A comparison between 11C-methionine PET/CT and MIBI SPECT/CT for localization of parathyroid adenomas/hyperplasia
Nobuyuki HayakawaYuji NakamotoKensuke KuriharaAkihiro YasodaNaotetsu KanamotoMasako MiuraNobuya InagakiKaori Togashi
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Abstract:
The purpose of this study was to compare the sensitivity of single-photon emission computed tomography/computed tomography (SPECT/CT) using 99mTc-sestamibi (MIBI) with that of PET/CT using 11C-methionine (MET) for localization of parathyroid adenomas/hyperplasia in primary hyperparathyroidism.Twenty-three patients with primary hyperparathyroidism were analyzed. Fifteen patients underwent surgery, and the remaining eight did not, but these patients were clinically diagnosed as having primary hyperparathyroidism. Patients underwent both MET PET/CT and MIBI SPECT/CT scanning. The sensitivities of both modalities were evaluated on a per-patient basis, and on a per-lesion basis for parathyroid lesions detected by surgery. The size of the parathyroid adenoma/hyperplasia and serum intact parathyroid hormone levels were compared with the results of each of the two modalities.Per-patient sensitivities of MET PET/CT and MIBI SPECT/CT were 65 and 61%, respectively. Per-lesion sensitivities of MET PET/CT and MIBI SPECT/CT were 91 and 73% for histologically confirmed adenomas and 30 and 30% for hyperplastic glands, respectively. No significant differences were observed between the two modalities. The size of uptake-positive lesions was significantly larger than that of uptake-negative lesions in both modalities. Intact parathyroid hormone levels showed no significant difference between uptake-positive and uptake-negative patients in both modalities.The sensitivities of MET PET/CT and MIBI SPECT/CT were comparable. MET PET/CT has a complementary role in localizing parathyroid adenomas/hyperplasia when MIBI SPECT/CT is inconclusive.Keywords:
PET-CT
Parathyroid neoplasm
The authors report the utility of very delayed Tc-99m methoxyisobutyl isonitrile (MIBI) SPECT for localization of a parathyroid adenoma. This case illustrates that very delayed MIBI SPECT could successfully be used in patients with a high clinical suspicion of primary hyperparathyroidism and when all diagnostic studies, including early MIBI SPECT parathyroid scintigraphy, fail to localize the parathyroid adenoma.
Parathyroid neoplasm
Technetium (99mTc) sestamibi
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Objectives: In patients who have parathyroid adenoma, combination of ultrasonography and technetium Tc 99m sestamethoxyisobutylisonitrile scan (also called sestamibi or MIBI scan), which allows anatomic and functional information about parathyroid adenomas, is used commonly to maximize operative cure. The sensitivity of MIBI scan may be increased by adding single photon emission computed tomography (SPECT) and computed tomography (CT) as a combined MIBI-SPECT CT scan. We assessed the accuracy of ultrasonography and parathyroid MIBISPECT scan in detecting parathyroid adenoma and evaluated the potential benefit of the combined protocol of ultrasonography and MIBI-SPECT parathyroid scan.
Methods: In 58 patients who had biochemical evidence of primary hyperparathyroidism, we retrospectively reviewed the preoperative ultrasonography and MIBI-SPECT scans. The results of these studies were correlated with surgical findings.
Results: In the 58 patients, surgery showed that 43 patients (74%) had solitary parathyroid adenoma. The sensitivity, specificity and accuracy of MIBI-SPECT for parathyroid adenoma was (72%,80%,74%) and for ultrasonography (53%,60%,55%) respectively. The highest sensitivity is noted with the combination of MIBI-SPECT and ultrasonography (79%), . 9 adenomas (21%) were missed by both modalities. In the 20 adenomas that were missed by ultrasound 11 were detected by MIBI SPECT.
Conclusion: The MIBI-SPECT had better performance than ultrasonography for parathyroid adenoma localization. The combined MIBI SPECT and ultrasonography has the highest sensitivity for parathyroid adenoma detection (79%). An alternative strategy may be to use MIBI-SPECT initially, and to proceed to ultrasonography only in patients with negative MIBI- SPECT. This may avoid many ultrasonography procedures.
Parathyroid neoplasm
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Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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With both improvement in preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone (PTH) assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT) compared to both historically and to cervical exploration. Still, many institutions are not familiar with performing MIP under regional or local anesthesia. We present such an operation under local cervical block anesthesia.
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症例は64歳，男性．近医で以前から高カルシウム血症を指摘されていたが，intact-PTHの高値を認め当院内分泌外科へ紹介となった．頸部超音波検査では甲状腺両葉の上極あるいは下極の背側に腫瘤はなく，甲状腺右葉内に，上極より1.7cm，下極より1.2cmの内部均一で低エコーな腫瘤を認めた．MIBIシンチグラム検査では甲状腺右葉にのみ結節状の集積がわずかに認められた．甲状腺腫瘤が副甲状腺腺腫の可能性があると考え甲状腺右葉切除のみを行った．甲状腺右葉上極よりの結節は濾胞上皮の密な増生よりなるものであり，下極よりの結節は境界明瞭で，好酸性上皮よりなる濾胞の密な増生を示した．ともに濾胞状構造を示し，甲状腺組織との鑑別が困難であったのでPTH・TTF-1・Tgの免疫染色を行ったが，上極よりの結節はPTH陽性，TTF-1・Tg陰性，下極よりの結節はPTH陰性，TTF-1・Tg陽性で，それぞれ甲状腺内副甲状腺腺腫，甲状腺好酸性細胞型濾胞腺腫と最終診断した．
Parathyroid neoplasm
Parathyroid carcinoma
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We herein illustrate an unusual but very helpful maneuver in the localization of parathyroid adenomas that have proven difficult to find at initial surgical exploration. This case also illustrates how metabolically active thyroid tumors can interfere with the localization of parathyroid tumors when using the technetium-thallium subtraction scan technique, and a possible way of overcoming such interference.
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Parathyroid neoplasm
Thyroid tumors
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A 71 yo woman with primary hyperparathyroidism awaiting surgery because of significant hypercalcemia and hypercalciuria presented to the local emergency department with the chief complaints of discomfort in her neck, sore throat, and difficulty swallowing. She was found to be hypocalcemic with a calcium level of 8.1 mg/dL. She was seen by her endocrinologist three days later at which time serum calcium, iPTH, and serum phosphate levels were all within normal limits. Based on history and a series of ultrasounds the patient was diagnosed with spontaneous infarction of her parathyroid adenoma, which resulted in resolution of her primary hyperparathyroidism.
Sore throat
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Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
Parathyroid neoplasm
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Parathyroid neoplasm
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Tc-99m sestamibi (MIBI) is increasingly used for the preoperative localization of parathyroid adenoma. As experience is gained with this radiopharmaceutical, instances of uptake by non-adenomas will be encountered. A case of focal Tc-99m MIBI uptake by parathyroid carcinoma mimicking parathyroid adenoma is presented.
Parathyroid carcinoma
Parathyroid neoplasm
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