Usefulness of 99m Tc-SESTAMIBI Scintigraphy in Persistent Hyperparathyroidism after Kidney Transplant

• Published in: Nuclear medicine and molecular imaging Vol. 55; no. 6; pp. 285 - 292
• Main Authors: Shin, Muheon, Choi, Joon Young, Kim, Sun Wook, Kim, Jung Han, Cho, Young Seok
• Format: Journal Article
• Language: English
• Published: Germany 대한핵의학회 01.12.2021
• Subjects: 방사선과학; Hyperparathyroid; Kidney transplant; Parathyroid; SPECT; Sestamibi
• ISSN: 1869-3474; 1869-3482
• DOI: 10.1007/s13139-021-00722-6

Tc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). The purpose of this study is to investigate the usefulness of Tc-sestamibi scintigraphy in persistent hyperparathyroidism after kidney transplant (KT). Retrospectively evaluated 50 patients who received parathyroidectomy after KT at a single medical center. The parathyroid lesion with the highest sestamibi uptake intensity of a patient was graded from 0 to 3. Uptake intensity was analyzed in correlation with parathyroid hormone (PTH), calcium, ionized calcium, phosphorus, and vitamin D. Per-patient analysis, 43 patients had hyperplasia, 6 patients had adenomas, and 1 patient had a carcinoma. Only 3 patients with hyperplasia did not demonstrate any sestamibi uptake in the parathyroid scans. Out of the 148 pathologically confirmed parathyroid lesions, SPECT/CT images were able to identify 89 lesions (60%) and planar images of 71 lesions (48%). The average of sestamibi uptake intensity was mild at grade 1.6. Uptake intensity showed a positive correlation with parathyroid hormone (PTH) level but not with phosphorus, calcium, ionized calcium, or vitamin D levels. The largest lesion showed a high positive predictive value, especially in lesions with a diameter over 1.0 cm. Regardless of relatively low and less discrete uptake in KT patients, it well depicts the largest and the most hyperfunctioning lesion.