<sup>99</sup>Tc<sup>m</sup>-MIBI SPECT Dual-Phase Imaging, B-Ultrasound, and CT in The Diagnostic Value of Primary Hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUYan ¹ ,  YANGAi-min ¹ , XUEJian-jun ¹ , GAORui ¹ , QIAOYou-mei ² , CHENGHu ¹ , GUOKun ¹

1. Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shan'xi Province, China;
2. Department of Internal Medicine, The Hospital of Sstaff and Workers of The Thirty-Ninth Research Institute of China Electronic Technology Group Corporation, Xi'an 710068, Shan'xi Province, China;

Corresponding?author：

YANGAi-min, Email: yangaimin@xjtu.edu.cn

Keywords：

⁹⁹Tc^m-MIBI SPECT dual-phase imaging; B-ultrasound; Computed tomography; Parathyroid hormone; Serum calcium; Primary hyperparathyroidism

DOI：

10.7507/1007-9424.20160017

Video：

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Objective To investigate the significance of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT in the diagnosis of primary hyperparathyroidism, and its relationship with the level of serum calcium (CA). Methods The clinical data of 73 patients with parathyroid dysfunction (serum parathyroid hormone (PTH) > 130 pg/mL) were retrospectively analyzed. The ⁹⁹Tc^m-MIBI SPECT double phase imaging were performed in 73 cases, 63 cases underwent cervical B-ultrasound examination, and 16 cases underwent CT examination. According to the serum calcium (CA) levels, the patients were divided into CA < 2.7 mmol/L group and CA > 2.7 mmol/L group, and the postoperative pathological examination and followed-up results were as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT for diagnosis of PHPT in different serum CA levels were compared. Results The sensitivity of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.6%, 81.8% and 35.7%, respectively; the specificity was 87.5%, 75.5% and 50.0%, respectively; the positive predictive value was 98.2%, 93.7% and 83.3%, respectively; and the negative predictive value was 46.7%, 33.3% and 10%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT were significantly higher than those of CT examination(P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging for diagnosis of PHPT were higher than those of B-ultrasound examination, but the difference was not statistically significant (P > 0.05). In the CA < 2.7 mmol/L group, the sensitivity of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 91.1%, 84.7% and 37.9%, respectively; the specificity was 80.2%, 72.9% and 49.7%, respectively; the positive predictive value was 96.8%, 96.0% and 79.4%, respectively; and the negative predictive value was 50.0%, 37.5% and 10.0%. In the CA > 2.7 mmol/L group, The sensitivity of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.9%, 83.9% and 42.8%, respectively; the specificity was 83.3%, 79.2% and 50.0%, respectively; the positive predictive value was 96.9%, 94.1% and 75.0%, respectively; and the negative predictive value was 50.0%, 40.5% and 20.0%. There were no significant difference in the diagnostic accuracy between the 3 methods and the level of serum CV in different levels. Conclusions The diagnostic accuracy of ⁹⁹Tc^m-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT patients with PTH > 130 pg/mL (especially parathyroid adenoma) were higher than that of CT examination, and it is not associated with the serum CA concentration.

Citation： LIUYan, YANGAi-min, XUEJian-jun, GAORui, QIAOYou-mei, CHENGHu, GUOKun. ⁹⁹Tc^m-MIBI SPECT Dual-Phase Imaging, B-Ultrasound, and CT in The Diagnostic Value of Primary Hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(1): 65-69. doi: 10.7507/1007-9424.20160017 Copy

1.	Cusano NE, Silverberg SJ, Bilezikian JP. Normocalcemic primary hyperparathyroidism. J Clin Densitom, 2013, 16(1):33-39.
2.	Rejnmark L, Amstrup AK, Mollerup CL, et al. Further insights into the pathogenesis of primary hyperparathyroidism:a nested case-control study. J Clin Endocrinol Metab, 2013, 98(1):87-96.
3.	Lewiecki EM, Miller PD. Skeletal effects of primary hyperparathyroi-dism:bone mineral density and fracture risk. J Clin Densitom, 2013, 16(1):28-32.
4.	吳全, 崔愛民, 柏楠, 等. 73例原發性甲狀旁腺功能充進癥的診治分析.中國普外基礎與臨床雜志, 2013, 20(7):776-778.
5.	Wémeau JL. Primary hyperparathyroidism. J Radiol, 2009, 90(3 Pt 2):392-396.
6.	鄔鵬躍, 張一秋, 石洪成.放射性核素檢查在甲狀旁腺腺瘤診斷中的應用.中國臨床醫學, 2012, 19(6):717-718.
7.	李榮紅.原發性甲狀旁腺功能亢進癥的臨床特點分析及治療觀察.大家健康, 2014, 8(9):131.
8.	游振輝, 黃東航, 顧恩郁, 等.原發性甲狀旁腺功能亢進癥的術前定位診斷.中華內分泌代謝雜志, 2004, 20(4):331-332.
9.	Yip L, Pryma DA, Yim JH, et al. Sestamibi SPECT intensity scoring system in sporadic primary hyperparathyroidism. World J Surg, 2009, 33(3):426-433.
10.	中華醫學會骨質疏松和骨礦鹽疾病分會, 中華醫學會內分泌分會代謝性骨病學組.原發性甲狀旁腺功能亢進癥診療指南.中華醫學會骨質疏松和骨礦鹽疾病雜志, 2014, 7(3):187-198.
11.	DeLellis RA, Mazzaglia P, Mangray S. Primary hyperparathyroidism:a current perspective. Arch Pathol Lab Med, 2008, 132(8):1251-1262.
12.	王歐, 邢小平, 孟迅吾, 等.不同病理類型原發性甲狀旁腺功能亢進癥臨床表現的比較分析.中國實用內科雜志, 2006, 26(22):.
13.	張悅, 張遵城, 李小東, 等. ⁹⁹Tc^m-MIBI雙時相顯像雙時相核素顯像在原發性甲旁亢術前定位診斷中的應用.天津醫科大學學報, 2010, 16(4):669-670.
14.	Wu HS, Liu YC, Kao A, et al. Using technetium 99m tetrofosmin parathyroid imaging to detect parathyroid adenoma and its relation to P-glycoprotein expression. Surgery, 2002, 132(3):456-460.
15.	Shiau YC, Tsai SC, Wang JJ, et al. Detecting parathyroid adenoma using technetium-99m tetrofosmin:comparison with P-glycopro-tein and multidrug resistance related protein expression-a prelimi-nary report. Nucl Med Biol, 2002, 29(3):339-344.
16.	Kao A, Shiau YC, Tsai SC, et al. Technetium-99m methoxyisobuty-lisonitrile imaging for parathyroid adenoma:relationship to P-glycoproteinor multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging, 2002, 29(8):1012-1015.
17.	汪太松, 趙晉華, 邢巖. ⁹⁹Tc^m-MIBI SPECT/CT雙時相顯像對原發性甲狀旁腺功能亢進癥的診斷價值.中國醫學影像學雜志, 2012, 20(11):855-857.
18.	Pons F, Torregrosa JV, Fuster D. Biological factors influencing parathyroid localization. Nucl Med Commu, 2003, 24(2):121-124.
19.	Levy JM, Kandil E, Yau LC, et al. Can ultrasound be used as the primary screening modality for the localization of parathyroid-disease prior to surgery for primary hyperparathyroidism? A review of 440 cases. ORL J Otorhinolaryngol Relat Spec, 2011, 73(2):116-120.
20.	Akbaba G, Berker D, Isik S, et al. A comparative study of pre-opera-tive imaging methods in patients with primary hyperparathyroi-dism:ultrasonography, 99mTc sestamibi, single photon emission computed tomography, and magnetic resonance imaging. J Endocrinol Invest, 2012, 35(4):359-364.
21.	Witteveen JE, Kievit J, Stokkel MP, et al. Limitations of 99Tcm MIBI-SPECT imaging scans in persistent primary hyperparathy-roidism. World J Surg, 2011, 35(1):128-139.
22.	Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1 650 consecutive patients with primary hyperparathyroidism. Ann Surg, 2011, 253(3):585-591.
23.	Wilson SD, Doffek KM, Wang TS, et al. Primary hyperparath-yroidism with a history of head and neck irradiation:the conseq-uences of associated thyroid tumors. Surgery, 2011, 150(4):869-877.
24.	Cating-Cabral MT, Cabungcal AC, Villafuerte CV 3rd, et al. Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis. BMJ Case Rep, 2012, 6(8):2012. pii:bcr2012006198.
25.	張祥銘, 張敏, 胡佳佳, 等. ⁹⁹Tc^m-甲氧基異丁基異腈雙時相平面顯像和⁹⁹Tc^m-MIBI SPECT/CT斷層顯像診斷原發性甲狀旁腺功能亢進癥.中國醫學影像技術, 2014, 30(6):850-853.
26.	張連娜, 楊芳, 馮瑾.原發性甲狀旁腺功能亢進癥的SPECT/CT診斷.中國醫學計算機成像雜志, 2014, 20(1):64-67.
27.	趙海鷹, 楊福全, 田忠, 等.超聲、CT與⁹⁹Tc^m-MIBI核素掃描在原發性甲狀旁腺功能亢進癥中的診斷價值比較及其漏診原因分析.中國普外基礎與臨床雜志, 2013, 20(9):1038-1044.
28.	Kim YI, Jung YH, Hwang KT, et al. Efficacy of 99mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy:comparative study with 99mTc-sestamibi scintigraphy, SPECT, US and CT. Ann Nucl Med, 2012, 6(10):804-810.

1. Cusano NE, Silverberg SJ, Bilezikian JP. Normocalcemic primary hyperparathyroidism. J Clin Densitom, 2013, 16(1):33-39.
2. Rejnmark L, Amstrup AK, Mollerup CL, et al. Further insights into the pathogenesis of primary hyperparathyroidism:a nested case-control study. J Clin Endocrinol Metab, 2013, 98(1):87-96.
3. Lewiecki EM, Miller PD. Skeletal effects of primary hyperparathyroi-dism:bone mineral density and fracture risk. J Clin Densitom, 2013, 16(1):28-32.
4. 吳全, 崔愛民, 柏楠, 等. 73例原發性甲狀旁腺功能充進癥的診治分析.中國普外基礎與臨床雜志, 2013, 20(7):776-778.
5. Wémeau JL. Primary hyperparathyroidism. J Radiol, 2009, 90(3 Pt 2):392-396.
6. 鄔鵬躍, 張一秋, 石洪成.放射性核素檢查在甲狀旁腺腺瘤診斷中的應用.中國臨床醫學, 2012, 19(6):717-718.
7. 李榮紅.原發性甲狀旁腺功能亢進癥的臨床特點分析及治療觀察.大家健康, 2014, 8(9):131.
8. 游振輝, 黃東航, 顧恩郁, 等.原發性甲狀旁腺功能亢進癥的術前定位診斷.中華內分泌代謝雜志, 2004, 20(4):331-332.
9. Yip L, Pryma DA, Yim JH, et al. Sestamibi SPECT intensity scoring system in sporadic primary hyperparathyroidism. World J Surg, 2009, 33(3):426-433.
10. 中華醫學會骨質疏松和骨礦鹽疾病分會, 中華醫學會內分泌分會代謝性骨病學組.原發性甲狀旁腺功能亢進癥診療指南.中華醫學會骨質疏松和骨礦鹽疾病雜志, 2014, 7(3):187-198.
11. DeLellis RA, Mazzaglia P, Mangray S. Primary hyperparathyroidism:a current perspective. Arch Pathol Lab Med, 2008, 132(8):1251-1262.
12. 王歐, 邢小平, 孟迅吾, 等.不同病理類型原發性甲狀旁腺功能亢進癥臨床表現的比較分析.中國實用內科雜志, 2006, 26(22):.
13. 張悅, 張遵城, 李小東, 等. ⁹⁹Tc^m-MIBI雙時相顯像雙時相核素顯像在原發性甲旁亢術前定位診斷中的應用.天津醫科大學學報, 2010, 16(4):669-670.
14. Wu HS, Liu YC, Kao A, et al. Using technetium 99m tetrofosmin parathyroid imaging to detect parathyroid adenoma and its relation to P-glycoprotein expression. Surgery, 2002, 132(3):456-460.
15. Shiau YC, Tsai SC, Wang JJ, et al. Detecting parathyroid adenoma using technetium-99m tetrofosmin:comparison with P-glycopro-tein and multidrug resistance related protein expression-a prelimi-nary report. Nucl Med Biol, 2002, 29(3):339-344.
16. Kao A, Shiau YC, Tsai SC, et al. Technetium-99m methoxyisobuty-lisonitrile imaging for parathyroid adenoma:relationship to P-glycoproteinor multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging, 2002, 29(8):1012-1015.
17. 汪太松, 趙晉華, 邢巖. ⁹⁹Tc^m-MIBI SPECT/CT雙時相顯像對原發性甲狀旁腺功能亢進癥的診斷價值.中國醫學影像學雜志, 2012, 20(11):855-857.
18. Pons F, Torregrosa JV, Fuster D. Biological factors influencing parathyroid localization. Nucl Med Commu, 2003, 24(2):121-124.
19. Levy JM, Kandil E, Yau LC, et al. Can ultrasound be used as the primary screening modality for the localization of parathyroid-disease prior to surgery for primary hyperparathyroidism? A review of 440 cases. ORL J Otorhinolaryngol Relat Spec, 2011, 73(2):116-120.
20. Akbaba G, Berker D, Isik S, et al. A comparative study of pre-opera-tive imaging methods in patients with primary hyperparathyroi-dism:ultrasonography, 99mTc sestamibi, single photon emission computed tomography, and magnetic resonance imaging. J Endocrinol Invest, 2012, 35(4):359-364.
21. Witteveen JE, Kievit J, Stokkel MP, et al. Limitations of 99Tcm MIBI-SPECT imaging scans in persistent primary hyperparathy-roidism. World J Surg, 2011, 35(1):128-139.
22. Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1 650 consecutive patients with primary hyperparathyroidism. Ann Surg, 2011, 253(3):585-591.
23. Wilson SD, Doffek KM, Wang TS, et al. Primary hyperparath-yroidism with a history of head and neck irradiation:the conseq-uences of associated thyroid tumors. Surgery, 2011, 150(4):869-877.
24. Cating-Cabral MT, Cabungcal AC, Villafuerte CV 3rd, et al. Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis. BMJ Case Rep, 2012, 6(8):2012. pii:bcr2012006198.
25. 張祥銘, 張敏, 胡佳佳, 等. ⁹⁹Tc^m-甲氧基異丁基異腈雙時相平面顯像和⁹⁹Tc^m-MIBI SPECT/CT斷層顯像診斷原發性甲狀旁腺功能亢進癥.中國醫學影像技術, 2014, 30(6):850-853.
26. 張連娜, 楊芳, 馮瑾.原發性甲狀旁腺功能亢進癥的SPECT/CT診斷.中國醫學計算機成像雜志, 2014, 20(1):64-67.
27. 趙海鷹, 楊福全, 田忠, 等.超聲、CT與⁹⁹Tc^m-MIBI核素掃描在原發性甲狀旁腺功能亢進癥中的診斷價值比較及其漏診原因分析.中國普外基礎與臨床雜志, 2013, 20(9):1038-1044.
28. Kim YI, Jung YH, Hwang KT, et al. Efficacy of 99mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy:comparative study with 99mTc-sestamibi scintigraphy, SPECT, US and CT. Ann Nucl Med, 2012, 6(10):804-810.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

⁹⁹Tc^m-MIBI SPECT Dual-Phase Imaging, B-Ultrasound, and CT in The Diagnostic Value of Primary Hyperparathyroidism

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

99Tcm-MIBI SPECT Dual-Phase Imaging, B-Ultrasound, and CT in The Diagnostic Value of Primary Hyperparathyroidism

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⁹⁹Tc^m-MIBI SPECT Dual-Phase Imaging, B-Ultrasound, and CT in The Diagnostic Value of Primary Hyperparathyroidism