Acta Med. 2019, 62: 1-5

https://doi.org/10.14712/18059694.2019.38

Dual Tracer 99mTc-Pertechnetate/99mTc-MIBI Dual-Time-Point SPECT/CT Parathyroid Gland Assessment Regarding to Parathyroid Gland Size and Biochemical Parameters – Two Years Single Imaging Centre Experience

Eva Krčálováa,b, Jiří Horáčeka,c, Edita Novákovád, Miroslav Cvejne, Daša Lazarákováf, Radek Mikuleckýf, Jiří Máslog, Jitka Čepkováh, Jan Tilšerb, Jiří Doležalb

aAcademic Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
bNuclear Medicine Department, University Hospital Hradec Králové, Czech Republic
c4th Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic
dNáchod Hospital Internal Medicine Department, Czech Republic
ePrivate Endocrinology Outpatient Clinic, Náchod, Czech Republic
fPardubice Hospital Internal Medicine Department, Czech Republic
gNáchod Hospital Osteology Outpatient Clinic, Czech Republic
hDepartment of Clinical Biochemistry, Faculty of Medicine Hradec Králové and University Hospital Hradec Králové

Received November 27, 2018
Accepted December 6, 2018

Introduction: Preoperative parathyroid imaging is inevitable part of focused parathyroid surgery. The aim of our study was assessment of parathyroid scintigraphy diagnostic accuracy regarding to size and metabolic parameters of hyperfunctioning parathyroid tissue. Material and methods: Parathyroid scintigraphy for suspected primary hyperparathyroidism was performed in 95 patients during years 2015 and 2016. Of them, 75 patients with known clinical outcome (40 underwent surgery, 35 had documented laboratory follow-up) were further retrospectively evaluated. The performance of dual tracer 99mTc-pertechnetate and 99mTc-MIBI subtraction and dual-time-point 99mTc-MIBI imaging with SPECT/CT was analysed. Serum parathyroid hormone (PTH), calcaemia, ionized calcaemia and phosphataemia and ultrasound detected adenoma volume and largest diameter in false negative and true positive findings were compared using Mann-Whitney test. Results: Sensitivity and specificity of parathyroid scintigraphy was 74.5% and 95.8%, respectively. NPV was 63.8% and PPV 97.4%. Hyperfunctioning parathyroid tissue detectability was almost significantly associated with hypophosphataemia and PTH levels. Conclusion: Parathyroid scintigraphy provides high sensitivity and superior specificity in parathyroid adenoma location, nevertheless the diagnostic accuracy tends to decline in smaller adenomas and in less metabolically active parathyroid tissue causing only subtle biochemical changes. 18F-Fluorocholine PET/CT or 3D SPECT/CT subtraction should be a reasonable option for those cases.

Funding

This work was supported by the programme PROGRES Q40-14.

References

20 live references

Open full article