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Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism
Ping Hu
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Imaging.
Background: Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT.
Methods: Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH).
Results: A total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US, early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99mTc-MIBI scintigraphy (P < 0.001). Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P < 0.05). The Spearman correlation results showed a significant linear association between calcification and both serum PTH and ALP (P = 0.002).
Conclusion: The ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.
Keywords
Secondary hyperparathyroidism, Ultrasonography, Dual-phase 99mTc-MIBI scintigraphy, 99mTc-MIBI SPECT/CT
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Received 10 Jun, 2020
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Invitations sent on 22 May, 2020
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On 29 Apr, 2020
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Received 26 Apr, 2020
Reviewer #2 agreed
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Received 10 Apr, 2020
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Invitations sent on 31 Mar, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Editor assigned
On 26 Mar, 2020
Submission checks complete
On 25 Mar, 2020
Editor invited
On 25 Mar, 2020
No comments provided
Editorial decision: Major revision
On 05 Mar, 2020
Review #2 received
Received 03 Mar, 2020
Review #1 received
Received 19 Feb, 2020
Reviewer #2 agreed
On 17 Feb, 2020
Reviewer #1 agreed
On 08 Feb, 2020
Reviewers invited
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First submitted
On 23 Jan, 2020
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Subject Areas
Nuclear Medicine & Medical Imaging
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This preprint is under consideration at BMC Medical Imaging. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism
Ping Hu
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 23 Jun, 2020
Published
On 03 Aug, 2020
No community comments so far
Editor assigned
On 22 Jun, 2020
Submission checks complete
On 21 Jun, 2020
Editor invited
On 21 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 10 Jun, 2020
Reviewer #1 agreed
On 10 Jun, 2020
Review #1 received
Received 10 Jun, 2020
Reviewers invited
Invitations sent on 22 May, 2020
Editor assigned
On 21 May, 2020
Submission checks complete
On 20 May, 2020
Editor invited
On 20 May, 2020
No comments provided
Editorial decision: Major revision
On 29 Apr, 2020
Review #2 received
Received 26 Apr, 2020
Reviewer #2 agreed
On 20 Apr, 2020
Review #1 received
Received 10 Apr, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Editor assigned
On 26 Mar, 2020
Submission checks complete
On 25 Mar, 2020
Editor invited
On 25 Mar, 2020
No comments provided
Editorial decision: Major revision
On 05 Mar, 2020
Review #2 received
Received 03 Mar, 2020
Review #1 received
Received 19 Feb, 2020
Reviewer #2 agreed
On 17 Feb, 2020
Reviewer #1 agreed
On 08 Feb, 2020
Reviewers invited
Invitations sent on 07 Feb, 2020
Editor assigned
On 24 Jan, 2020
First submitted
On 23 Jan, 2020
Submission checks complete
On 23 Jan, 2020
Editor invited
On 23 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nuclear Medicine & Medical Imaging
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Imaging.
Background: Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT.
Methods: Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH).
Results: A total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US, early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99mTc-MIBI scintigraphy (P < 0.001). Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P < 0.05). The Spearman correlation results showed a significant linear association between calcification and both serum PTH and ALP (P = 0.002).
Conclusion: The ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.
Figure 1
Figure 2
Due to technical limitations the Tables are available as downloads in the Supplementary Files.