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Usefulness of SPECT/CT in Parathyroid Lesion Detection in Patients with Thyroid Parenchymal 99mTc-Sestamibi Retention

Nuclear Medicine and Molecular Imaging volume 51, pages 32–39 (2017)Cite this article

Abstract

Purpose

Parathyroid adenoma detection with dual-phase 99mTc-sestamibi (MIBI) scintigraphy depends on differential MIBI washout from thyroid. However, autoimmune thyroid disease (AITD) may cause MIBI to be retained in the thyroid gland and reduce parathyroid detection. We evaluated the impact of AITD on MIBI thyroid retention and additional benefit of SPECT/CT in these patients.

Methods

Dual phase planar MIBI and SPECT/CT was performed on 82 patients. SPECT/CT was performed immediately after delayed planar scan. Thyroid density (Hounsfield unit, CT-HU) and size were measured on CT component of SPECT/CT. MIBI uptake in early scans and retention in delayed scans were visually graded and correlated with clinical factors and CT findings. Finally, planar and SPECT/CT findings were compared for parathyroid lesion visualization according to thyroid MIBI retention.

Results

In early scan, multivariate analysis showed only thyroid size predicted early uptake. In delayed scan, multivariate analysis showed higher visual grade in early scan, lower CT-HU or AITD were significant predictors for delayed thyroid parenchymal retention. Overall, ten more parathyroid lesions were visualized on SPECT/CT compared to planar scans (57 vs. 47, p = 0.002). SPECT/CT was especially more useful in patients with thyroidal MIBI retention, as eight out of the ten additional lesions detected were found in patients with thyroid MIBI retention.

Conclusion

AITD is an important factor for MIBI thyroid parenchymal retention on delayed scans, and may impede parathyroid lesion detection. Patients with MIBI retention in the thyroid parenchyma on delayed scans are likely to benefit from an additional SPECT/CT.

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Affiliations

  1. Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Sang Hyun Hwang, Mijin Yun & Arthur Cho

  2. Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Yumie Rhee

  3. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Jung Hyun Yoon

  4. Department of Nuclear Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Beon-gil, Seo-gu, Incheon, 22711, South Korea

    Jeong Won Lee

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  1. Sang Hyun Hwang
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  2. Yumie Rhee
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  3. Mijin Yun
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  6. Arthur Cho
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Correspondence to Arthur Cho.

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Conflict of Interest

Sang Hyun Hwang, Yumie Rhee, Mijin Yun, Jung Hyun Yoon, Jeong Won Lee, and Arthur Cho declare that they have no conflict of interest.

Ethical Statement

This study was approved by the institutional review board (IRB) of our institution. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived because of the retrospective design of this study. We declare that this paper is solely submitted to Nuclear Medicine and Molecular Image. The content has not been published or submitted for publication elsewhere. Final approval of the version to be published was done by all authors.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Hwang, S.H., Rhee, Y., Yun, M. et al. Usefulness of SPECT/CT in Parathyroid Lesion Detection in Patients with Thyroid Parenchymal 99mTc-Sestamibi Retention. Nucl Med Mol Imaging 51, 32–39 (2017). https://doi.org/10.1007/s13139-016-0438-5

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  • DOI: https://doi.org/10.1007/s13139-016-0438-5

Keywords

  • Autoimmune thyroid disease
  • 99mTc-sestamibi scintigraphy
  • SPECT/CT
  • Parathyroid