Skip to main content

Clinical Utility of Tc-99m MIBI SPECT/CT for Preoperative Localization of Parathyroid Lesions

Indian Journal of Surgery volume 79, pages 312–318 (2017)Cite this article

Abstract

We aimed to demonstrate the role of SPECT/CT in preoperative localization of parathyroid lesions in patients with hyperparathyroidism who had technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI) dual-phase parathyroid scintigraphy. We evaluated retrospectively the scintigraphic data of 103 patients who had parathyroidectomy after Tc-99m MIBI dual-phase parathyroid scintigraphy with SPECT/CT. The planar and SPECT/CT images were evaluated separately to determine their efficacy in localizing parathyroid lesions. These results were then compared with surgical data. There were 84 female and 19 male patients whose mean age was 54 ± 12 years. A total of 115 parathyroid lesions in 103 patients were resected during operations. In 87 patients, with both planar and SPECT/CT images, a total of 100 lesions could be detected correctly. In 11 patients, only SPECT/CT images could show 13 subcentimetric lesions. In three patients, three lesions were evaluated as parathyroid lesions both with planar and SPECT/CT images, but according to histopathologic evaluation, they came out to be nonparathyroidal lesions. In two patients, two parathyroid lesions could not be detected preoperatively neither with planar nor with SPECT/CT images. The lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87 %, 99 %, 97.1 %, 95.3 %, and 95.8 % for planar images and 98.3 %, 99 %, 97.4 %, 99.4 %, and 98.8 % for SPECT/CT images, respectively. Tc-99m MIBI parathyroid scintigraphy should be a diagnostic modality of choice in preoperative evaluation of patients with hyperparathyroidism. SPECT/CT has an incremental value both in demonstrating subcentimetric lesions and in accurately localizing lesions anatomically.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Coakley AJ, Kettle AG, Wells CP, O’Doherty MJ, Collins RE (1989) 99Tcm sestamibi: a new agent for parathyroid imaging. Nucl Med Commun 10:791–794

    CAS  Article  PubMed  Google Scholar 

  2. Hurley DL, Gharib H (1996) Evaluation and management of multinodular goiter. Otolaryngol Clin N Am 29:527–540

    CAS  Google Scholar 

  3. Taillefer R, Boucher Y, Potvin C, Lambert R (1992) 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 33:1801–1807

    CAS  PubMed  Google Scholar 

  4. Rubello D, Casara D, Fiore D, Muzzio P, Zonzin G, Shapiro B (2002) An ectopic mediastinal parathyroid adenoma accurately located by a single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction scintigraphy and MIBI-SPECT-computed tomographic image fusion. Clin Nucl Med 27:186–190

    Article  PubMed  Google Scholar 

  5. Lorberboym M, Minski I, Macadziob S, Nikolov G, Schachter P (2003) Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 44:904–908

    PubMed  Google Scholar 

  6. Billotey C, Sarfati E, Aurengo A, Duet M, Mündler O, Toubert ME et al (1996) Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 37:1773–1778

    CAS  PubMed  Google Scholar 

  7. Turkish Endocrinology and Metabolism Association Guideline for Diagnosis and Treatment of Metabolic Bone Diseases (2015) Ankara, Turkey.

  8. Taubman M, Goldfarb M, Lew J (2011) Role of SPECT and SPECT/CT in the surgical treatment of primary hyperparathyroidism. Int J Mol Imaging. Article ID: 141593, 7 pages.

  9. Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR et al (2003) Preoperative localization and radioguided parathyroid surgery. J Nucl Med 44:1443–1458

    PubMed  Google Scholar 

  10. Zhen L, Li H, Liu X, Ge BH, Yan J, Yang J (2013) The application of SPECT/CT for preoperative planning in patients with secondary hyperparathyroidism. Nucl Med Commun 34:439–444

    Article  PubMed  Google Scholar 

  11. Dasgupta D, Navalkissoor S, Ganatra R, Buscombe J (2013) The role of single photon computed tomography/computed tomography in localizing parathyroid adenoma. Nucl Med Commun 34:621–626

    Article  PubMed  Google Scholar 

  12. Lavely W, Goetze S, Friedman K, Leal JP, Zhang Z, Garret-Mayer E et al (2007) Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med 48:1084–1089

    Article  PubMed  Google Scholar 

  13. Noda S, Onoda N, Kashiwagi H, Kawajiri H, Takashima T, Ishikawa T et al (2014) Strategy of operative treatment of hyperparathyroidism using US scan and Tc-99m-MIBI SPECT/CT. Endocr J 61:225–230

    Article  PubMed  Google Scholar 

  14. Mahajan A, Starker L, Ghita M, Udelsman R, Brink JA, Carling T (2012) Parathyroid four-dimensional computed tomography: evaluation of radiation dose exposure during preoperative localisation of parathyroid tumors in primary hyperparathyroidism. World J Surg 36:1335–1339

    Article  PubMed  Google Scholar 

  15. Saggiorato E, Angusti T, Rosas R, Martinese M, Finessi M, Arecco F et al (2009) 99mTc-MIBI imaging in the presurgical characterization of thyroid follicular neoplasms: relationship to multidrug resistance protein expression. J Nucl Med 50:1785–1793

    Article  PubMed  Google Scholar 

  16. Leidig-Bruckner G, Cichorowski G, Sattler P, Bruckner T, Sattler B (2012) Evaluation of thyroid nodules—combined use of 99mTc-methylisobutylnitrile scintigraphy and aspiration cytology to assess risk of malignancy and stratify patients for surgical or nonsurgical therapy—a retrospective cohort study. Clin Endocrinol 76:749–758

    CAS  Article  Google Scholar 

  17. Qiu ZL, Wu B, Shen CT, Zhu RS, Luo QY (2014) Dual-phase (99m)Tc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables. Ann Nucl Med 28:725–735

    Article  PubMed  Google Scholar 

  18. Mihai R, Gleeson F, Buley ID, Roskell DE, Sadler GP (2006) Negative imaging studies for primary hyperparathyroidism are unavoidable: correlation of sestamibi and high resolution ultrasound scanning with histological analysis in 150 patients. World J Surg 30:697–704

    Article  PubMed  Google Scholar 

  19. Taieb D, Urena-Torres P, Zanotti-Fregonara P, Rubello D, Ferretti A, Henter I et al (2013) Parathyroid scintigraphy in renal hyperparathyroidism. Clin Nucl Med 38:630–635

    Article  PubMed  PubMed Central  Google Scholar 

  20. Witteveen JE, Kievit J, Stokkel MPM, Morreau H, Romijn JA, Hamdy NAT (2011) Limitations of Tc99m-MIBI SPECT imaging scans in persistent primary hyperparathyroidism. World J Surg 35:128–139

    Article  PubMed  Google Scholar 

  21. Öksüz MÖ, Dittman H, Wicke C, Müssig K, Bares R, Pfannenberg C et al (2011) 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 17:297–307

    PubMed  Google Scholar 

  22. Shafiei B, Hoseinzadeh S, Fotouhi F, Malek H, Azizi F, Jahed A et al (2012) Preoperative Tc-99m-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: comparison of SPECT-CT, SPECT, and planar imaging. Nucl Med Commun 33:1070–1076

    CAS  Article  PubMed  Google Scholar 

  23. Ciappuccini R, Morera J, Pascal P, Rame JP, Heutte N, Aide N et al (2012) Dual-phase Tc-99m sestamibi scintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism. Clin Nucl Med 37:223–228

    Article  PubMed  Google Scholar 

  24. Patel C, Salahudeen HM, Lansdown M, Scarsbrook A (2010) Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localisation of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol 65:278–287

    CAS  Article  PubMed  Google Scholar 

  25. Im HJ, Lee IK, Paeng JC, Lee KE, Cheon GJ, Kang KW et al (2014) Functional evaluation of parathyroid adenoma using Tc-99m-MIBI parathyroid SPECT/CT: correlation with functional markers and disease severity. Nucl Med Commun 35:649–654

    CAS  Article  PubMed  Google Scholar 

  26. Wei WJ, Shen CT, Song HJ, Qiu ZL, Luo QY (2015) Comparison of SPECT/CT, SPECT and planar imaging using (99m)Tc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: a meta-analysis. Hell J Nucl Med 18:127–135

Download references

Author information

Affiliations

  1. Istanbul Medical Faculty, Nuclear Medicine Department, Istanbul University, Millet Cad, 34390, Capa-Fatih, Istanbul, Turkey

    Zeynep Gozde Ozkan, Seher Nilgun Unal, Serkan Kuyumcu, Yasemin Sanli & Mehmet Fatih Gecer

  2. Istanbul Medical Faculty, General Surgery Department, Istanbul University, Millet Cad, 34390, Capa-Fatih, Istanbul, Turkey

    Beyza Ozcinar, Yasemin Senyurek Giles & Yesim Erbil

Authors
  1. Zeynep Gozde Ozkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seher Nilgun Unal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Serkan Kuyumcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasemin Sanli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet Fatih Gecer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Beyza Ozcinar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasemin Senyurek Giles
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yesim Erbil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zeynep Gozde Ozkan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

Our research has not been funded by any organization.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

Our study is retrospectively designed. For this type of study, formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ozkan, Z.G., Unal, S.N., Kuyumcu, S. et al. Clinical Utility of Tc-99m MIBI SPECT/CT for Preoperative Localization of Parathyroid Lesions. Indian J Surg 79, 312–318 (2017). https://doi.org/10.1007/s12262-016-1489-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-016-1489-7

Keywords

  • Hyperparathyroidism
  • Tc-99m MIBI
  • Parathyroid scintigraphy
  • SPECT/CT