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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Factors associated with negative 99mTc-MIBI scanning in patients with primary hy...
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Vol. 40. Issue 4.
Pages 222-228 (July - August 2021)
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Vol. 40. Issue 4.
Pages 222-228 (July - August 2021)
Original Article
Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism
Factores asociados con la ausencia de captación en la gammagrafía con 99mTc-MIBI en pacientes con hiperparatiroidismo primario
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F. Carrala,
Corresponding author
florencarral@hotmail.com

Corresponding author.
, A.I. Jiméneza, M. Toméa, J. Álvarezb, A. Díezb, F. Partidac, C. Ayalaa
a Endocrinology and Nutrition Department, Puerto Real University Hospital, Cádiz, Spain
b General and Digestive Surgery Department, Puerto Real University Hospital, Cádiz, Spain
c Nuclear Medicine Department, Puerta del Mar University Hospital, Cádiz, Spain
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Table 1. Clinical and biochemical characteristics and imaging studies in patients with Primary hyperparathyroidism based on the scintigraphy result for localization (n = 195).
Table 2. 1 Clinical and biochemical characteristics and imaging studies and anatomy pathology results based on the localizations of the parathyroid adenomas.
Table 3. Factors associated in the multivariate analysis with a negative scintigraphy result in the multivariate analysis.
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Abstract
Objective

The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT).

Methods

A retrospective observational study was designed in 195 patients (mean age: 59.2 ± 13.0 years; 77% woman) with PHPT (calcium: 11,3 ± 1,1 mg/dl and PTH: 218 ± 295 pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning.

Result

50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146 ± 98 vs. 244 ± 334; p < 0,001), adenomas with smaller sonographic dimensions (maximum diameter: 1,2 ± 0,4 vs. 1,7 ± 0,9 cm; p = 0,001 and volume: 0,36 ± 0,43 vs. 1,7 ± 4,1 cm3; p < 0,001), localized more frequently in upper parathyroid glands (37% vs 14%; p = 0,005) and associated more frequently to thyroid nodules (72% vs 57%; p = 0,045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1,3 ± 0,5 vs. 1,9 ± 1,1 cm; p = 0,008 and volume: 0,30 ± 0,20 vs. 1,2 ± 1,1 cm3; p < 0,001), less heavy (567 ± 282 vs. 1470 ± 1374 mgr.; p = 0,030) and were localized more frequently in upper situation (65% vs 16%; p < 0,001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1 cm (OR: 5,77; IC 95: 1,46–22,71) and upper adenoma localization were observed (OR: 8,05; IC 95%: 2,22–29,16).

Conclusions

One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1 cm and upper adenoma localization.

Keywords:
Primary hyperparathyroidism
Parathyroid adenoma
Fine needle aspiration puncture
Parathyroid hormone
Resumen
Objetivo

El objetivo ha sido evaluar los factores clínicos y biológicos asociados con la ausencia de captación en la gammagrafía 99mTc-MIBI en pacientes con hiperparatiroidismo primario (HPTP).

Material y métodos

Estudio observacional retrospectivo en el que se evalúan 195 pacientes (edad media: 59,2 ± 13,0 años; 77% mujeres) con HPTP (calcemia: 11,3 ± 1,1 mg/dl y PTH: 218 ± 295 pg/ml) atendidos en consulta de endocrinología entre 2013 y 2020. Se realiza un análisis univariante y multivariante de los factores clínicos y biológicos asociados a la negatividad en la gammagrafía planar con 99mTc-MIBI.

Resultados

Los 50 pacientes (26%) sin captación en la gammagrafía 99mTc-MIBI presentaban menores niveles de PTH (146 ± 98 vs. 244 ± 334; p < 0,001), adenomas de menores dimensiones ecográficas (diámetro máximo: 1,2 ± 0,4 vs. 1,7 ± 0,9 cm; p = 0,001 y volumen: 0,36 ± 0,43 vs. 1,7 ± 4,1 cm3; p < 0,001), situados con mayor frecuencia en las glándulas paratiroideas superiores (37% vs 14%; p = 0,005) y una mayor frecuencia de nódulos tiroideos asociados (72% vs 57%; p = 0,045) que los pacientes con captación positiva. Se intervinieron 116 pacientes y los adenomas extirpados eran más pequeños (diámetro máximo: 1,3 ± 0,5 vs. 1,9 ± 1,1 cm; p = 0,008 y volumen: 0,30 ± 0,20 vs. 1,2 ± 1,1 cm3; p < 0,001), pesaban menos (567 ± 282 vs. 1470 ± 1374 gr.; p = 0,030) y se encontraban más frecuentemente en las glándulas superiores (65% vs 16%; p < 0,001) en los pacientes con gammagrafía 99mTc-MIBI positiva. En el análisis multivariante se observó una asociación independiente entre la ausencia de captación en la gammagrafía 99mTc-MIBI con el tamaño del adenoma extirpado ≤1 cm (OR: 5,77; IC 95: 1,46–22,71) y su localización en las glándulas paratiroideas superiores (OR: 8,05; IC 95%: 2,22–29,16).

Conclusiones

uno de cada 4 pacientes estudiados por HPTP presentan ausencia de captación en la gammagrafía 99mTc-MIBI, asociándose la ausencia de captación de forma independiente con un diámetro del adenoma <1 cm y su localización en el área de las glándulas paratiroideas superiores.

Palabras clave:
Hiperparatiroidismo primario
Adenoma paratiroideo
Punción aspiración con aguja fina
Hormona paratiroidea

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