Localization value of ultrasonography, contrast-enhanced ultrasound and 99mTc-MIBI SPECT/CT in refractory secondary hyperparathyroidism

Objective To explore the diagnostic value of ultrasonography (US), contrast-enhanced ultrasonography (CEUS), (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in refractory secondary hyperparathyroidism. Methods From August 2015 to August 2017, 18 cases of refractory hyperparathyroidism admitted to the Affiliated Hospital of Qingdao University were collected. All patients underwent US, CEUS, 99mTc-MIBI SPECT/CT imaging before operation. The diagnostic efficiency of the three methods was compared with the pathological results as the gold standard. Results A total of 73 nodules were removed from 18 cases, 71 of them were parathyroid nodules confirmed by pathology. The imaging sensitivity of US, CEUS, 99mTc-MIBI SPECT/CT was 98.59%, 94.37% and 78.87% respectively, and the accuracy was 97.26%, 94.52% and 78.08% respectively. There was no significant difference between US and CEUS in locating parathyroid hyperplasia nodules (P=0.250). The diagnostic value of US and CEUS was superior to 99mTc-MIBI SPECT/CT (P=0.001, 0.012), and the specificity was increased when combination of US with CEUS (50.00% vs 100.00%). When combined with 99mTc-MIBI SPECT/CT imaging, the accuracy of localization was further improved (98.63% vs 100.00%). Conclusion For refractory secondary hyperparathyroidism, comprehensive preoperative diagnosis can be made after combined application of US, CEUS and 99mTc-MIBI SPECT/CT. Key words: Ultrasonography; Technetium Tc 99m sestamibi; Tomography, spiral computed; Hyperparathyroidism