D, Fernández-Cruz L, Herranz R. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism. Eur J Nucl Med. 1998;24:1494–8.CrossRefGoogle Scholar
  20. 20.
    Ishibashi M, Nishida H, Okuda S, Suekane S, Hayabuchi N. Localization of parathyroid glands in hemodialysis patients using Tc-99m sestamibi imaging. Nephron. 1998;78:48–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Torregrosa JV, Palomar MR, Pons F, Sabater L, Gilabert R, Llovera J, et al. Has double-phase MIBI scintigraphy usefulness in the diagnosis of hyperparathyroidism? Nephrol Dial Transplant. 1998;13(S3):37–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Blanco I, Carril JM, Banzo I, Quirce R, Gutierrez C, Uriarte I, et al. Double-phase Tc-99m sestamibi scintigraphy in the preoperative location of lesions causing hyperparathyroidism. Clin Nucl Med. 1998;23:291–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Takebayashi S, Hidai H, Chiba T, Takagi Y, Nagatani Y, Matsubara S. Hyperfunctional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings. J Nucl Med. 1999;40:1792–7.PubMedGoogle Scholar
  24. 24.
    Hindié E, Urenã P, Jeanguillaume C, Mellière D, Berthelot JM, Menoyo-Calonge V, et al. Preoperative imaging of parathyroid glands with technetium-99m-labelled sestamibi and iodine-123 subtraction scanning in secondary hyperparathyroidism. Lancet. 1999;353:2200–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Torregrosa JV, Fernández-Cruz L, Canalejo A, Vidal S, Astudillo E, Almaden Y, et al. (99m)Tc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg. 2000;24:1386–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Olaizola I, Zingraff J, Heuguerot C, Fajardo L, Léger A, Lopez J, et al. [(99m)Tc]-sestamibi parathyroid scintigraphy in chronic haemodialysis patients: static and dynamic explorations. Nephrol Dial Transplant. 2000;15:1201–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Chou FF, Lee CH, Chen HY, Chen JB, Hsu KT, Sheen-Chen SM. Persistent and recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Ann Surg. 2002;235:99–104.PubMedCrossRefGoogle Scholar
  28. 28.
    Arveschoug AK, Bertelsen H, Vammen B. Presurgical localization of abnormal parathyroid glands using a single injection of Tc-99m sestamibi: comparison of high-resolution parallel-hole and pinhole collimators, and interobserver and intraobserver variation. Clin Nucl Med. 2002;27:249–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Gotthardt M, Lohmann B, Behr TM, Bauhofer A, Franzius C, Schipper ML, et al. Clinical value of parathyroid scintigraphy with technetium-99m methoxyisobutylisonitrile: discrepancies in clinical data and a systematic metaanalysis of the literature. World J Surg. 2004;28:100–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Otto D, Boerner AR, Hofmann M, Brunkhorst T, Meyer GJ, Petrich T, et al. Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET. Eur J Nucl Med Mol Imaging. 2004;31:1405–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Takeyama H, Shioya H, Mori Y, Ogi S, Yamamoto H, Kato N, et al. Usefulness of radio-guided surgery using technetium-99m methoxyisobutylisonitrile for primary and secondary hyperparathyroidism. World J Surg. 2004;28:576–82.PubMedCrossRefGoogle Scholar
  32. 32.
    Custódio MR, Montenegro F, Costa AF, dos Reis LM, Buchpiguel CA, Oliveira SG, et al. MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients. Nephrol Dial Transplant. 2005;20:1898–903.PubMedCrossRefGoogle Scholar
  33. 33.
    Nishida H, Ishibashi M, Hiromatsu Y, Kaida H, Baba K, Miyake I, et al. Comparison of histological findings and parathyroid scintigraphy in hemodialysis patients with secondary hyperparathyroid glands. Endocr J. 2005;52:223–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Lomonte C, Buonvino N, Selvaggiolo M, Dassira M, Grasso G, Vernaglione L, et al. Sestamibi scintigraphy, topography, and histopathology of parathyroid glands in secondary hyperparathyroidism. Am J Kidney Dis. 2006;48:638–44.PubMedCrossRefGoogle Scholar
  35. 35.
    Muros MA, Bravo Soto J, López Ruiz JM, Rodríguez-Portillo M, Ramírez Navarro A, Bellón Guardia M, et al. Two-phase scintigraphy with technetium 99m-sestamibi in patients with hyperparathyroidism due to chronic renal failure. Am J Surg. 2007;193:438–42.PubMedCrossRefGoogle Scholar
  36. 36.
    Sukan A, Reyhan M, Aydin M, Yapar AF, Sert Y, Canpolat T, et al. Preoperative evaluation of hyperparathyroidism: the role of dual-phase parathyroid scintigraphy and ultrasound imaging. Ann Nucl Med. 2008;22:123–31.PubMedCrossRefGoogle Scholar
  37. 37.
    de la Rosa A, Jimeno J, Membrilla E, Sancho JJ, Pereira JA, Sitges-Serra A. Usefulness of preoperative Tc-mibi parathyroid scintigraphy in secondary hyperparathyroidism. Langenbecks Arch Surg. 2008;393:21–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Jorna FH, Hollema H, Hendrikse HN, Bart J, Brouwers AH, Plukker JT. P-gp and MRP1 expression in parathyroid tumors related to histology, weight and (99m)Tc-sestamibi imaging results. Exp Clin Endocrinol Diabetes. 2009;117:406–12.PubMedCrossRefGoogle Scholar
  39. 39.
    Vulpio C, Bossola M, De Gaetano A, Maresca G, Bruno I, Fadda G, et al. Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. Head Neck. 2010;32:1226–35.PubMedCrossRefGoogle Scholar
  40. 40.
    Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008;52:519–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Hindié E, Ugur O, Fuster D, O’Doherty M, Grassetto G, Ureña P, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36:1201–16.PubMedCrossRefGoogle Scholar
  42. 42.
    Numano M, Tominaga Y, Uchida K, Orihara A, Tanaka Y, Takagi H. Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg. 1998;22:1098–103.PubMedCrossRefGoogle Scholar
  43. 43.
    Koukouraki S, Damilakis J, Giatromanolaki A, Androulakis E, Karkavitsas N, Koukourakis M. Functional imaging of tumours with 99mTc-sestamibi pinhole scintigraphy. Nucl Med Commun. 1996;17:943–51.PubMedCrossRefGoogle Scholar
  44. 44.
    Neumann DR, Esselstyn CB Jr, Madera A, Wong CO, Lieber M. Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography. J Clin Endocrinol Metab. 1998;83:3867–71.PubMedCrossRefGoogle Scholar
  45. 45.
    Neumann DR, Esselstyn CB Jr, Madera AM. Sestamibi/iodine subtraction single photon emission computed tomography in reoperative secondary hyperparathyroidism. Surgery. 2000;128:22–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Billotey C, Sarfati E, Aurengo A, Duet M, Mündler O, Toubert ME, et al. Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med. 1996;37:1773–8.PubMedGoogle Scholar
  47. 47.
    Gayed IW, Kim EE, Broussard WF, Evans D, Lee J, Broemeling LD, et al. The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med. 2005;46:248–52.PubMedGoogle Scholar
  48. 48.
    Weber AL, Randolph G, Aksoy FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 2000;38:1105–29.PubMedCrossRefGoogle Scholar
  49. 49.
    Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 2006;140:932–40.PubMedCrossRefGoogle Scholar
  50. 50.
    Lubitz CC, Hunter GJ, Hamberg LM, Parangi S, Ruan D, Gawande A, et al. Accuracy of 4-dimensional computed tomography in poorly localized patients with primary hyperparathyroidism. Surgery. 2010;148:1129–37.PubMedCrossRefGoogle Scholar
  51. 51.
    Eichhorn-Wharry LI, Carlin AM, Talpos GB. Mild hypercalcemia: an indication to select 4-dimensional computed tomography scan for preoperative localization of parathyroid adenomas. Am J Surg. 2011;201:334–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Vu TH, Guha-Thakurta N, Harrell RK, Ahmed S, Kumar AJ, Johnson VE, et al. Imaging characteristics of hyperfunctioning parathyroid adenomas using multiphase multidectector computed tomography: a quantitative and qualitative approach. J Comput Assist Tomogr. 2011;35:560–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Stucken EZ, Kutler DI, Moquete R, Kazam E, Kuhel WI. Localization of small parathyroid adenomas using modified 4-dimensional computed tomography/ultrasound. Otolaryngol Head Neck Surg. 2012;146:33–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Wakamatsu H, Noguchi S, Yamashita H, Yamashita H, Tamura S, Jinnouchi S, et al. Technetium-99m tetrofosmin for parathyroid scintigraphy: a direct comparison with (99m)Tc-MIBI, (201)Tl, MRI and US. Eur J Nucl Med. 2001;28:1817–27.PubMedCrossRefGoogle Scholar
  55. 55.
    Chen CC, Skarulis MC, Fraker DL, Alexander R, Marx SJ, Spiegel AM. Technetium-99m-sestamibi imaging before reoperation for primary hyperparathyroidism. J Nucl Med. 1995;36:2186–91.PubMedGoogle Scholar
  56. 56.
    Torregrosa JV, Félez I, Fuster D. Usefulness of imaging techniques in secondary hyperparathyroidism. Nefrologia. 2010;30:158–67.PubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2012

Authors and Affiliations

  • Carmelo Caldarella
    • 1
    Email author
  • Giorgio Treglia
    • 1
  • Alfredo Pontecorvi
    • 2
  • Alessandro Giordano
    • 1
  1. 1.Department of Bioimaging and Radiological Sciences, Institute of Nuclear MedicineCatholic University of the Sacred HeartRomeItaly
  2. 2.Department of Internal Medicine, Institute of EndocrinologyCatholic University of the Sacred HeartRomeItaly

Personalised recommendations