^99mTc-MIBI SPECT in primary hyperparathyroidism

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

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