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Quantitative analysis in Parathyroid scintigraphy: [99mTc]Tc-MIBI SPECT/CT a tool for noninvasive characterization of parathyroid lesions

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Abstract

Objective

This prospective, small sample study aims at exploring the potential of quantitative SUV analysis of dual-phase [99mTc]Tc-MIBI SPECT/CT for preoperative localization and differentiation of hyper-functioning parathyroid lesions (PL).

Materials and methods

40 hyperparathyroid patients (M: F; 12:28, Mean Age ± SD, 40.92 ± 13.48 years) underwent SPECT/CT scintigraphy with neck and mediastinum in field of view at early (90 min) and delayed (180 min) post injection (p.i.) of [99mTc] Tc-MIBI. Images were analyzed for PL localization. Maximum and mean SUV (SUVmax; SUVmean) at 90 and 180 min p.i. for PL as well as reference thyroid tissue were measured. PL classified as adenomas, carcinoma and hyperplasia on the basis of SUV were correlated with post-surgical histopathology. Statistical analysis with paired t-test was used to measure the significance of the difference in SUV values of adenoma and hyperplasia with reference thyroid tissue.

Results

SPECT/CT identified PL in 25 out of 40 patients. Using SUVmax and SUVmean, PL were labeled as hyperplasia (02), adenomas (22), and carcinoma (01). Both SUV values showed a decline at 180 min p.i. as compared to 90 min p.i., but SUVmax was considered better for lesion characterization. SUVmax (g/mL) of carcinoma, adenomas, hyperplasia, and reference thyroid tissue were 16.656, 6.933 ± 2.037, 2.788 ± 0.279, and 1.117 ± 0.221 at 90 min p.i. Significant difference (P < 0.0001) of SUVmax between adenomas and reference thyroid tissue but no significant difference (P = 1.000) between hyperplasia and reference thyroid tissue at both time points was found. SUVmax at 90 min p.i. for carcinoma (16.656 g/ml) was also found higher than adenoma and hyperplasia. Parathyroid adenomas and carcinoma were confirmed on post-surgical histopathology of lesions in respective patients however two patients with hyperplasia could not undergo surgery.

Conclusion

SUVmax at 90 min p.i. of [99mTc]Tc-MIBI SPECT/CT was found to be a good quantitative parameter for PL localization and their noninvasive image-based classification.

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Acknowledgements

Authors acknowledge the contributions of technologists and radiochemist at the Department of Nuclear Medicine, AECH-NORI for their kind support in the execution and completion of the research study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Sidra Bashir, Shazia Fatima, Ayesha Ammar and Ambreen Khawar have contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Sciences, Pakistan Institute of Engineering and Applied Sciences, P.O. Nilore, Islamabad, Pakistan

    Sidra Bashir & Ambreen Khawar

  2. Atomic Energy Cancer Hospital, Nuclear Medicine Oncology and Radiotherapy Institute (AECHNORI), Islamabad, Pakistan

    Shazia Fatima & Ayesha Ammar

Authors
  1. Sidra Bashir
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  2. Shazia Fatima
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Contributions

Sidra Bashir, Shazia Fatima and Ambreen Khawar contributed in the design and execution of the study; All the authors contributed equally in drafting or revising of the manuscript critically for important intellectual content as well as final manuscript approval for submission and publication.

Corresponding author

Correspondence to Ambreen Khawar.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures were followed in accordance with the ethical standards of the institutional review board; Research Training and Monitoring Cell (RTMC) of NORI, in January 2022 and therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and all subsequent revisions.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for the publication of the images in Figs. 1, 2, 3, 4 and 5.

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Bashir, S., Fatima, S., Ammar, A. et al. Quantitative analysis in Parathyroid scintigraphy: [99mTc]Tc-MIBI SPECT/CT a tool for noninvasive characterization of parathyroid lesions. Clin Transl Imaging 12, 81–89 (2024). https://doi.org/10.1007/s40336-023-00590-4

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