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Functional evaluation of parathyroid adenoma using 99mTc-MIBI parathyroid SPECT/CT: correlation with functional markers and disease severity

Im, Hyung-Juna,c; Lee, In Kia; Paeng, Jin Chula; Lee, Kyu Eunb; Cheon, Gi Jeonga; Kang, Keon Wooka; Chung, June-Keya; Lee, Dong Sooa,c

Nuclear Medicine Communications: June 2014 - Volume 35 - Issue 6 - p 649–654
doi: 10.1097/MNM.0000000000000102
Original Articles

Objectives In parathyroid adenoma, uptake of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) has been suggested to have a correlation with functional markers. The purpose of this study was to evaluate the feasibility of 99mTc-MIBI parathyroid single photon emission computed tomography/computed tomography (SPECT/CT) in evaluating the function and disease severity of parathyroid adenoma.

Patients and methods Twenty-three patients with surgically confirmed parathyroid adenoma were retrospectively enrolled. A parathyroid planar scan and SPECT/CT were performed before parathyroidectomy. Functional and clinical makers reflecting the disease severity of parathyroid adenoma were also evaluated, including serum intact parathyroid hormone, calcium, bone mineral density, and creatinine clearance. The pathologic volume (V P) of the adenoma was measured after parathyroidectomy. On parathyroid SPECT/CT, metabolic volume (V M) was measured using an isocontour method. Maximum uptakes of parathyroid adenoma and mean uptakes of contralateral thyroid tissue were measured to calculate the parathyroid adenoma-to-background ratio on parathyroid SPECT/CT (PBRSCT) and planar scan (PBRPL).

Results V M significantly correlated with V P (r=0.669, P=0.0005). Serum intact parathyroid hormone level significantly correlated with PBRPL, PBRSCT, V M, and V P (P=0.0004, 0.005, 0.003, and 0.025, respectively). However, serum calcium level correlated only with V M (P=0.012). Regarding the surgical indication criteria, PBRSCT and PBRPL were significantly higher in the young-aged group (P=0.0004 and 0.024, respectively) and V M was significantly higher in the high calcium level group (P=0.049), whereas V P was not different between groups on the basis of any criteria.

Conclusion Quantitative indices of parathyroid SPECT/CT closely correlate with laboratory functional markers and disease severity of parathyroid adenoma. Thus, parathyroid SPECT/CT could be used for evaluation of the underlying functional state and disease severity of parathyroid adenoma, particularly for decision pertaining to surgical treatment.

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Departments of aNuclear Medicine

bSurgery, Seoul National University Hospital

cDepartment of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine or College of Pharmacy, Seoul National University, Seoul, Korea

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Data were presented previously at 2013 SNMMI Annual Meeting and published as an abstract in J Nucl Med 2013; 54 (Suppl 2):146.

Correspondence to Jin Chul Paeng, MD, PhD, Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel: +82 2 2072 3341; fax: +82 2 745 7690; e-mail:

Received February 6, 2014

Accepted February 10, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins