The Additional Advantages of 99Tcm-MIBI SPECT/CT Imaging in Hyperparathyroidism
Objective To evaluate the diagnostic efficacy and related factors of Technetium-99 methoxyisobutylisonitrile (99Tcm-MIBI)Single-Photon Emission Computed Tomography/Computed Tomography(SPECT/CT)for hyperparathyroidism,as well as additional advantages of MIBI fusion imaging.Methods Inclusion criteria of the study cohort:①Retrospective analysis of patients with clinically suspected hyperparathyroidism between May,2017 and June,2023;②Patients performed parathyroidectomy in our hospital;③ Patients performed 99Tcm-MIBI SPECT/CT parathyroid imaging within 2 weeks before surgery.Two senior attending physicians from the Nuclear Medicine Department jointly reviewed the images.Relevant data were recorded.Results A total of 100 patients who met the screening criteria were enrolled in our study.165 lesions,including 112 parathyroid lesions,were resected.The sensitivity,specificity,Jordan index,positive predictive value,and negative predictive value of MIBI planar imaging and fusion imaging in the diagnosis of hyperparathyroidism lesions were 66.07％,87.03％,53.10％,91.36％,and 55.29％ and 85.71％,87.03％,72.74％,93.20％,and 74.60％,respectively.Levels of serum thyroid stimulating hormone (PTH)and creatinine (Cr)in patients with positive MIBI planar imaging were significantly higher than those in the negative group.There was no significant difference in clinical characteristics between the positive and negative MIBI tomographic imaging groups.MIBI tomographic fusion imaging showed 96 true positive lesions,of which 76 lesions appeared as uniformly dense circular or elliptical nodules on CT,while 17 lesions with cystic changes,and 3 lesions with calcification.MIBI tomographic fusion imaging revealed 8 ectopic parathyroid adenomas,4 located within the thyroid gland and 4 located in the mediastinum.29 patients had thinning of the skull cortex,while 38 patients had bone thickening,and 9 patients had low-density bone resorption lesions.The MIBI planar imaging positive group was more prone to thinning of the skull cortex and thickening of the skull.The correlation analysis showed that there was a correlation between serum alkaline phosphatase (ALP)levels and skull CT values,thinning of skull cortex,skull thickening,and the presence or absence of bone resorption lesions.Conclusion MIBI imaging plays an important role in the diagnosis of hyperthyroidism. SPECT/CT fusion imaging can improve the diagnostic accuracy of traditional planar imaging and provide accurate localization of hyperthyroidism lesions.The bone characteristics displayed by integrated CT could provide more useful clinical information of hyperparathyroidism.
MIBI imagingSPECT/CT fusion imagingHyperparathyroidismGain value
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