The Relationship Between Technetium-99m-Methoxyisobutyl Isonitrile Parathyroid Scintigraphy and Hormonal and Biochemical Markers in Suspicion of Primary Hyperparathyroidism

Amaç: Teknesyum-99m-metoksiizobutil izonitril (Tc-99m MIBI), intakt paratiroid hormon (iPTH) ve/veya kalsiyum (Ca) seviyeleri yükselmiş olan hastalarda hiperfonksiyone otonom paratiroid bezlerinin değerlendirilmesinde sıklıkla kullanılmaktadır. Bu çalışmada primer hiperparatiroidi (PHPT) şüphesi olan hastalarda hormonal ve diğer biyokimyasal belirteçler ile Tc-99m MIBI görüntüleme arasındaki ilişkiyi değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: PHPT şüphesi olan 60 hastada (52 kadın, 8 erkek; ortalama yaş, 59,38±12,51 yıl; yaş aralığı, 34- 86 yıl) dual faz Tc-99m MIBI paratiroid sintigrafisi, serum iPTH, Ca, fosfor (P), albumin ölçümleri yapıldı. Bulgular: Hasta grubunda iPTH seviyeleri 47,80- 782,60 pg/ml arasında, iPTH median değeri 160,3 pg/mL olarak tespit edildi (referans değerleri, 11- 79,5 pg/ml). Hastaların otuz beşinde hiperfonksiyone paratiroid bezleri cerrahi eksizyon ile çıkarıldı. Histopatolojik olarak paratiroid adenomu tanısı teyit edildi. Sintigrafi histopatolojik tanısı pozitif olan otuz beş hastanın 30’unda pozitifti. Otuz hastada Tc- 99m MIBI paratiroid sintigrafisi negatifti. Tc-99m MIBI pozitif grup ve negatif grup arasında serum iPTH, Ca, P seviyelerinde (sırasıyla 202,1 (47,8-782,6) pg/ml yerine 111,6 (80.1-373) pg/ml; p

Primer Hiperparatiroidi Tanısında Teknesyum-99m-Metoksiizobutil İzonitril Paratiroid Sintigrafisi ile Hormonal ve Biyokimyasal Belirteçler Arasındaki İlişki

Objective: Technetium-99m-methoxyisobutyl isonitrile (Tc-99m MIBI) has been widely used to evaluate hyperfunctioning autonomous parathyroid glands in patients with elevated intact parathyroid hormone (iPTH) and/or calcium (Ca) level. The aim of this study was to evaluate the relationship between Tc-99m MIBI imaging and hormonal and biochemical markers in suspicion of primary hyperparathyroidism (PHPT). Material and Methods: Dual-phase parathyroid Tc-99m MIBI imaging and total serum iPTH, Ca, phosphorus (P) and albumin measurements were performed in 60 patients (52 females, 8 males; mean age, 59.38±12.51 years; range, 34 to 86 years) with suspicion of PHPT. Results: The iPTH median level was 160.3 pg/mL (47.8 to 782.6). Thirty-five of the patients had surgical resection of hyperfunctioning parathyroid glands. Of the 35 patients, parathyroid gland pathology was detected in 30 patients using scintigraphic examination. Tc- 99m MIBI scintigraphy was negative in 30 patients. The iPTH, Ca and P levels were significantly different between in the Tc-99m MIBI positive group and the negative group, respectively: For iPTH, 202.1 (47.8-782.6) pg/mL versus 111.6 (80.1-373) pg/mL; p<0.001. For Ca, 11.7±1.15 mg/dL versus 10.3±1.05 mg/dL; p<0.001 and for P levels, 2.46±0.62 mg/dL versus 3.40±0.70 mg/dL; p<0.001). There was no significant difference in serum albumin levels between the MIBI-positive and MIBI-negative groups (4.25±0.27 g/dL versus 4.25±0.41 g/dL; p>0.05). Tc-99m MIBI parathyroid scintigraphy showed good correlation with iPTH level and histopathological diagnosis. Sensitivity and specificity was found 83.3% and 76.7%, respectively at the level of iPTH>147.7pg/mL. Conclusion: In conclusion, Tc-99m MIBI parathyroid imaging is most likely to produce identification and localization of a parathyroid adenoma when both iPTH and Ca are elevated as well as decreased P levels

Kaynakça

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