Skip to main content

Advertisement

SpringerLink
Log in

Usefulness of 99mTc-SESTAMIBI Scintigraphy in Persistent Hyperparathyroidism after Kidney Transplant

  • Original Article
  • Published:
Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

99mTc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). The purpose of this study is to investigate the usefulness of 99mTc-sestamibi scintigraphy in persistent hyperparathyroidism after kidney transplant (KT).

Methods

Retrospectively evaluated 50 patients who received parathyroidectomy after KT at a single medical center. The parathyroid lesion with the highest sestamibi uptake intensity of a patient was graded from 0 to 3. Uptake intensity was analyzed in correlation with parathyroid hormone (PTH), calcium, ionized calcium, phosphorus, and vitamin D.

Results

Per-patient analysis, 43 patients had hyperplasia, 6 patients had adenomas, and 1 patient had a carcinoma. Only 3 patients with hyperplasia did not demonstrate any sestamibi uptake in the parathyroid scans. Out of the 148 pathologically confirmed parathyroid lesions, SPECT/CT images were able to identify 89 lesions (60%) and planar images of 71 lesions (48%). The average of sestamibi uptake intensity was mild at grade 1.6. Uptake intensity showed a positive correlation with parathyroid hormone (PTH) level but not with phosphorus, calcium, ionized calcium, or vitamin D levels. The largest lesion showed a high positive predictive value, especially in lesions with a diameter over 1.0 cm.

Conclusions

Regardless of relatively low and less discrete uptake in KT patients, it well depicts the largest and the most hyperfunctioning lesion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Contact the corresponding author for data requests.

References

  1. Coakley AJ, Kettle AG, Wells CP, O’Doherty MJ, Collins RE. 99Tcm sestamibi—a new agent for parathyroid imaging. Nucl Med Commun. 1989;10:791–4.

    Article  CAS  Google Scholar 

  2. 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.

    CAS  PubMed  Google Scholar 

  3. Civelek AC, Ozalp E, Donovan P, Udelsman R. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery. 2002;131:149–57.

    Article  Google Scholar 

  4. Eslamy HK, Ziessman HA. Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics. 2008;28:1461–76.

    Article  Google Scholar 

  5. Ciappuccini R, Morera J, Pascal P, Rame JP, Heutte N, Aide N, et al. Dual-phase 99mTc sestamibi scintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism: a single-institution experience. Clin Nucl Med. 2012;37:223–8.

    Article  Google Scholar 

  6. Caixas A, Berna L, Piera J, Rigla M, Matias-Guiu X, Farrerons J, et al. Utility of 99mTc-sestamibi scintigraphy as a first-line imaging procedure in the preoperative evaluation of hyperparathyroidism. Clin Endocrinol (Oxf). 1995;43:525–30.

    Article  CAS  Google Scholar 

  7. 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.

    Article  CAS  Google Scholar 

  8. Shaha AR, Sarkar S, Strashun A, Yeh S. Sestamibi scan for preoperative localization in primary hyperparathyroidism. Head Neck. 1997;19:87–91.

    Article  CAS  Google Scholar 

  9. Pons F, Torregrosa JV, Vidal-Sicart S, Sabater L, Fuster D, Fernandez-Cruz L, et al. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism. Eur J Nucl Med. 1997;24:1494–8.

    Article  CAS  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. Muros MA, Bravo Soto J, Lopez Ruiz JM, Rodriguez-Portillo M, Ramirez Navarro A, Bellon 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.

    Article  Google Scholar 

  12. Jones BA, Lindeman B, Chen H. Are Tc-99m-sestamibi scans in patients with secondary hyperparathyroidism and renal failure needed? J Surg Res. 2019;243:380–3.

    Article  Google Scholar 

  13. Spence RAJ, Patterson TJ, Currie P, Convie L, Tong L, Brown T, et al. Renal failure parathyroidectomy—is pre-operative imaging worthwhile? Surgeon. 2019;17:201–6.

    Article  Google Scholar 

  14. Slitt GT, Lavery H, Morgan A, Bernstein B, Slavin J, Karimeddini MK, et al. Hyperparathyroidism but a negative sestamibi scan: a clinical dilemma. Am J Surg. 2005;190:708–12.

    Article  Google Scholar 

  15. Koziolek MJ, Riess R, Geiger H, Thevenod F, Hauser IA. Expression of multidrug resistance P-glycoprotein in kidney allografts from cyclosporine A-treated patients. Kidney Int. 2001;60:156–66.

    Article  CAS  Google Scholar 

  16. Torregrosa JV, Felez I, Fuster D. Usefulness of imaging techniques in secondary hyperparathyroidism. Nefrologia. 2010;30:158–67.

    CAS  PubMed  Google Scholar 

  17. Cheon M, Choi JY, Chung JH, Lee JY, Cho SK, Yoo J, et al. Differential findings of Tc-99m sestamibi dual-phase parathyroid scintigraphy between benign and malignant parathyroid lesions in patients with primary hyperparathyroidism. Nucl Med Mol Imaging. 2011;45:276–84.

    Article  CAS  Google Scholar 

  18. Wei JP, Burke GJ. Analysis of savings in operative time for primary hyperparathyroidism using localization with technetium 99m sestamibi scan. Am J Surg. 1995;170:488–91.

    Article  CAS  Google Scholar 

  19. Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg. 1998;186:293–305.

    Article  CAS  Google Scholar 

  20. Parel RJ, Bolton JS, Fuhrman GM. An analysis of sestamibi-positive versus -negative patients with primary hyperparathyroidism. Am Surg. 2001;67:1101–4.

    CAS  PubMed  Google Scholar 

  21. Pinero A, Rodriguez JM, Ortiz S, Soria T, Bermejo J, Claver MA, et al. Relation of biochemical, cytologic, and morphologic parameters to the result of gammagraphy with technetium 99m sestamibi in primary hyperparathyroidism. Otolaryngol Head Neck Surg. 2000;122:851–5.

    Article  CAS  Google Scholar 

  22. Erbil Y, Kapran Y, Issever H, Barbaros U, Adalet I, Dizdaroglu F, et al. The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism. Am J Surg. 2008;195:34–9.

    Article  Google Scholar 

  23. Yang J, Wang H, Zhang J, Xu W, Weng W, Lv S, et al. Sestamibi single-positron emission computed tomography/diagnostic-quality computed tomography for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism: what clinicopathologic factors affect its accuracy? J Endocrinol Invest. 2021; 44:1649–58.

  24. Merlino JI, Ko K, Minotti A, McHenry CR. The false negative technetium-99m-sestamibi scan in patients with primary hyperparathyroidism: correlation with clinical factors and operative findings. Am Surg. 2003;69:225–9; discussion 9–30.

  25. Cermik TF, Puyan FO, Sezer A, Firat MF, Berkarda S. Relation between Tc-99m sestamibi uptake and biological factors in hyperparathyroidism. Ann Nucl Med. 2005;19:387–92.

    Article  Google Scholar 

  26. Kandil E, Tufaro AP, Carson KA, Lin F, Somervell H, Farrag T, et al. Correlation of plasma 25-hydroxyvitamin D levels with severity of primary hyperparathyroidism and likelihood of parathyroid adenoma localization on sestamibi scan. Arch Otolaryngol Head Neck Surg. 2008;134:1071–5.

    Article  Google Scholar 

  27. Swanson TW, Chan SK, Jones SJ, Bugis S, Irvine R, Belzberg A, et al. Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism. Am J Surg. 2010;199:614–20.

    Article  Google Scholar 

  28. Tay YD, Yeh R, Kuo JH, McManus C, Lee JA, Bilezikian JP. Pre-operative localization of abnormal parathyroid tissue by (99m)Tc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: an evaluation of the predictive value of vitamin D deficiency. Endocrine. 2018;60:36–45.

    Article  CAS  Google Scholar 

  29. Gupta Y, Ahmed R, Happerfield L, Pinder SE, Balan KK, Wishart GC. P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. Br J Surg. 2007;94:1491–5.

    Article  CAS  Google Scholar 

  30. Takeuchi H, Greep NC, Hoon DS, Giuliano AE, Hansen NM, Umetani N, et al. Hypermethylation of adenosine triphosphate-binding cassette transporter genes in primary hyperparathyroidism and its effect on sestamibi imaging. J Clin Endocrinol Metab. 2007;92:1785–90.

    Article  CAS  Google Scholar 

  31. Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med. 1998;39:1441–4.

    CAS  PubMed  Google Scholar 

  32. Dy BM, Richards ML, Vazquez BJ, Thompson GB, Farley DR, Grant CS. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol. 2012;19:2272–8.

  33. Krishnamurthy VD, Sound S, Okoh AK, Yazici P, Yigitbas H, Neumann D, et al. The utility of repeat sestamibi scans in patients with primary hyperparathyroidism after an initial negative scan. Surgery. 2017;161:1651–8.

    Article  Google Scholar 

  34. Badii B, Staderini F, Foppa C, Tofani L, Skalamera I, Fiorenza G, et al. Cost-benefit analysis of the intraoperative parathyroid hormone assay in primary hyperparathyroidism. Head Neck. 2017;39:241–6.

    Article  Google Scholar 

  35. Noltes ME, Coester AM, van der Horst-Schrivers ANA, Dorgelo B, Jansen L, Noordzij W, et al. Localization of parathyroid adenomas using (11)C-methionine pet after prior inconclusive imaging. Langenbecks Arch Surg. 2017;402:1109–17.

    Article  Google Scholar 

  36. Parvinian A, Martin-Macintosh EL, Goenka AH, Durski JM, Mullan BP, Kemp BJ, et al. (11)C-Choline PET/CT for detection and localization of parathyroid adenomas. AJR Am J Roentgenol. 2018;210:418–22.

    Article  Google Scholar 

Download references

Acknowledgements

This article is the expansion of a previous abstract presented at the SNMMI 2021 annual meeting (https://jnm.snmjournals.org/content/62/supplement_1/87.abstract).

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Muheon Shin, Joon Young Choi & Young Seok Cho

  2. Department of Endocrinology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sun Wook Kim

  3. Department of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jung Han Kim

Authors
  1. Muheon Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joon Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sun Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jung Han Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young Seok Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The study was designed by Muheon Shin and Young Seok Cho. Material preparation and data collection were performed by Muheon Shin, Sun Wook Kim, and Jung Han Kim. The image interpretation and data analysis were performed by Muheon Shin and Joon Young Choi. The first draft of the manuscript was written by Muheon Shin, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Young Seok Cho.

Ethics declarations

Conflict of Interest

Muheon Shin, Joon Young Choi, Sun Wook Kim, Jung Han Kim, and Young Seok Cho declare no conflict of interest.

Ethical Statement

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 Helsinki Declaration as revised in 2013 and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Consent to Participate

This retrospective study was approved by the institutional review board of Samsung Medical Center, and the requirement to obtain informed consent was waived.

Consent for Publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, M., Choi, J.Y., Kim, S.W. et al. Usefulness of 99mTc-SESTAMIBI Scintigraphy in Persistent Hyperparathyroidism after Kidney Transplant. Nucl Med Mol Imaging 55, 285–292 (2021). https://doi.org/10.1007/s13139-021-00722-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13139-021-00722-6

Keywords

Search

Navigation