The role of (99m)Tc-MIBI SPECT/CT in patients with secondary hyperparathyroidism: comparison with (99m)Tc-MIBI planar scintigraphy and ultrasonography

BACKGROUND: This study aimed to compare the sensitivity of (99m)Tc-MIBI SPECT/CT, (99m)Tc-MIBI planar scintigraphy and ultrasonography (US) in patients with secondary hyperparathyroidism (SHPT), and to explore the factors that affect the sensitivity of (99m)Tc-MIBI SPECT/CT. METHODS: In this retrospective study, forty-six patients with SHPT who underwent (99m)Tc-MIBI planar scintigraphy, (99m)Tc-MIBI SPECT/CT and US were enrolled. They underwent surgery within 1 month. We compared the sensitivity of the different imaging methods based on the lesions according to the pathological results. The parathyroid lesions on (99m)Tc-MIBI SPECT/CT images were divided into missed diagnosis group (MDG) and non-missed diagnosis group (NMDG). We compared the lesion to background ratio (LBR), maximum diameter, volume, the mean CT Hounsfield unit values (CT(mean)) and location of lesions between MDG and NMDG. RESULTS: The sensitivity of (99m)Tc-MIBI SPECT/CT, (99m)Tc-MIBI planar scintigraphy and US were 70.30% versus 48.48% versus 61.82%, respectively. The sensitivity of (99m)Tc-MIBI SPECT/CT combined US was 79.39%, which was higher than (99m)Tc-MIBI SPECT/CT with significant difference (P = 0.000). On (99m)Tc-MIBI SPECT/CT images, the LBR, maximum diameter and volume of lesions in MDG was smaller than those in NMDG with significant difference (P < 0.001). The average LBR, maximum diameter and volume of lesions in MDG and NMDG were 3.42 ± 1.28, 9.32 ± 2.69 mm, 208.51 ± 163.22 mm(3) versus 6.75 ± 5.08, 15.03 ± 4.94 mm and 863.85 ± 1216.0 mm(3), respectively. CONCLUSIONS: (99m)Tc-MIBI SPECT/CT exhibited the highest sensitivity among the three methods. When (99m)Tc-MIBI SPECT/CT combined with US, the sensitivity can be further improved. Lesions with lower MIBI uptake and smaller lesions on (99m)Tc-MIBI SPECT/CT images were easily missed.