Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists | 2021
The Detection of Preoperative Parathyroid Lesions: The Success of Ultrasonography, Technetium-99m Methoxyisobutylisonitrile Parathyroid Scintigraphy and Spect-CT.
Abstract
AIMS\nWe aimed to find out and compare the efficacy of ultrasonography (US), technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy (MIBI-S) and single-photon emission computed tomography-computed tomography (SPECT-CT) in detecting the localization of parathyroid adenomas in patients with primary hyperparathyroidism.\n\n\nMETHODS\nPreoperative parathyroid imaging with US, MIBI-S, and SPECT-CT were evaluated and compared with operative findings. 348 patients were included in the study. The results of the imaging methods were compared with the pathology and operation reports.\n\n\nRESULTS\nIt was seen that in 318 (91.3%) of 348 patients, one of the imaging methods was able to localize the lesion correctly. US detected the localization of the parathyroid lesions correctly in 268 patients (77%), whereas SPECT and MIBI-S were correct in 254 (73%) and 209 (60%) patients, respectively. There was a statistically significant relationship between the PTH level and three imaging methods success rates (p<0.05). The PTH cut-off value, which best determined the correct localization, was 152.5 pg/ml in the US, 143 pg/ml in the MIBI-S, and 143 pg/ml in the SPECT-CT. It was observed that the correct localization rate for parathyroid lesions increased with higher PTH levels.\n\n\nCONCLUSION\nIn our study population, US was more successful than other imaging methods in localizing parathyroid lesions in most cases, but SPECT-CT was more successful in localizing mediastinal lesions accurately. It was also detecte that preoperative PTH levels affect the accuracy of imaging methods.