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Diagnostic Performance of 18F-Choline Positron Emission Tomography/Contrast-Enhanced Computed Tomography in Adenoma Detection in Primary Hyperparathyroidism after Inconclusive Imaging: A Retrospective Study of 215 Patients. Cancers (Basel) 2022; 14:cancers14082029. [PMID: 35454936 PMCID: PMC9028950 DOI: 10.3390/cancers14082029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Primary hyperparathyroidism is a common pathology. Its curative treatment is based on surgery with precise localisation of the affected parathyroid glands. Our retrospective study aimed to assess the diagnostic performance of a novel imaging method called 18F-choline positron emission tomography/contrast-enhanced computed tomography (PET/ceCT) in adenoma detection after inconclusive imaging. 18F-choline PET/ceCT presented excellent diagnostic performance as a second-line imaging method. These results confirm its utility, and it could replace Tc99m-sestamibi single photon emission CT/CT as the first-line imaging method in patients with primary hyperparathyroidism. Abstract This large, retrospective, single-centre study evaluated the diagnostic performance of 18F-choline positron emission tomography/contrast-enhanced computed tomography (PET/ceCT) in preoperative parathyroid adenoma detection in primary hyperparathyroidism cases after negative/inconclusive ultrasound or other imaging findings. We included patients who underwent surgery and 18F-choline PET/ceCT for inconclusive imaging results between 2015 and 2020. We compared the 18F-choline PET/ceCT results with surgical and histopathological findings and identified the variables influencing the correlation between 18F-choline PET/ceCT and surgical findings. Of 215 enrolled patients, 269 glands (mean lesion size, 10.9 ± 8.0 mm) were analysed. There were 165 unilocular and 50 multilocular lesions; the mean preoperative calcium level was 2.18 ± 0.19 mmol/L. Among 860 estimated lesions, 219 were classified as true positive, 21 as false positive, and 28 as false negative. The per-lesion sensitivity was 88.66%; specificity, 96.57%; positive predictive value, 91.40%; and negative predictive value, 95.39%. The detection and cure rates were 82.0% and 95.0%, respectively. On univariate and multivariate analyses, the maximum standardised uptake value (SUVmax), lesion size, and unilocularity correlated with the pathologic findings of hyperfunctioning glands. 18F-choline PET/ceCT presents favourable diagnostic performance as a second-line imaging method, with SUVmax, lesion size, and unilocularity predicting a high correlation between the 18F-choline PET/ceCT and surgical findings.
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Ishii S, Sugawara S, Yaginuma Y, Kobiyama H, Hiruta M, Watanabe H, Yamakuni R, Hakozaki M, Fujimaki H, Ito H. Causes of false negatives in technetium-99 m methoxyisobutylisonitrile scintigraphy for hyperparathyroidism: influence of size and cysts in parathyroid lesions. Ann Nucl Med 2020; 34:892-898. [PMID: 32920750 DOI: 10.1007/s12149-020-01520-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to elucidate the causes of false-negative cases of technetium-99 m methoxyisobutylisonitrile scintigraphy (MIBI) for hyperparathyroidism. METHODS Consecutive MIBI examinations performed in 154 patients between April 2011 and March 2017 were retrospectively reviewed. Sensitivities of MIBI, CT and US were calculated. The effects of serum calcium, phosphorus, PTH, weight of parathyroid lesions, use of NSAIDs and Ca-channel blocker (CCB), presence of cyst in parathyroid lesions, and a number of lesions observed by MIBI were investigated. RESULTS Seventy-nine patients (21 men and 58 women), ranging from 18 to 88 years of age (mean ± SD: 57.6 ± 15.3 years), who underwent parathyroidectomy, were included. MIBI and preoperative US were performed in the 79 patients and single-phase parenchymal contrast-enhanced CT (CE-CT) was performed in 55 patients. A total of 120 parathyroid proliferative nodules were detected by MIBI and US, and 92 lesions were detected by CE-CT. In the lesion base, MIBI detected 82 out of the 120 lesions (sensitivity = 68.3%), US detected 103 out of the 120 lesions (sensitivity = 85.8%), CE-CT detected 63 out of the 92 lesions (sensitivity = 68.5%), and MIBI plus CE-CT detected 72 of the 92 lesions (sensitivity = 78.3%). A significant difference in the sensitivity was found between US and MIBI (P < 0.01), and between US and CT (P < 0.01). In the patient base, MIBI detected 67 out of the 79 patients (sensitivity = 84.8%), US detected 74 out of the 79 patients (sensitivity = 93.7%), CE-CT detected 45 out of the 55 patients (sensitivity = 81.8%), and MIBI plus CE-CT detected 52 out of the 55 patients (sensitivity = 94.5%). No significant difference was observed in any of the comparisons. A significant difference was observed in lesion weight (P < 0.01), single or multiple lesions (P = 0.02), and presence of cyst (P < 0.01) between the MIBI false-negative (n = 38) and the true-positive groups (n = 82). CONCLUSION The presence of cyst in parathyroid proliferative lesions as well as small size and multiple number of parathyroid lesions contribute to false negative in parathyroid MIBI scan.
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Affiliation(s)
- Shiro Ishii
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan.
| | - Shigeyasu Sugawara
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Yuuki Yaginuma
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Honami Kobiyama
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Mahori Hiruta
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hirotake Watanabe
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Ryo Yamakuni
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Motoharu Hakozaki
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hideki Fujimaki
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
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Maccora D, Rizzo V, Fortini D, Mariani M, Giraldi L, Giordano A, Bruno I. Parathyroid scintigraphy in primary hyperparathyroidism: comparison between double-phase and subtraction techniques and possible affecting factors. J Endocrinol Invest 2019; 42:889-895. [PMID: 30600433 DOI: 10.1007/s40618-018-0996-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/18/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Parathyroid scintigraphy is superior to other imaging techniques in detecting hyperfunctioning parathyroid glands. It is mainly performed using double-phase or dual-tracer subtraction methods. Neither of the techniques is perfect and different protocols are being used. We aimed to evaluate the accuracy of double-phase and subtraction methods in detecting abnormal gland as well as the potential effects of coexisting thyroid disease and clinical-laboratory data. METHODS We considered patients with primary hyperparathyroidism who underwent parathyroid surgery, after a parathyroid scintigraphy between April 2015 and February 2017. Sixty-eight patients were included; in 45 cases (66.2%), a thyroid disease was coexistent. Diagnostic performances of the two techniques were compared. The effect of thyroid disease and clinical-pathological data on examination interpretation was considered. RESULTS Double-phase scintigraphy showed higher sensitivity and accuracy in detecting the exact abnormal gland compared to the digital subtraction (90% and 75% vs. 76% and 66%, respectively). For double-phase technique, sensitivity and accuracy were higher in cases with no thyroid disease when compared to those with thyroid disease (92% and 86% vs. 88% and 69%, respectively). Similarly, for digital subtraction, sensitivity and accuracy were higher in the absence of thyroid disease compared to their presence (84% and 79% vs. 70% and 58%, respectively). There was no significant variation in the performance of both techniques, considering clinical-laboratory data. CONCLUSIONS Double-phase scintigraphy has been more accurate than digital subtraction. The presence of thyroid disease could be a possible limit, affecting the subtraction more than the double-phase technique. Clinical data did not influence the scintigraphic outcome.
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Affiliation(s)
- D Maccora
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy.
| | - V Rizzo
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - D Fortini
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - M Mariani
- Institute of Public Health, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - L Giraldi
- Institute of Public Health, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - A Giordano
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - I Bruno
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
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Stanciu M, Boicean LC, Popa FL. The role of combined techniques of scintigraphy and SPECT/CT in the diagnosis of primary hyperparathyroidism: A case report. Medicine (Baltimore) 2019; 98:e14154. [PMID: 30681579 PMCID: PMC6358356 DOI: 10.1097/md.0000000000014154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary hyperparathyroidism, usually as a result of a hyperfunctioning parathyroid gland, represents more than 90% cases of patients evaluated for hypercalcemia. Combined techniques of preoperative scintigraphy and SPECT/CT serve as a successful minimally-invasive parathyroidectomy. This recent imaging method provides four-dimensional functional images with advanced contrast resolution which greatly facilitates preoperative localization of parathyroid adenomas. PATIENT CONCERNS We presented the case of a male Caucasian patient, aged 67 years, who was investigated for hypercalcemia. Increased levels of parathormone, cervical ultrasonography without pathological changes, and negative planar parathyroid scintigraphy have led to the performance of a parathyroid scintigraphy combined with SPECT/CT. DIAGNOSES The diagnosis of right inferior parathyroid adenoma was confirmed by the 99mTc-MIBI-SPECT/CT that revealed on early phase increased radiotracer uptake in the area of projection of the lower third of the right thyroid lobe. The SPECT/CT scan localized this area behind the lower pole of the right thyroid lobe, in the right side of the trachea, with CT correspondent of hypodense lesion, with a maximum diameter of 20 mm. INTERVENTIONS During hospitalization, the decision to undergo surgical intervention was taken. The patient underwent surgical intervention, and minimally-invasive right inferior parathyroidectomy was performed. OUTCOMES The histopathological examination confirmed the diagnosis and the patient's recovery was complete, with the normalization of parathormone, calcium levels, and metabolic parameters. LESSONS Modern combined techniques of scintigraphy and SPECT/CT proved to be of excellent clinical utility in the preoperative diagnosis of primary hyperparathyroidism, localizing a parathyroid tumor undetected by planar scintigraphy alone.
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Affiliation(s)
- Mihaela Stanciu
- “Lucian Blaga” University of Sibiu, Romania
- Academic Emergency Hospital Sibiu, Romania
| | | | - Florina Ligia Popa
- “Lucian Blaga” University of Sibiu, Romania
- Academic Emergency Hospital Sibiu, Romania
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