Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism

Am J Surg. 2010 May;199(5):614-20. doi: 10.1016/j.amjsurg.2010.02.001.

Abstract

Background: The aim of this study was to evaluate the influence of patient and adenoma characteristics on (99m)Tc-methoxy isobutyl isonitrile (MIBI) scan performance in individuals diagnosed with primary hyperparathyroidism (PHP).

Methods: Records of patients undergoing parathyroidectomy for PHP over 6 years at a single center were reviewed.

Results: The overall true-positive (TP) rate for (99m)Tc-MIBI scans was 56%. Adenomas sized 1.9 to 3.5 cm were more likely to have TP scans than 0.3-cm to 1.8-cm adenomas (74% vs 40%, P < .001). Preoperative ionized calcium levels between 1.49 and 1.72 mmol/L were more likely to have TPs than levels between 1.27 and 1.48 mmol/L (65% vs 47%, P < .05). No single class of medication was shown to significantly effect TP rates. A decrease in TP rate was observed for larger adenomas in patients on >or=1 medication (74% vs 65%, P = .05).

Conclusions: In PHP, (99m)Tc-MIBI scan positivity is most related to adenoma size and preoperative ionized calcium level.

Publication types

  • Comparative Study

MeSH terms

  • Adenoma / diagnostic imaging*
  • Adenoma / pathology
  • Adenoma / surgery
  • Aged
  • Cohort Studies
  • False Positive Reactions
  • Female
  • Humans
  • Hyperparathyroidism, Primary / diagnostic imaging*
  • Hyperparathyroidism, Primary / pathology
  • Hyperparathyroidism, Primary / surgery
  • Male
  • Middle Aged
  • Parathyroid Neoplasms / diagnostic imaging*
  • Parathyroid Neoplasms / pathology
  • Parathyroid Neoplasms / surgery
  • Parathyroidectomy / methods
  • Preoperative Care / methods
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi*
  • Tomography, Emission-Computed, Single-Photon / methods*
  • Treatment Outcome

Substances

  • Technetium Tc 99m Sestamibi