Clinical Value Of⁹⁹Tc^m-MIBI SPECT/CT For Preoperative Diagnosis In Hyperparathyroidism

ObjectiveThe aim of this study was to assess the clinical value of 99Tcm-MIBI SPECT/CT for preoperative localization in hyperparathyroidism(HPT),with retrospective analysis of clinical data and pathological results in 273 HPT cases(38 PHPT cases,235 SHPT cases).Methods1.38 patients(11 males,27 females,average age 55.3 ± 15.2 years)who were clinically diagnosed as PHPT between February 2012 and March 2019 in our hospital were enrolled in the study and collected the data of preoperative imaging and biochemical indexes.Each patient was calculated of 4 parathyroid glands on both sides.The pathological results were taken as the 'gold standard',the diagnostic efficacy of 99Tcm-MIBI dual-phase planar imaging,99Tcm-MIBI SPECT/CT delayed phase fusion imaging,ultrasound,CT/MRI and biochemical indicators(serum PTH,serum calcium,serum phosphorus,and serum alkaline phosphatase)were compared and analyzed.2.The clinical data of 235 patients(121 males,114 females,18-76 years old,average age 48.7 ± 11.3 years old,average course of chronic renal failure 8 ± 3 years)who were clinically diagnosed as SHPT from February 2012 to March 2019 were analyzed retrospectively.The results of pathology were taken as the‘gold standard',and the diagnostic efficacy of various imaging methods and biochemical indexes were analyzed.3.Statistical analysis:(1)Chi-Square Test or Fisher Exact Probability Method was used to compare the diagnostic accuracy of PHPT and SHPT.(2)Pearson Correlation Analysis was used to analyze the correlation between the ratio of T/NT and serum PTH,serum calcium,serum phosphorus,serum alkaline phosphatase,the volume of the lesions(v=?/6*a*b*c.a,b,c(long axis,short axis,height))measured after parathyroidectomy,and T-Test or Rank Sum Test was used to compare the age,gender,biochemical indexes,T/NT and the volume of the lesions among different pathological types(PH and PA)of PHPT.(3)Pearson correlation analysis was used to analyze the correlation between the lesions volume and the preoperative serum PTH,calcium,phosphorus and alkaline phosphatase in SHPT patients,and the difference in the age,gender,biochemical indexes,and the volume of the lesions in different pathological types(PH and PA)were compared with Rank Sum Test.The diagnostic accuracy of each imaging method for different pathological types(PH and PA)used Chi-Square Test.Results1.The diagnostic accuracy of 99Tcm-MIBI dual-phase planar imaging,99Tcm-MIBI SPECT/CT delayed phase fusion imaging,ultrasound,CT/MRI and serum PTH for PHPT were 98.68%(150/152),97.97%(145/148),94.29%(132/140),83.33%(30/36)and 89.47%(34/38),respectively,and the accuracy for SHPT was 67.94%(659/970),73.17%(660/902),67.66%(680/1005),48.48%(16/33)and 95.71%(223/233),respectively.2.T/NT in delayed phase fusion imaging was significantly correlated with preoperative PTH and the lesions volume(r=0.415,P<0.05;r=0.574,P<0.05).There was no significant correlation between T/NT and calcium,phosphorus and alkaline phosphatase(P>0.05).3.In SHPT patients,the total volume or the maximum volume of lesions were significantly correlated with the preoperative serum calcium(r=0.248,0.242,respectively,P<0.05),the total volume of lesions was correlated with serum phosphorus(r=-0.144,P=0.033),but they were not significantly correlated with serum PTH and serum alkaline phosphatase(P>0.05).In 155 SHPT patients without definite history of medical treatment,the total volume or the maximum volume of the lesions were significantly correlated with the serum calcium(r=0.321,0.312,P<0.05),but not with the serum PTH,phosphorus and alkaline phosphatase(P>0.05).4.Among 32 PHPT patients,the proportion of women(P=0.035,Fisher's exact probability method),the preoperative serum PTH(z=-1.991,P=0.046)and the lesions volume(z=-2.434,P=0.015)were statistically different in hyperplasia(PH)and adenoma groups(PA),but the age(t=-0.135,P=0.893),serum calcium(z=-0.65,P=0.516),serum phosphorus(z=-1.258,P=0.208),serum phosphate(z=-0.914,P=0.361)and T/NT(z=-1.61,P=0.107)had no significant difference(P>0.05).5.Among the two groups of SHPT patients,there were significant differences in preoperative serum alkaline phosphatase(z=-2.9,P=0.004),but in gender(P=0.738,Fisher exact probability method),age(z=-0.1.496,P=0.135),course of disease(z=-1.11,P=0.267),preoperative serum PTH(z=-0.013,P=0.918),serum calcium(z=-0.621,P=0.535),serum phosphorus(z=-0.016,P=0.988),total and maximum volume of lesions was found no difference(P>0.05).6.Among the SHPT patients,there was no significant difference in the diagnostic sensitivity,specificity and accuracy of 99Tcm-MIBI dual-phase planar imaging,99Tcm-MIBI SPECT/CT delayed phase fusion imaging,ultrasound and CT/MRI in adenoma(PA,9 cases)(P>0.05).The diagnostic sensitivity and accuracy of 99Tcm-MIBI SPECT/CT for hyperplasia(pH,143 cases)were not significantly different from that of ultrasound(P>0.05),while that was significantly better than that of 99Tcm-MIBI dual-phase planar imaging(?2=5.11,5.54,P=0.024,0.019)and CT/MRI(?2=15.48,18.86,P=0.000).In specificity,99Tcm-MIBI SPECT/CT has no significant difference with 99Tcm-MIBI dual-phase planar imaging,but was superior to ultrasound(?2=8.44,P=0.004).Conclusion1.99Tcm-MIBI imaging can improve the accuracy of HPT diagnosis,and 99Tcm-MIBI SPECT/CT fusion imaging can provide a clearer anatomical position,which has an important clinical value in the preoperative localization of PHPT.However,the diagnostic specificity of 99Tcm-MIBI imaging in SHPT is relatively low(99Tcm-MIBI SPECT/CT fusion imaging is 57.9%and 99Tcm-MIBI dual-phase planar imaging is 63.57%).2.The uptake of 99Tcm-MIBI in PHPT patients was related to the functional status and the lesions volume.Pathological type of women was more prone to hyperplasia,and the serum PTH and the volume of the lesion in patients with single adenoma in PHPT were significantly higher than those in patients with single hyperplasia,but there was no significant difference in T/NT between the two groups.3.No clear correlation was found between the lesions volume and the biochemical indexes in SHPT patients.The serum alkaline phosphatase was higher and the skeletal system symptoms were more common in adenoma patients,the diagnostic efficacy of 99Tcm-MIBI SPECT/CT in hyperplastic lesions is higher than that of 99Tcm-MIBI dual-phase planar imaging,while the efficacy is similar in adenoma patients.