Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism

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 99m Tc-MIBI scintigraphy, early and delayed 99m Tc-MIBI SPECT/CT in patients with SHPT. Methods: : Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99m Tc-MIBI scintigraphy, early and delayed 99m Tc-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 99m Tc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99m Tc-MIBI scintigraphy (P < 0.001). Furthermore, early 99m Tc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99m Tc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99m Tc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99m Tc-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 99m Tc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99m Tc-MIBI scintigraphy and delayed 99m Tc-MIBI SPECT/CT; furthermore, dual-phase 99m Tc-MIBI SPECT/CT is not essential.