The role of 99mTc-MIBI SPECT/low dose CT with 3D subtraction in patients with secondary hyperparathyroidism due to chronic kidney disease.

OBJECTIVE

The aim of the present work was to assess the incidence of parathyroid glands hyperplasia or adenoma in patients with various stages of chronic renal insufficiency using 99mTc-methoxyisobutylisonitrile (MIBI) SPECT and 3D subtraction technique with 99mTc-pertechnetate (Tc).

SUBJECTS AND

METHODS

Sixty one patients underwent hybrid SPECT with low-dose CT of the parathyroid glands and thyroid SPECT scintigraphy. Thirty six patients were with chronic kidney disease (CKD) without renal failure (RF) and 25 patients underwent peritoneal dialysis or hemodialysis. In each patient, two SPECT studies were performed - an early and a late one with low dose of CT with MIBI injection. Additional SPECT was performed on another day with Tc. SPECT studies were evaluated visually using volume rendering method and semi-quantitatively by 3D subtraction of Tc SPECT from early MIBI SPECT.

RESULTS

From all 61 patients, 40/61 (66%) findings were positive, 7/61 (12%) inconclusive, and 14/61 (23%) negative. Solitary lesions were detected in 22 patients. More than one lesion was found in 18 patients.

CONCLUSION

The incidence of secondary hyperparathyroidism was detected in 40/61 patients (66%) with chronic kidney disease using scintigraphy and 16 patients (40%) from them underwent surgery. MIBI SPECT/low dose CT with 3D dual - tracer subtraction (MIBI-Tc) method is an effective tool for preoperative detection of the parathyroid glands hyperplasia or adenoma.