Paratiroid adenomunda Tc-99m MIBI retansiyonu ile intakt parathormon düzeyleri arasındaki ilişki

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The relationship between Tc-99m MIBI retention and intact parathyroid hormone levels in parathyroid adenoma
Journal Name: 
2007
Volume: 
49
Number: 
1
Sayfa Aralığı:: 
36-39
Publication Language: 
Turkish
Abstract (Original Language): 
Hiperparatiroidizmde Tc-99m MIBI paratiroid sintigrafisi ve intakt parathormon (iPTH) düzeyi ölçümü, önemli tanısal yöntemlerdir. Bu çalışmanın amacı paratiroid adenomunda Tc-99m MIBI retansiyonu ile iPTH düzeyleri arasındaki ilişkiyi değerlendirmektir. Tc-99m MIBI paratiroid sintigrafisinde paratiroid adenomu ile uyumlu bulgu saptanan ve operasyon ile sonucu doğrulanan 30 hasta (21 kadın, 9 erkek; ortalama yaş: 52.47 yıl, yaş aralığı: 27-80) çalışmaya dahil edildi. Tc-99m MIBI'nin intravenöz enjeksiyonundan sonra 10. ve 120. dakikalarda anteriyor boyun görüntülemesi yapıldı. Paratiroid adenomu ve normal tiroid dokusundan ilgi alanları çizildikten sonra erken (E) ve geç (G) paratiroid/tiroid oranları hesaplandı. Retansiyon indeksi hesaplamasında (G-E)X100/E formülü kullanıldı. Hastaların iPTH düzeyleri 9- 1705 pmol/L arasında (ortanca değeri: 30.5 pmol/L) idi. Retansiyon indeksi değerleri 4-158 arasında değişmekte olup, ortanca değeri 14.5 olarak hesaplandı. Retansiyon indeksi ile iPTH düzeyi arasında istatistiksel olarak anlamlı ilişki saptandı (p=0.0001). Sonuç olarak serum iPTH düzeyi yüksek olan olguların paratiroid adenomlarının sintigrafik görüntülenmesinin daha iyi olduğu görülmektedir. iPTH düzeyinin düşük olduğu durumda MIBI retansiyonunun azalmasına bağlı olarak adenomun saptanabilirliği güçleşmektedir.
Abstract (2. Language): 
Tc-99m MIBI parathyroid scintigraphy and intact parathyroid hormone (iPTH) assay are important diagnostic tests for hyperparathyroidism. The aim of the current study was to assess the relationship between Tc-99m MIBI retention and iPTH levels in parathyroid adenoma. Thirty patients (21 female, 9 male, aged 52.47 years, range 27 to 80) who had findings on parathyroid scintigraphy compatible with parathyroid adenoma and were confirmed to have the same diagnosis after surgery were included in the study. Anterior neck imaging was performed at the 10th and 120th minutes after the intravenous administration of Tc-99m MIBI. Regions of interest were generated from the tissues of parathyroid adenoma and normal thyroid tissue, and the early (E) and late (L) parathyroid/thyroid ratios were calculated. Retention index was calculated using the formula of (LE)X100/E. The iPTH levels of the patients were between 9 to 1705 pmol/L (median: 30.5 pmol/L). The retention indexes ranged between 4 to 158 (median: 14.5). There was a significant correlation between the retention index and iPTH level (p=0.0001). As a conclusion scintigraphic visualization of parathyroid adenomas in patients with high levels of serum iPTH is better. In cases with low iPTH levels, detection of the adenoma is difficult due to decreased MIBI retention.
References: 

1. Taillefer R, Boucher Y, Potvin C,
Lambert R. Detection and localization
of parathyroid adenomas in patients
with hyperparathyroidism using a single radionuclide imaging procedure
with technetium-99m-sestamibi (double-phase study). J Nucl Med 1992;
33: 1801-1807.
2. Marx SJ. Hyperparathyroid and
hypoparathyroid disorders. N Engl J
Med 2000; 21: 1863-1875.
3. Mischis-Troussard C, Goudet P,
Verges B, Cougard P, Tavernier C,
Maillefert JF. Primary hyperparathyroidism with normal serum intact
parathyroid hormone levels. Q J Med
2000; 93: 365-367.
4. Takebayashi S, Hidai H, Chiba T,
Takagi Y, Nagatani Y, Matsubara S.
Hyperfunctional parathyroid glands
with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings. J Nucl Med 1999; 40:
1792-1797.
5. Melloul M, Paz A, Koren R, Cytron S,
Feinmesser R, Gal R. 99mTc-MIBI
scintigraphy of parathyroid adenomas
and its relation to tumour size and
oxyphil cell abundance. Eur J Nucl
Med 2001; 28: 209-213.
6. Tanaka Y, Funahashi H, Imai T, Seo H,
Tominaga Y, Takagi H. Oxyphil cell
function in secondary parathyroidhyperplasia. Nephron 1996; 73: 580-586.
7. Taillefer R. Tc-99m sestamibi parathyroid scintigraphy. In: Freeman L
(ed). Nuclear Medicine Annual. New
York: Raven Pres, 1995; 51-79.
8. Pons F, Torregrosa JV, Fuster D.
Biological factors influencing parathyroid localization. Nucl Med Commun
2003; 24: 121-124.
9. McBiles M, Lambert AT, Cote MG,
Kim SY. Sestamibi parathyroid imaging. Semin Nucl Med 1995; 25: 221-
234.
10.Light VL, McHenry CR, Jarjura D,
Sodee DB, Miron SD. Prospective
evaluation of dual-phase technetium-
99m-sestamibi scintigraphy and high
resolution ultrasonography in the evaluation of abnormal parathyroid glands.
Am Surg 1996; 62: 567-568.
11.Krausz Y, Shiloni E, Bocher M,
Agranovicz S, Manos B, Chisin R.
Diagnostic dilemmas in parathyroid
scintigraphy. Clin Nucl Med 2001; 26:
997-1001.
12.McHenry CR, Lee K, Saadey J, Neumann DR, Esselstyn CB. Parathyroid
localization with technetium-99msestamibi: a prospective evaluation. J
Am Coll Surg 1996; 183: 25-30.
13.Lee VS, Wilkinson RH, Leight GS,
Coogan AC, Coleman RE. Hyperparathyroidism in high-risk surgical
patients: evaluation with double-phase
technetium-99m sestamibi imaging.
Radiology 1995; 197: 627-633.
14.Caixas A, Berna L, Hernandez A, et al.
Efficacy of preoperative diagnostic
imaging localization of technetium
99m-sestamibi scintigraphy in hyperparathyroidism. Surgery 1997; 121:
535-541.
15.Piwnica-Worms D, Holman BL.
Noncardiac applications of hexakis-
(alkylisonitrile) technetium-99m complexes. J Nucl Med 1990; 31: 1166-
1167.
16.Chapuis Y, Fulla Y, Bonnichon P, et al.
Values of ultrasonography, sestamibi
scintigraphy and intraoperative measurement of I-84 PTH for unilateral
neck exploration of primary hyperparathyroidism. World J Surg 1996;
20: 835-839.
17.Sandrock D, Merino MJ, Norton JA,
Neumann RD. Ultrastructural histology correlates with results of thallium-
201/technetium-99m parathyroid subtraction scintigraphy. J Nucl Med
1993; 34: 24-29.
18.Arbab AS, Koizumi K, Toyama K, Arai
T, Araki T. Ion transport systems in
the uptake of 99Tcm-tetrofosmin,
99Tcm-MIBI and 201T1 in a tumour
cell line. Nucl Med Commun 1997;
18: 235-240.
19.O'Doherty MJ, Kettle AG, Wells P,
Collins RE, Coakley AJ. Parathyroid
imaging with technetium-99m-sestamibi: preoperative localization and
tissue uptake studies. J Nucl Med
1992; 33: 313-318.
20.Fuster D, Ybarra J, Torregrosa JV, et
al. Double-phase parathyroid 99mTcsestamibi scintigraphy in chronic
haemodialysis patients: correlation
with biochemical markers of parathyroid function. Nucl Med Commun
2002; 24: 85-90.
21.Piga M, Bolasco P, Satta L, et al.
Double phase parathyroid technetium-99m-MIBI scintigraphy to
identify functional autonomy in secondary hyperparathyroidism. J Nucl
Med 1996; 37: 565-569.
22.Ambrosoni P, Heuguerot C, Olaizola
I, et al. Can we use 99mTc-MIBI in
functional studies of the parathyroid
gland? Nephrol Dial Transplant 1998;
3: 33-36.
23.Hung GU, Wang SJ, Lin WY. Tc-99m
MIBI parathyroid scintigraphy and
intact parathyroid hormone levels in
hyperparathyroidism. Clin Nucl Med
2003; 28: 180-185.
24.Biertho LD, Kim C, Wu HS, Unger P,
Inabnet WB. Relationship between
sestamibi uptake, parathyroid hormone assay, and nuclear morphology
in primary hyperparathyroidism. J Am
Coll Surg 2004; 199: 229-233.

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