Dual-phase ^sup 99m^Tc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables

• Published in: Annals of nuclear medicine 2014-10, Vol.28 (8), p.725
• Main Authors: Qiu, Zhong-ling, Wu, Bo, Shen, Chen-tian, Zhu, Rui-sen, Luo, Quan-yong
• Format: Article
• Language: English
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/s12149-014-0876-z

The purpose of this study was to assess the relationship between ^sup 99m^Tc-MIBI and ^sup 99m^Tc-MDP bone scintigraphy and clinical or pathological variables, including preoperative serum PTH levels and tumor diameter, in patients with newly diagnosed PHPT. Dual-phase ^sup 99m^Tc-MIBI planar scintigraphy was performed in 244 patients with PHPT. Of these patients, 155 underwent ^sup 99m^Tc-MDP bone scintigraphy to detect bone changes before parathyroidectomy. Factors influencing ^sup 99m^Tc-MIBI scintigraphy and ^sup 99m^Tc-MDP bone scintigraphy detection rate were assessed using univariate and multivariate logistic regression analysis; optimal cutoff values for predicting positive ^sup 99m^Tc-MIBI and ^sup 99m^Tc-MDP bone scintigraphy were evaluated using ROC analysis. Among 244 patients, 174 (71.31 %) patients with 181 foci had a positive ^sup 99m^Tc-MIBI planar scintigraphy; delayed neck and thorax SPECT/CT could identify and locate the ^sup 99m^Tc-MIBI lesions but could not find more lesions than planar scintigraphy. 70 (28.69 %) patients had a negative ^sup 99m^Tc-MIBI planar scintigraphy. Tumor diameter, serum PTH level and symptoms were statistically significant predictive factors in predicting positive ^sup 9m^Tc-MIBI scintigraphy both univariate and multivariate logistic regression analyses. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.03 cm and 127.60 ng/L, respectively. Among 155 patients with bone scintigraphy, ^sup 99m^Tc-MDP bone scintigraphy showed positive finding in 80 (51.61 %) patients and negative finding in 75 patients. Univariate logistic regression analysis showed that patient age, sex, tumor diameter and PTH level (>=150 ng/L) were statistically significant in predicting positive ^sup 99m^Tc-MDP bone scintigraphy. Multivariate logistic regression analysis showed both tumor diameter and PTH >= 150 ng/L were statistically significant in predicting positive ^sup 99m^Tc-MDP bone scintigraphy. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.96 cm and 163.85 ng/L, respectively. The utility of delayed neck and thorax SPECT/CT over dual-phase ^sup 99m^Tc-MIBI planar scintigraphy is that it can identify and locate a parathyroid tumor in about more than 70 % of patients in PHPT and provide the assistance for surgical planning. These studies also suggest that ^sup 99m^Tc-MIBI scintigraphy and ^sup 99m^Tc-MDP bone scintigraphy are closely correlated with tumor diameter and PTH; wh