Primer Hiperparatiroidide Tc-99m MİBİ ile Yapılan Sintigrafik Görüntüleme Sonuçlarının İncelenmesi ve Biyokimyasal Parametreler ile İlişkisinin Değerlendirilmesi

Yıl 2021, Cilt: 43 Sayı: 2, 138 - 148, 30.03.2021

Seda Turgut , Ezgi Başak Erdoğan

https://doi.org/10.20515/otd.787841

Öz

Yeni tanı primer hiperparatiroidili (PHPT) hastalarda Teknesyum-99m MIBI ile yapılan sintigrafik görüntüleme yöntemi ile klinik, laboratuvar ve histopatolojik bulgular arasındaki ilişki retrospektif olarak incelenmiş, biyokimyasal ve histopatolojik parametrelerin sintigrafik lezyon tespitindeki rolünün değerlendirilmesi amaçlanmıştır. 2012-2018 yılları arasında paratiroid sintigrafisi için başvurmuş 516 hiperparatiroidili hasta dosyası retrospektif olarak tarandı. Hastalardan PHPT tanısı almış ve ilk defa paratiroidektomi uygulanmış 105 (94 kadın, 11 erkek) hasta dosyası çalışmaya dahil edilerek laboratuvar, ultrason (USG) ve klinik bulgular kaydedildi. Sintigrafik olarak paratiroid dokusu lokalize edilebilenler MIBI-pozitif (n=92) ve edilemeyenler MIBI-negatif (n=13) olarak iki grupta incelendi. USG ve sintigrafi yönteminin ve kombinasyonlarının duyarlılıkları ve tanısal doğruluğu değerlendirildi. MIBI-pozitif hastalarda kalsiyum değeri (11,48±0,75 mg/dl), MIBI-negatif olan gruba göre (11±0,68 mg/dl) anlamlı olarak yüksekti (p=0,047). USG’nin lezyon saptamadaki duyarlılığı %60,2, sintigrafinin %89,1 iken iki yöntemin kombinasyonunda duyarlılık %91,9 olarak saptandı. Sintigrafi tek başına kullanıldığında tanısal keskinlik %87,6 iken USG+sintigrafide %92 olarak saptandı. Paratiroid adenom boyutu ile PTH ve ALP arasında pozitif yönde anlamlı korelasyon saptandı (sırasıyla, p<0,001 r=0,572; p=0,003 r=0,424). Çalışmamızda paratiroid sintigrafisinin kalsiyumun yüksek olduğu durumlarda bir paratiroid patolojisi tanımlamasının daha olası olduğu ve PTH düzeyi arttıkça adenom boyutunun arttığı gösterilmiştir. PHPT’de preoperatif lokalizasyon için sintigrafi USG’den çok daha etkili olmakla beraber USG ile kombinasyonu sintigrafinin etkinliğine katkı sağlamaktadır.

Anahtar Kelimeler

paratiroid adenom, primer hiperparatiroidi, sestamibi sintigrafi

Association of Tc99m-MIBI Scintigraphy and Biochemical Parameters in Primary Hyperparathyroidism

Öz

It was aimed to evaluate the relationship between clinical, laboratory, and histopathological findings with the scintigraphy performed with Technetium-99m MIBI in patients with primary hyperparathyroidism (PHPT). 516 patients who applied for parathyroid scintigraphy between 2012-2018 were retrospectively scanned. Files of 105(94 female, 11 male) patients, which were diagnosed as PHPT, were included in the study and laboratory, ultrasonography (USG), and findings were recorded. The scintigraphically parathyroid tissues that can be localized were examined in two groups as MIBI-positive(n=92) and those that could not be MIBI-negative (n=13). Sensitivity and diagnostic accuracy of USG and scintigraphy and combinations were evaluated. The calcium value (11.48±0.75 mg/dl) in MIBI-positive group was higher than MIBI-negative group (11±0.68 mg/dl) (p=0.047). While the sensitivity of USG in lesion detection was 60.2%, and scintigraphy was 89.1%, the sensitivity in the combination of the those was 91.9%. Diagnostic acuity of scintigraphy was 87.6%, USG+scintigraphy was 92%. A positive correlation was found between parathyroid adenoma size and PTH and ALP (p<0.001 r=0.572; p=0.003 r=0.424, respectively). Parathyroid scintigraphy is more likely to define a parathyroid pathology when calcium is high, and the adenoma size increases consistent with increasing PTH. Although scintigraphy is much more effective than USG for preoperative localization in PHPT, its combination with USG contributes to the localization of PHPT.

Anahtar Kelimeler

parathyroid adenoma, primary hyperparathyroidism, sestamibi scintigraphy

Kaynakça

• 1. Griebeler ML, Kearns AE, Ryu E et al. Secular trends in the incidence of primary hyperparathyroidism over five decades (1965-2010). Bone. 2015;73:1-7.
• 2. Wermers RA, Khosla S, Atkinson EJ et al. Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993-2001: an update on the changing epidemiology of the disease. J Bone Miner Res. 2006;21(1):171-7.
• 3. Yeh MW, Ituarte PH, Zhou HC et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122-9.
• 4. Ruda JM, Hollenbeak CS, Stack BC, Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132(3):359-72.
• 5. Khan AA, Hanley DA, Rizzoli R et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1-19.
• 6. Sullivan DP, Scharf SC, Komisar A. Intraoperative gamma probe localization of parathyroid adenomas. Laryngoscope. 2001;111(5):912-7.
• 7. Wojtczak B, Syrycka J, Kaliszewski K et al. Surgical implications of recent modalities for parathyroid imaging. Gland Surg. 2020;9(Suppl 2):S86-S94.
• 8. Greenspan BS, Dillehay G, Intenzo C et al. SNM practice guideline for parathyroid scintigraphy 4.0. J Nucl Med Technol. 2012;40(2):111-8.
• 9. NIH conference. Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference statement. Ann Intern Med. 1991;114(7):593-7.
• 10. Bilezikian JP, Potts JT, Jr., Fuleihan Gel H et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab. 2002;87(12):5353-61.
• 11. Hindie E, Ugur O, Fuster D et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36(7):1201-16.
• 12. Wilhelm SM, Wang TS, Ruan DT et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016;151(10):959-68.
• 13. Wong KK, Fig LM, Gross MD et al. Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT: a meta-analysis. Nucl Med Commun. 2015;36(4):363-75.
• 14. Aygün N İA, Uludağ M. Primer Hiperparatiroidili Hastalarda Preoperatif Ultrasonografi ve Sintigrafinin İlk Görüntülemede Patolojik Bezin Lokalizasyonunda Etkinliği. THE MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL. 2019;4(53):379-84.
• 15. Çolakoğlu B AD. Diagnostic Value of Ultrasound and Tc-99m MIBI scintigraphy and SPECT/CT for Pre-operative Localization of Parathyroid Adenoma in Patients with Primary Hyperparathyroidism: A Single-Center Comparative Study. JAREM. 2019;3(9):115-20.
• 16. Qiu ZL, Wu B, Shen CT et al. Dual-phase (99m)Tc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables. Ann Nucl Med. 2014;28(8):725-35.
• 17. Ciappuccini R, Morera J, Pascal P et al. Dual-phase 99mTc sestamibi scintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism: a single-institution experience. Clin Nucl Med. 2012;37(3):223-8.
• 18. Parikshak M, Castillo ED, Conrad MF et al. Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Am Surg. 2003;69(5):393-8; discussion 9.
• 19. Mshelia DS, Hatutale AN, Mokgoro NP et al. Correlation between serum calcium levels and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy in primary hyperparathyroidism. Clin Physiol Funct Imaging. 2012;32(1):19-24.
• 20. Im HJ, Lee IK, Paeng JC et al. Functional evaluation of parathyroid adenoma using 99mTc-MIBI parathyroid SPECT/CT: correlation with functional markers and disease severity. Nucl Med Commun. 2014;35(6):649-54.
• 21. Silverberg SJ, Shane E, Jacobs TP et al. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999;341(17):1249-55.
• 22. Yamashita H, Noguchi S, Uchino S et al. Vitamin D status in Japanese patients with hyperparathyroidism: seasonal changes and effect on clinical presentation. World J Surg. 2002;26(8):937-41.
• 23. Einollahi B TM, Motalebi M, Ramezani-Binabaj M. Normal alkaline phosphatase level in a patient with primary hyperparathyroidism due to parathyroid adenoma. Journal of parathyroid disease. 2014;1(2):47-50.
• 24. Fogelman I, Bessent RG, Beastall G et al. Estimation of skeletal involvement in primary hyperparathyroidism. Use of 24-hour whole-body retention of technetium-99m diphosphonate. Ann Intern Med. 1980;92(1):65-7.
• 25. Lo CY, Lang BH, Chan WF et al. A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. Am J Surg. 2007;193(2):155-9.
• 26. Hwang-Bo Y, Kim JH, An JH et al. Association of the Parathyroid Adenoma Volume and the Biochemical Parameters in Primary Hyperparathyroidism. Endocrinol Metab. 2011;26(1):62-6.
• 27. De Lucia F, Minisola S, Romagnoli E et al. Effect of gender and geographic location on the expression of primary hyperparathyroidism. J Endocrinol Invest. 2013;36(2):123-6.
• 28. Cordes M, Dworak O, Papadopoulos T et al. MIBI scintigraphy of parathyroid adenomas: correlation with biochemical and histological markers. Endocr Res. 2018;43(3):141-8.