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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primar...
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Vol. 35. Issue 6.
Pages 351-357 (November - December 2016)
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Vol. 35. Issue 6.
Pages 351-357 (November - December 2016)
Original Article
Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters
Aportación del SPECT/TC precoz a la gammagrafía de doble fase con 99mTc-MIBI en pacientes con hiperparatiroidismo primario: valor diagnóstico y correlación de la captación con parámetros biológicos
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P. García-Talaveraa,
Corresponding author
palomagtalavera@gmail.com

Corresponding author.
, G. Díaz-Sotob, A.A. Montesc, J.G. Villanuevad, A. Cobod, C. Gamazod, M.Á. Ruizd, M.L. González-Selmad
a Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
b Servicio de Endocrinología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
c Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
d Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Figures (2)
Tables (3)
Table 1. Characteristics of the patients (mean±s.d.).
Table 2. Ultrasonography and scintigraphy correlation (results by patients).
Table 3. Scintigraphy results in patients with thyroid pathology.
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Abstract
Aim

To evaluate the value of 99mTc-MIBI double-phase scintigraphy (DPS) and early SPECT/CT in the pre-surgical assessment of patients with primary hyperparathyroidism (PHPT). Also, to calculate the correlation between uptake and some biological parameters.

Material and methods

Forty patients with PHPT were included: 37 solitary adenomas, 1 hyperplasia, and 2 double adenomas. Fifteen patients had ectopic glands.

DPS and early SPECT/CT were acquired in all patients. Ultrasound was performed in 31/40. All patients underwent surgery, intra-operative iPTH measurements, and histopathological examinations.

Qualitative DPS uptake was assessed and correlated to pre-surgical calcium, iPTH levels, gland weight, and maximum diameter.

Results

In the planar study, there were 23 positive cases, 8 doubtful, and 9 negatives. With the SPECT/CT, 8/9 negatives cases were located. All doubtful cases were confirmed as positives. Gland location improved in 16 cases (12 ectopic).

DPS+SPECT/CT failed to detect a solitary adenoma and at least one gland in three cases of multiglandular disease (MGD). The sensitivity by patient was: DPS 72.5%, DPS+SPECT/CT 90%, and ultrasound 42%.

Ultrasound and scintigraphy (DPS+SPECT/CT) were concordant in 16/31 patients. For the rest of them, scintigraphy proved correct in 14/15, and both techniques failed in one case.

There was a significant correlation between level of uptake and iPTH level, gland weight, and maximum diameter.

Conclusion

Early SPECT/CT improves sensitivity and the locating of parathyroid pathological glands and increases diagnostic confidence. iPTH level, glandular size, and weight are related to the qualitative assessment of 99mTc-MIBI uptake in early DPS.

Keywords:
Early SPECT/CT
99mTc-MIBI double-phase scintigraphy
Primary hyperparathyroidism
iPTH
Glandular size
Resumen
Objetivo

Evaluar la gammagrafía de doble fase con 99mTc-MIBI (GDF) y el SPECT/TC precoz, en la valoración prequirúrgica del hiperparatiroidismo primario (HPTP), calculando la correlación entre grado de captación y algunos parámetros biológicos.

Material y métodos

Se incluyeron 40 pacientes: 37 adenomas solitarios, dos adenomas dobles, una hiperplasia. Quince tenían glándulas ectópicas.

En 40 pacientes se realizaron GDF y SPECT/TC; en 31/40, ecografía. Todos los pacientes fueron intervenidos, realizando determinación de PTHi intraoperatoria y examen histopatológico.

Se evaluó cualitativamente la captación en la GDF, correlacionándose con calcio y PTHi prequirúrgicos, peso y diámetro máximo glandulares.

Resultados

En el estudio planar se obtuvieron 23 casos positivos, 8 dudosos, y 9 negativos. Con SPECT/TC se localizaron 8/9 de los negativos. Todos los dudosos se confirmaron como positivos. La localización glandular mejoró en 16 casos (12 ectópicos).

La GDF+SPECT/TC fallaron en la detección de un adenoma solitario y en la visualización de alguna de las glándulas en tres casos de enfermedad multiglandular (EMG). La sensibilidad por pacientes fue: GDF 72,5%, GDF+SPECT/TC 90%, ecografía 42%.

Ecografía y gammagrafía (GDF+SPECT/TC) concordaron en 16/31 pacientes. De los no concordantes, la gammagrafía acertó en 14/15 y ambas técnicas fallaron en uno.

Hubo correlación significativa entre captación y PTHi, peso y diámetro máximo glandulares.

Conclusion

El SPECT/TC precoz mejora la sensibilidad y la localización de las paratiroides patológicas y aumenta la confianza diagnóstica. PTHi, tamaño y peso glandulares se correlacionan con la valoración cualitativa de la captación precoz de 99mTc-MIBI en la GDF.

Palabras clave:
SPECT/TC precoz
Gammagrafía de doble fase con 99mTc-MIBI
Hiperparatiroidimo primario
PTHi
Tamaño glandular

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