<sup>99m</sup>Tc-MIBI Dual-phase Imaging with Hybrid SPECT/CT for the Diagnosis of Rare Parathyroid Carcinoma — ASN Events
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  3. 99mTc-MIBI Dual-phase Imaging with Hybrid SPECT/CT for the Diagnosis of Rare Parathyroid Carcinoma

99mTc-MIBI Dual-phase Imaging with Hybrid SPECT/CT for the Diagnosis of Rare Parathyroid Carcinoma (#53)

Feng Wang 1 , zejun chen 2 , Rui Luo 1 , Chuan Zhang 1
  1. Nanjing First Hospital,Nanjing Medical university, Nanjing, JIANGSU, China
  2. Department of Nuclear Medicine, , the affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, Jiangsu, China

Abstract

Parathyroid carcinoma (PC) is rare neuroendocrine tumor associated with significant increased parathyroid hormone (PTH) and hyperparathyroidism which is difficult to distinguish from primary parathyroid adenoma.

Purpose: The objective of this retrospective study was to investigate the clinical value of 99mTc- MIBI dual- phase imaging with hybrid SPECT/CT for diagnosis of rare parathyroid carcinoma (PC), the clinical manifestation and biochemical marker were also addressed.

Patients and methods: Four consecutive patients suspected with hyperparathyroidism were enrolled in this study, 99mTc-MIBI dual-phase imaging with hybrid SPECT/CT was performed for validating of parathyroid adenoma (PA), ultrasonography, enhanced CT and MRI was also undertaken for imaging follow-up. The serum PTH was also measured on presurgery and during operation, the serum calcium and alkaline phosphatase (AKP) were also analyzed. Final diagnosis was confirmed by histopathology after surgery.

Results: The primary tumor size was 3.45± 1.03 cm , PTH  was  165.14± 90.26 pmol/L and rapidly decline postsurgery was observed in 3pts, 1pt with persistent high PTH level postsurgery present multiple lymphadenopathy in the neck (PTH,147.5 pmol/L). All four primary lesion and 2 recurrent lesions showed high focal uptake on the 99mTc-MIBI -phase images, whereas lymph nodule metastasis was false negative, which was confirmed by MRI and surgery. The immunohistochemistry and HE staining further confirmed differentiated PA , some biomedical marker consistent with neuroendocrine tumor.

Conclusion: 99mTc-MIBI dual-phase imaging with hybrid SPECT/CT is recommended preoperatively for localization of primary lesion, ultrasonography, CT and MRI is of great importance for the detection of recurrence or lymphadenopathy. If PTH level significantly 10 times higher , tumor size greater than 3.0 cm, it may indicate PC. If PTH had no decline after surgery or  rebound rapidly ,which also indicate recurrence or metastases. Due to small cohort study, large scale multi-center trial is needed.

Key words: parathyroid carcinoma,  PTH,  SPECT/CT, 99mTc-MIBI.