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Dual-phase 99mTc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables

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Abstract

Purpose

The purpose of this study was to assess the relationship between 99mTc-MIBI and 99mTc-MDP bone scintigraphy and clinical or pathological variables, including preoperative serum PTH levels and tumor diameter, in patients with newly diagnosed PHPT.

Methods

Dual-phase 99mTc-MIBI planar scintigraphy was performed in 244 patients with PHPT. Of these patients, 155 underwent 99mTc-MDP bone scintigraphy to detect bone changes before parathyroidectomy. Factors influencing 99mTc-MIBI scintigraphy and 99mTc-MDP bone scintigraphy detection rate were assessed using univariate and multivariate logistic regression analysis; optimal cutoff values for predicting positive 99mTc-MIBI and 99mTc-MDP bone scintigraphy were evaluated using ROC analysis.

Results

Among 244 patients, 174 (71.31 %) patients with 181 foci had a positive 99mTc-MIBI planar scintigraphy; delayed neck and thorax SPECT/CT could identify and locate the 99mTc-MIBI lesions but could not find more lesions than planar scintigraphy. 70 (28.69 %) patients had a negative 99mTc-MIBI planar scintigraphy. Tumor diameter, serum PTH level and symptoms were statistically significant predictive factors in predicting positive 9mTc-MIBI scintigraphy both univariate and multivariate logistic regression analyses. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.03 cm and 127.60 ng/L, respectively. Among 155 patients with bone scintigraphy, 99mTc-MDP bone scintigraphy showed positive finding in 80 (51.61 %) patients and negative finding in 75 patients. Univariate logistic regression analysis showed that patient age, sex, tumor diameter and PTH level (≥150 ng/L) were statistically significant in predicting positive 99mTc-MDP bone scintigraphy. Multivariate logistic regression analysis showed both tumor diameter and PTH ≥ 150 ng/L were statistically significant in predicting positive 99mTc-MDP bone scintigraphy. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.96 cm and 163.85 ng/L, respectively.

Conclusions

The utility of delayed neck and thorax SPECT/CT over dual-phase 99mTc-MIBI planar scintigraphy is that it can identify and locate a parathyroid tumor in about more than 70 % of patients in PHPT and provide the assistance for surgical planning. These studies also suggest that 99mTc-MIBI scintigraphy and 99mTc-MDP bone scintigraphy are closely correlated with tumor diameter and PTH; which may show negative results when tumor diameter is small and serum PTH level is low.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, People’s Republic of China

    Zhong-Ling Qiu, Chen-Tian Shen, Rui-Sen Zhu & Quan-Yong Luo

  2. Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, China

    Bo Wu

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  1. Zhong-Ling Qiu
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  2. Bo Wu
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Corresponding author

Correspondence to Quan-Yong Luo.

Additional information

Zhong-Ling Qiu and Bo Wu contributed equally to this work.

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Qiu, ZL., Wu, B., Shen, CT. et al. Dual-phase 99mTc-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 (2014). https://doi.org/10.1007/s12149-014-0876-z

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  • DOI: https://doi.org/10.1007/s12149-014-0876-z

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