Correlation between serum calcium levels and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy in primary hyperparathyroidism.

Abstract

AIM:

The goal of the study is to correlate serum calcium levels with the results of dual-phase (99m)Tc-sestamibi parathyroid scintigraphy to find the best cut-off level of the serum calcium that correlates with a positive presurgery.

METHODS:

In 111 patients, serum calcium and plasma parathormone (PTH) levels were compared with the results of the (99m)Tc-MIBI scintigraphy and with this data determined the level of calcium above which the (99m)Tc-MIBI scintigraphy was likely to be positive and below which the study was likely to be negative.

RESULTS:

In total, 11 men (18%) and 50 women (82%) had a positive (99m)Tc-MIBI study. Overall 67% of those patients with a positive (99m)Tc-MIBI study had a PTH >200 ng l(-1) compared to only 9% of those with a negative (99m)Tc-MIBI scintigraphy; however, for those with a positive study on an early (99m)Tc-MIBI scintigraphy, this rose to 85%. Overall a serum calcium of >2·70 mmol l(-1) was found in 82% of patients with a positive (99m)Tc-MIBI study but only 14% of those with a negative (99m)Tc-MIBI study, this is rose to 97% of patients with a parathyroid adenoma identified on early images. It is also shown that patients whose serum total calcium <2·51 mmol l(-1) rarely have positive (99m)Tc-MIBI scintigraphy.

CONCLUSION:

(99m)Tc-MIBI parathyroid scintigraphy is most likely to yield identification and localization of a parathyroid adenoma when both PTH and calcium are elevated; however, although there is no lower limit of PTH which can predict a negative study, we cannot recommend (99m)Tc-MIBI parathyroid scintigraphy if the serum calcium is <2·51 mmol l(-1).

• Authors: D S Mshelia, A N Hatutale, N P Mokgoro, M E Nchabaleng, J R Buscombe, M M Sathekge
• Journal: Clinical physiology and functional imaging (Clin Physiol Funct Imaging) Vol. 32 Issue 1 Pg. 19-24 (Jan 2012) ISSN: 1475-097X [Electronic] England
• PMID: 22136277 (Publication Type: Journal Article)
• Copyright: © 2011 The Authors. Clinical Physiology and Functional Imaging © 2011 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

Chemical References

• Biomarkers
• PTH protein, human
• Parathyroid Hormone
• Radiopharmaceuticals
• Technetium Tc 99m Sestamibi
• Calcium

Topics

• Adenoma (blood, complications, diagnosis, diagnostic imaging)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Calcium (blood)
• Cross-Sectional Studies
• Female
• Humans
• Hypercalcemia (blood, diagnosis, etiology)
• Hyperparathyroidism, Primary (blood, diagnosis, diagnostic imaging, etiology)
• Male
• Middle Aged
• Multimodal Imaging
• Parathyroid Glands (diagnostic imaging, metabolism)
• Parathyroid Hormone (blood)
• Parathyroid Neoplasms (blood, complications, diagnosis, diagnostic imaging)
• Positron-Emission Tomography
• Predictive Value of Tests
• Prospective Studies
• Radiopharmaceuticals
• South Africa
• Technetium Tc 99m Sestamibi
• Tomography, X-Ray Computed
• Up-Regulation
• Young Adult