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| UDK 616.447-008.61-073.9 |
ISSN 035-2899, 39(2014) br.4 p.198-204 |
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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 |
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| 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 |
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Corresponding Address: Sanja Dugonjić Institut za nuklearnu medicinu, Vojnomedicinska akademija, Crnotravska 17, 11 000 Beograd, Srbija; E-mail: sanja.dugonjic14@gmail.com |
Paper received: 24.8.2014 Paper accepted: 30.8.2014 Paper Internet issues: 17.11.2014 |
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