99mTc-MIBI SPECT/CT imaging contribution in the diagnosis of patients with hyperparathyroidism

Introduction: Hyperparathyroidism is presented with increased parathyroid hormone (PTH) secretion due to hyperfunctioning of one or more of the four parathyroid glands. Primary hyperparathyroidism (p-HPT) can be due to parathyroid adenoma, hyperplasia or carcinoma of the parathyroid gland. Secondary hyperparathyroidism (s-HPT) is usually a response to hypocalcaemia and consecutive hyperplasia of the glands. Our aim was to compare the efficacy of (99m)Tcmethoxyisobutylisonitrile (MIBI) SPECT/CT in identification of the location of the lesion(s) in cases of HPT by comparing these results with the findings of ultrasound (US) and planar scintigraphy. Methods: Forty one consecutive patients (54 +/- 17 age, 12 males and 29 females) with primary or secondary hyperparathyroidism were included. All patients were examined by US and afterwards patients underwent conventional double-phase Tc-99m-MIBI scintigraphy combined with neck SPECT/CT procedure. Planar images (early and delayed), US and SPECT/CT image sets were evaluated for adenoma localization at the neck and thorax. Regions of interest (ROIs), equal sized, were selected and compared, over the hyperfunctioning parathyroid tissue (accumulated impulses-counts value) and over the contralateral lobe of the thyroid gland (control counts value). Results: The ultrasonography detected 24 positive findings. The late phase of planar scan detected 26 positive findings. SPECT/CT presented with bigger detection rate than late planar phase or US (75.6%, 63.4%, 61.5%) and with higher sensitivity (100%, 83.8%, 77.4%), respectively. Conclusion: The SPECT/CT study seems reliable, sensitive and with added value in diagnosing hyperparathyroidism as a complementary method to planar scintigraphy. US as compatible method, should be performed prior the scintigraphy protocols.