Download PDF
Nuklearmedizin 2008; 47(01): 01-07
DOI: 10.3413/nukmed-0057
Originalarbeiten
Schattauer GmbH

99mTc-MIBI SPECT in primary hyperparathyroidism

Influence of concomitant vitamin D deficiency for visualization of parathyroid adenomas 99mTc-MIBI SPECT bei primärem HyperparathyroidismusEinfluss eines begleitenden Vitamin-D-Mangels auf den Nachweis von Nebenschilddrüsenadenomen
M. Schmidt
1   Departments of Nuclear Medicine
,
N. Thoma
1   Departments of Nuclear Medicine
,
M. Dietlein
1   Departments of Nuclear Medicine
,
D. Moka
1   Departments of Nuclear Medicine
,
W. Eschner
1   Departments of Nuclear Medicine
,
M. Faust
2   Departments of II of Internal Medicine (Endocrinology)
,
W. Schröder
3   Departments of Surgery, University of Cologne
,
M. von Hülst-Schlabrendorff
4   Departments of Endocrinology Clinic, Cologne, Germany
,
W. Ehses
4   Departments of Endocrinology Clinic, Cologne, Germany
,
H. Schicha
1   Departments of Nuclear Medicine
› Author Affiliations
Further Information

Publication History

Received: 23 October 2006

accepted in revised form: 26 June 2007

Publication Date:
02 January 2018 (online)

    Permissions and Reprints

Summary

Aim of the study was to analyse the influence of a concomitant vitamin D deficiency on the results of 99mTc-MIBI studies in patients (pts) with primary hyperparathyroidism (pHPT). Patients, methods: Between January 1998 and May 2004, 71 pts with pHPT had undergone operation after a 99mTc-MIBI study of whom 54 pts (76%) had normal values of 25-OH-vitamin D3 and 17 pts (24%) had vitamin D deficiency. Results of a dual-phase 99mTc-MIBI protocol with SPECT were compared with histopathology. Results: In 54 pts with normal vitamin D values late SPECT images identified more lesions (n = 51, sensitivity 91%) than early planar (n = 45, sensitivity 82%) or late planar images (n = 50, sensitivity 88%). In 17 pts with vitamin D deficiency late SPECT images identified more lesions (n = 13, sensitivity 72%) than early planar (n = 10, sensitivity 56%) or late planar images (n = 10, sensitivity 56%) too. In pts with vitamin D deficiency the sensitivity of a 99mTc-MIBI SPECT study was lower than in those with normal vitamin D status (72% vs. 91%) and dependent on the value for PTH. However, the results did not reach statistical significance: early planar: p = 0.1625; late planar: p = 0.0039; 99mTc-MIBI SPECT: p = 0.1180. Conclusion: The likelihood of a pathological 99mTc-MIBI study being obtained in pts with pHPT is dependent on the parathyroid hormone level. However, a negative influence of a low vitamin D level on the scintigraphic detection rate of a parathyroid adenoma could not be proven which may be due to the low number of pts with vitamin D deficiency.

Zusammenfassung

Das Ziel der Studie bestand in der Analyse eines begleitenden Vitamin-D-Mangels auf die Ergebnisse einer 99mTc- MIBI-Untersuchung bei Patienten (Pt) mit primärem Hyperparathyreoidismus (pHPT). Patienten, Methoden: Zwischen Januar 1998 und Mai 2004 wurden 71 Pt mit pHPT nach einer 99mTc-MIBI-Untersuchung operiert, von denen 54 Pt (76%) normale Werte für 25-OH-Vitamin D3 und 17 Pt (24%) einen Vitamin-D-Mangel hatten. Ergebnisse eines Zweiphasen 99mTc-MIBI-Protokols mit SPECT wurden mit den histopathologischen Resultaten verglichen. Ergebnisse: Bei 54 Pt mit normalen Vitamin D-Werten zeigte die späte SPECT mehr Herdbefunde (n = 51, Sensitivität 91%) als frühe planare (n = 45, Sensitivität 82%) oder späte planare (n = 50, Sensitivität 88%) Aufnahmen. Bei 17 Pt mit Vitamin-D-Mangel fand die späte SPECT ebenfalls mehr Herdbefunde (n = 13, Sensitivität 72%) als frühe planare (n = 10, Sensitivität 56%) oder späte planae (n = 10, Sensitivität 56%) Aufnahmen. Bei Pt mit Vitamin-D-Mangel war die Sensitivität einer 99mTc- MIBI SPECT niedriger als bei Pt mit normalen Vitamin- D-Werten (72% vs. 91%) und zudem abhängig vom PTHWert. Die Ergenbisse waren aber statistisch nicht signifikant: planar früh: p = 0.1625; planar spät: p = 0.0039; 99mTc-MIBI SPECT: p = 0.1180. Schlussfolgerung: Die Wahrscheinlichkeit einer pathologischen 99mTc-MIBI-Untersuchung bei Pt mit pHPT ist abhängig vom Parathormonwert. Der negative Einfluss eines niedrigen Vitamin- D-Wertes auf die szintigraphische Nachweiswahrscheinlichkeit eines Nebenschilddrüsenadenoms konnte nicht bewiesen werden, möglicherweise bedingt durch zu wenige Pt mit Vitamin-D-Mangel.

Keywords

Primary hyperparathyroidism - parathyroid hormone - 25-OH-vitamin D deficiency - 99mTc-MIBI scintigraphy - planar and SPECT imaging - single-tracer dual-phase protocol

Schlüsselwörter

Primärer Hyperparathroidismus - Parathormon - 25-OH-Vitamin-D-Mangel - 99mTc-MIBI-Szintigraphie - planare Aufnahmen - SPECT - Monoradionuklid-2-Phasen-Protokoll
 

  • References

  • 1 Albright F. A page out of the history ofhyperpara- thyroidism. JClin Endocrinol 1948; 8: 637-657.
    Google Scholar
  • 2 Bandeira F, Caldas G, Freese E. et al. Relationship between serum vitamin D status and clinical manifestations of primary hyperparathyroidism. Endocr Practice 2002; 8: 266-270.
    Google Scholar
  • 3 Bauer W, Federman DD. Hyperparathyroidism epitomized: the case of Captain Charles E. Martell. Metabolism 1962; 11: 21-29.
    PubMedGoogle Scholar
  • 4 Bekis R, Aydin A, Tasci C. et al. The role of gamma probe activity counts in minimally invasive parathyroidectomy. Preliminaryresults. Nuklearmedizin 2004; 43: 190-194.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Benard F, Lefebvre B, Beuvon F. et al. Rapid washout of Technetium-99m-MIBI from a large para-thyroidadenoma. J Nucl Med 1995; 36: 241-243.
    PubMedGoogle Scholar
  • 6 Billotey C, Sarfati E, Aurengo A. et al. Advantages of SPECT inTechnetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 1996; 37: 1773-1778.
    PubMedGoogle Scholar
  • 7 Borley NR, Collins REC, O'Doherty M. et al. Technetium-99m sestamibi parathyroid localization is accurate enough for scan-directed unilateral neck exploration. Br J Surg 1996; 83: 989-991.
    CrossrefPubMedGoogle Scholar
  • 8 Brain HP, Sharma AK, Nussey SS. Hypothesis: the case for quaternary hyperparathyroidism. Med Hypotheses 2004; 62: 701-703.
    CrossrefPubMedGoogle Scholar
  • 9 Bussey AD, Bruder JM. Urinary calcium excretion in primary hyperparathyroidism: relationship to 25-hydroxyvitamin D status. Endocr Pract 2005; 11: 37-42.
    CrossrefPubMedGoogle Scholar
  • 10 Coakley AJ, Kettle AG, Wells CP. et al. 99mTc sestamibi - a new agent for parathyroid imaging. Nucl Med Comm 1989; 10: 791-794.
    CrossrefPubMedGoogle Scholar
  • 11 Greenspan BS, Brown ML, Dillehay GL. et al. Procedure guideline for parathyroid scintigraphy. J Nucl Med 1998; 39: 1111-1114.
    PubMedGoogle Scholar
  • 12 Grey A, Lucas J, Horne A. et al. Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab 2005; 90: 2122-2126.
    CrossrefPubMedGoogle Scholar
  • 13 Hannon RR, Shorr E, McClellan WS. et al. A case of osteitis fibrosa cystica (osteomalacia) with evidence ofhyperactivity of the parathyroid bodies. Metabolic study I. JClin Invest 1930; 8: 215-227.
    Google Scholar
  • 14 Harinarayan CV, Gupta N, Kochupillai N. Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol (Oxf) 1995; 43: 351-358.
    CrossrefPubMedGoogle Scholar
  • 15 Klingler PJ, Strolz S, Profanter C. et al. Management of hyperparathyroidism in an endemic goiter area. Worl J Surg 1998; 22: 301-308.
    CrossrefPubMedGoogle Scholar
  • 16 Krubsack AJ, Wilson SD, Lawson TL. et al. Prospective comparison of radionuclide, computed tomographic, sonography, and magnetic resonance localization of parathyroid tumors. Surgery 1989; 106: 639-644.
    PubMedGoogle Scholar
  • 17 Leslie WD, Riese KT, Dupont JO. et al. Parathyroid adenomas without sestamibi retention. Clin Nucl Med 1995; 20: 699-702.
    CrossrefPubMedGoogle Scholar
  • 18 Lumb GA, Stanbury SW. Parathyroid function in human vitamin D deficiency and vitamin D deficiency in primary hyperparathyroidism. Am J Med 1974; 56: 833-839.
    CrossrefPubMedGoogle Scholar
  • 19 Mariani G, Gulec SA, Rubello D. et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 2003; 44: 1443-1458.
    PubMedGoogle Scholar
  • 20 Moka D, Eschner W, Voth E. et al. Iterative reconstruction: an improvement of technetium-99m MIBI SPET for the detection of parathyroid adenomas ?. Eur J Nucl Med 2000; 27: 485-489.
    CrossrefPubMedGoogle Scholar
  • 21 Moka D, Voth E, Dietlein M. et al. Technetium 99mTc-MIBI-SPECT: ahighly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000; 128: 29-35.
    CrossrefPubMedGoogle Scholar
  • 22 Moka D, Voth E, Larena-Avellaneda A. et al. 99mTc-MIBI-SPECT parathyroid gland scintigraphy for the preoperative localization of small parathyroid gland adenomas. Nuklearmedizin 1997; 36: 240-244.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Moosgaard B, Vestergaard P, Heickendorff L. et al. Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clin Endocrinol 2005; 63: 506-513.
    CrossrefPubMedGoogle Scholar
  • 24 Moosgaard B, Vestergaard P, Heickendorff L. et al. Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study. Eur J Endocrinol 2006; 155: 237-244.
    CrossrefPubMedGoogle Scholar
  • 25 O'Doherty MJ, Kettle AG, Wells P. et al. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 1992; 33: 313-318.
    PubMedGoogle Scholar
  • 26 Palestro C J, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med 2005; 35: 266-276.
    CrossrefPubMedGoogle Scholar
  • 27 Petti GJ, Chonkich GD, Morgan JW. Unilateral parathyroidectomy: the value of the localizing scan. J Otolaryngol 1993; 22: 307-310.
    PubMedGoogle Scholar
  • 28 Rao DS, Agarwal G, Talpos GB. et al. Role of vitamin D and calcium nutrition in disease expression and parathyroid tumor growth in primary hyperparathyroidism: a global perspective. J Bone Miner Res 2002; 17 (suppl 2) N75-N80.
    PubMedGoogle Scholar
  • 29 Rao DS, Honasoge M, Divine GW. et al. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Met 2000; 85: 1054-1058.
    PubMedGoogle Scholar
  • 30 Ruf J, Lopez Hanninen E, Steinmüller T. et al. Preoperative localization of parathyroid glands. Use of MRI, scintigraphy, and image fusion. Nuklearmedizin 2004; 43: 85-90.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Safi S, Hassikou H, Messary A. et al. Severe primary hyperparathyroidism and vitamin D deficiency. Ann Endocrinol 2004; 65: 226-232.
    CrossrefPubMedGoogle Scholar
  • 32 Sandrock D. Leitlinie für die Nebenschilddrü-senszintigraphie. Nuklearmedizin 1999; 38: 223-225.
    PubMedGoogle Scholar
  • 33 Sandström I. On a new gland in man and several mammals (glandulae parathyreoideae). Upsala Läkareförenings Förhandlingar 1879; -80 15: 441-471.
    Google Scholar
  • 34 Schommertz B, Cupisti K, Antke C. et al. Localisation of parathyroid glands using planar 99mTc-sestamibi scintigraphy. Comparisonbetween subtraction- and dual-phase technique. Nuklearmedizin 2006; 45: 115-121.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Spence HM. The life and death of Captain Charles Martell and kidney stone disease. J Urol 1984; 132: 1204-1207.
    CrossrefPubMedGoogle Scholar
  • 36 Staudenherz A, Abela C, Niederle B. et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with ahigh prevalence of concomitant thyroid diseases. Eur J Nucl Med 1997; 24: 143-149.
    CrossrefPubMedGoogle Scholar
  • 37 Taillefer R, Boucher Y, Potvin C. et al. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium- 99m-sestamibi (double-phase study). J Nucl Med 1992; 33: 1801-1807.
    PubMedGoogle Scholar
  • 38 Tibblin S, Bondeson AG, Bondeson L. et al. Surgical strategy in hyperparathyroidism due to solitary adenoma. Ann Surg 1994; 200: 776-784.
    Google Scholar
  • 39 Woodhouse NJ, Doyle FH, Joplin GF. Vitamin D deficiency and primary hyperparathyroidism. Lancet 1971; 2: 283-286.
    PubMedGoogle Scholar