Vol 23, No 2 (2020)
Research paper
Published online: 2020-07-20

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The diagnostic value of dual-phase SPECT/CT scintigraphy based on transport kinetics of 99mTc-sestamibi confirmed with histopathological findings in patients with secondary hyperparathyroidism — practical consideration

Maria H. Listewnik1, Hanna Piwowarska-Bilska1, Krzysztof Safranow2, Marek Ostrowski3, Jacek Iwanowski1, Maria Chosia4, Bozena Birkenfeld1
Pubmed: 33007093
Nucl. Med. Rev 2020;23(2):71-77.


BACKGROUND: Dual phase 99mTc-sestamibi SPECT/CT preoperative parathyroid scintigraphy (PPS) is seldom discussed
in terms of the transport kinetics of the tracer.
Objectives: To assess the relationship between the characteristic type of tracer transport in particular PPS and histopathological
findings in patients with secondary hyperparathyroidism (sHPT).
MATERIAL AND METHODS: The study comprised 27 patients (13 females and 14 males) with sHPT. Based on tracer accumulation
in early phase (EP) and delayed phase (DP), the following types of accumulation for PPS(+) lesions were identified: EP(–)/
DP(+) (type I), EP(+)/DP(+) (type II), EP(+)/DP(–) (type III). EP(–)/DP(–) (type IV) lesions constituted PPS(–) group invisible in
SPECT/CT. Overall, 69 lesions 59 PPS(+) and 10 PPS(–) were evaluated histopathologically.
RESULTS: Among SPECT/CT PPS(+), types I, II and III occurred in 9 (15%), 49 (83%), and 1 (2%) lesions, respectively. The
frequency of histopathological diagnosis of normal and abnormal (APG — adenoma or hyperplasia) parathyroid gland, as well
as non-parathyroid (thyroid, lymph nodes, or fat) lesions differed significantly between type I, II, and III lesions (p = 0.036).
APG histopathological diagnosis was significantly more frequent in lesions with type II uptake than in lesions with type I uptake
(76% vs. 33%, p = 0.0197). Type II lesions had significantly higher odds for histopathological diagnosis of APG or NPG than
type IV, PPS(–) lesions [odds ratio = 13.1 (95% CI: 2.75 to 63.27)].
CONCLUSIONS: For SHP patients evaluated with SPECT/CT PPS accumulation type I is a weak premise for surgeon to find
parathyroid pathology. Only persistent 99mTc-sestamibi accumulation in both phases - equivocal with accumulation type II
— effectively differentiates parathyroid and non-parathyroid lesions as well as indicates with high probability the presence of
adenoma or hyperplasia. Type III consistent with washout pattern is rare in sHPT.

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