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Double-Phase Parathyroid Technetium-99m-MIBI Scintigraphy to Identify Functional Autonomy in Secondary Hyperparathyroidism

Departments of Nuclear Medicine, Clinical Surgery, Endocrinology, University of Cagliari, Cagliari
Dialysis Department, S. Michele Hospital, Cagliari, Italy

Correspondence: For correspondence or reprints contact: Mario Piga, MD, Nuclear Medicine Center, Polyclinic Hospital, Via S. Giorgio 12, 09124 Cagliari, Italy.

ABSTRACT

Double-phase ^99mTc-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy has been proposed to detect hyperplastic parathyroid tissue, but the clinical usefulness of this technique in secondary hyperparathyroidism is still debated. Methods: Technetium-99m-MIBI parathyroid scintigraphy associated with parathyroid echography and [^99mTc]pertechnetate thyroid scans were performed on 38 patients with chronic renal failure (CRF) and secondary hyperparathyroidism. In all patients, serum calcium, phosphorus, FT3, FT4, TSH, calcitonin and intact PTH (iPTH) were determined. Nine patients eventually underwent neck exploration and 28 parathyroid glands were removed. Results: Thyroid diseases were excluded in all patients. Echography revealed parathyroid enlargement in 22/38 (58%) patients, while MIBI scintigraphy was positive in 28/38 (74%), including 5-ectopic glands. Mean serum iPTH concentration was significantly higher in MIBI-positive patients compared to MIBI-negative patients. Mean echographic and surgical parathyroid size were significantly higher in MIBI-positive glands compared to MIBI-negative glands, but several discrepancies were observed in single patients. A significant positive correlation between serum iPTH and gland size was observed when MIBI-positive, but not MIBI-negative, parathyroids were considered. A paradoxical positive correlation between serum calcium and iPTH concentrations was found in MIBI-positive patients. Conclusion: Double-phase ^99mTc-MIBI scintigraphy is positive in the majority of patients with uremic hyperparathyroidism. Comparison of scintigraphic data with morphological and functional data strongly suggests that ^99mTc-MIBI scans do not reveal simple parathyroid enlargement but rather, identify the presence of hyperfunctioning (autonomous) parathyroid tissue suggestive of tertiary hyperparathyroidism.

Key Words: uremic secondary hyperparathyroidism • technetium-99m-MIBI • parathyroid hyperfunction • parathyroid hyperplasia

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