Utility of MIBI SPECT-CT and contrast-enhanced CT in primary hyperparathyroidism
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Abstract Background: To investigate the role of parathyroid technetium-99m-hexakis2-methoxy-2-methylpropylisonitrile ( 99m Tc-MIBI) single photon emission computed tomography/ computed tomography (SPECT/CT) combined with the serum calcium (Ca) and serum parathyroid hormone (PTH) in the differential diagnosis of MIBI uptake lesion. Methods: 201 patients with MIBI uptake lesion on parathyroid 99m Tc-MIBI SPECT/CT from January 2015 to July 2019 were enrolled in this study. All patients who underwent surgical resection were classified into two groups: primary hyperparathyroidism (PHPT) and non-PHPT in terms of the pathological findings. Radiological performance of 99m Tc-MIBI SPECT/CT, serum Ca and serum PTH were comparable between the two groups. Results: 201 patients (135 females; median age, 53.0 years; age range, 29 – 79 years) were included. Pathological findings were as follows: PHPT was in 126 (62.7%) patients, including parathyroid adenoma in 106 patients, parathyroid cancer in 12 patients and parathyroid hyperplasia in 8 patients, while non-PHPT were in 75 (37.3%) patients, including thyroid adenoma in 14 patients, thyroid papillary cancer in 15 patients and thyroid nodular goiter in 46 patients. In the following multivariable logistic regression analysis, serum Ca and diameter of the shortest axis of the lesion were the independent factors for differentiating PHPT from non-PHPT. In receiver operating characteristic (ROC) analyses, the cut-off value of serum Ca differentiating PHPT from non-PHPT was 2.6 mmol/L, yielding the area under the ROC curve (AUC) of 0.931, sensitivity of 85.7%, specificity of 89.2%; the cut-off value of diameter of the shortest axis of the lesion was 20.4mm, yielding AUC of 0.728, sensitivity of 62.2%, specificity of 87.1%. Conclusion: Parathyroid 99m Tc-MIBI SPECT/CT combined with serum Ca and serum PTH contributed to the differential diagnosis of PHPT from non-PHPT, evenly can assist the determination of the specific pathology of MIBI uptake lesion before surgery.
Parathyroid neoplasm
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99Tcm-MIBI SPECT exhibited high sensitivity in hyperparathyroidism. Combination of ultrasound or CT can raise the diagnostic and location accuracy, especially in ectopic parathyroid adenoma. With the development of minimally invasive parathyroidectomy, the value of 99Tcm-MIBI SPECT/CT in preoperative location accuracy stands out. Many factors such as size of the gland lesions and biochemical indexes affect the sensitivity and location accuracy of 99Tcm-MIBI scintigraphy. For the negative imaging hyperparathyroidism patients, 11C-methionine PET/CT, 4D-CT and intraoperative radiation navigation is current research hot spot and development orientation.
Key words:
Hyperparathyroidism; Technetium Tc 99m sestamibi; Tomography, emission-computed, single-photon; Tomography, X-ray computed
Emission computed tomography
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Spect imaging
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Introduction: Cancers that are known collectively as head and neck cancers can vary in their histological form and localization. This disease has a high social significance thus it require well-timed and delicate approach, especially in children. We can improve the accuracy of our methods by using new algorithms and technologies. We were the first to implement 99mTc-MIBI SPECT/CT imaging in evaluation of children with head and neck cancer and introduce it as a routine method in Russia.
Purpose: Improve the accuracy in diagnostics of children with head and neck cancer by practical application of hybrid SPECT/CT method. To determine diagnostic value of planar scintigraphy and 99mTc-MIBI SPECT/CT in children with head and neck cancer.
Material and methods: This study was performed as a prospective clinical study. Between January 2017 and December 2017, 53 patients which met the inclusion criteria were examined. The inclusion criteria were patients with histologically proven malignancy, age 1–18, weight more than 10 kg, up to date CT or MRI scans (less than two weeks passed from scanning), for initial patients a tumor findings (more than 20 mm in the largest scale). We concluded 61 whole body planar scintigraphy followed by head and neck 99mTc-MIBI SPECT/CT examinations. 10 patients were examined twice, 1patient was undergoing for this procedure for three times. Initial patients – 23, dynamic – 30. We performed scanning using a hybrid SPECT/CT after 15 minutes 99mTc-MIBI was injected. First stage was standard whole-body planar scintigraphy, second stage SPECT/CT (head and neck).
Results: We evaluated diagnostic accuracy of planar scintigraphy and 99mTc-MIBI SPECT/CT.
Planar scintigraphy sensitivity, specificity, NPV and PPV were 68.8, 96.6, 73.7, 95.7 %. SPECT/CT – 87.5, 96.6, 87.5, 96.6 %.
The verification method was histological examination or follow-up imagining (CT or MRI) during a 12 month period. Additional imagining using hybrid SPECT/CT method allows us to increase sensitivity and NPV of isotope scanning.
Most of false-negative results were obtained after planar scintigraphy, it can be related with image interpretation difficulties caused by equivocal image, especially, in patients during therapy. Six of such patients were correctly diagnosed with SPECT/CT and we revealed the presence of active tumor tissue.
With CT we additionally detected destruction of skull bones in 10 patients.
Conclusion:
1. Diagnostic accuracy of scintigraphy with 99mTc-MIBI is high: Sens. – 68.8 %.
2. We can increase diagnostic accuracy using hybrid methods, and so it plays an important role in final diagnosis: Sens. – 87.5 %, Spec. – 96.6 %.
3. SPECT/CT additionally detected destruction of skull bones even with negative scintigraphy results.
4. A strict clinical reasoning is needed in each individual case.
5. A further evaluation of the diagnostic capabilities of 99mTc-MIBI SPECT/CT in a larger number of patients appears justified.
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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.
PET-CT
Parathyroid neoplasm
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