Journal of Regional Section of Serbian Medical Association in Zajecar

Year 2014     Vol 39     No 4
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      UDK 616.447-008.61-073.9

ISSN 035-2899, 39(2014) br.4 p.198-204

Original paper

Subtraction parathyroid scintigraphy with 99mtc - liposolubile radiopharmaceuticals in primary and secondary hyperplasia of parathyroid glands – correlation with weight and histopathological findings
(Nalaz suptrakcione paratireoidne scintigrafije 99mtc- liposolubilnim radiofarmacima kod primarne i sekundarne hiperplazije paratireoidnih žlezda – korelacija sa veličinom i histopatološkim nalazom)

Sanja Dugonjić
Institut za nuklearnu medicinu, Vojnomedicinska akademija, Beograd


  Download in pdf format   Extended summary: Background. Parathyroid hyperplasia (PHP) is defined as an absolute increase in mass of parenchymal cells of the parathyroid gland (PG). PHP is classified as primary, secondary and tertiary PHP. The enlargement of parathyroid glands is usually asymmetric, resulting in a “dominant” gland. In order to confirm the diagnosis, at least two glands should be examined histologically. Subtotal parathyroidectomy i.e. removal of the three PG and leaving small remnant of forth, is a treatment of choice. High percentage of PHP recurrence imposes the need for preoperative high sensitivity localizing procedures. Parathyroid scintigraphy localizes about 60% of hyperplastic glands. Aim. The aim of this study was to correlate the findings of subtraction parathyroid scintigraphy (SPS) with 99mTc - liposolubile radiopharmaceuticals (99mTc-MIBI and 99mTc-tetrofosmin), with weight, pathohistologic findings of PG in patients with primary, secondary and tertiary parathyroid hyperplasia. Material and methods: 27 patients with primary/secondary PHP underwent SPS before surgery. Static scintigrams of neck and chest and static scintigram of chest were performed in supine position, 15min and 2h after iv. inj. of 740 MBq or 99mTc-MIBI/99mTc-tetrofosmin. Four hours later (or at need – 24 hours to the latest), thyroid scintigraphy was performed, after iv. inj. of 185 MBq 99mTc. Subtraction (99mTc from 99mTc-MIBI/99mTc-tetrofosmin scintigrams) was done, after normalization and motion correction. Scintigraphic results were graded from 1–5, in relation to the degree of uptake. SPS graded 3, 4 and 5 were considered positive. Number, weight and mass of the removed PG were analyzed macroscopically, while the intraoperative ex tempore analyses was done microscopically on standard hematoxylin-eosin stained slides in order to determine the substrate: adenoma, type of hyperplasia, distribution and substitution of the main, light, OC and degenerative alterations. Results: SPS localized dominant gland in all patients with 100% sensitivity, and 51 of 73 hyperplastic PG, with sensitivity per gland of 70%. PG weighed 0.1g to 6.7g (median 1g). Between SPS results and PG weight, significant positive correlation was found (p<0.0001). Four patients had diffuse PHP and 23 patients had nodular HPH. Between PG weight and hyperplasia type significant positive correlation was found (p< 0.05). Conclusion: Sensitivity of SPS per patient was 100% and per gland it was 70%. High positive correlation was found between: SPS results and PG weight and PG weight and hyperplasia type. Between SPS results and hyperplasia type, insignificant correlation was found.
Keywords: parathyroid adenoma, parathyroid hyperplasia, 99mTc-pertechnetate, 99mTc-tetrofosmin, 99mTc-sestamibi

Napomena: kompletan tekst rada na srpskom jeziku
Note: full text in Serbian
      Corresponding Address:
Sanja Dugonjić
Institut za nuklearnu medicinu, Vojnomedicinska akademija, Crnotravska 17, 11 000 Beograd, Srbija; E-mail: 
Paper received: 24.8.2014
Paper accepted: 30.8.2014
Paper Internet issues: 17.11.2014
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Timočki medicinski glasnik, Zdravstveni centar Zaječar
Journal of Regional section of Serbian medical association in Zajecar
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