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Quantitative and comparative assessment of Tc-99 m MIBI imaging in parathyroid adenomas: associations with
Semra Demirtas Senlik1, Derya Cayir2, Aysenur Erdem Karaoglu2
1Department of Nuclear Medicine, University of Health Sciences Türkiye, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye, Turkey. demirtasemra13@gmail.com.
Purpose:
To investigate the relationships between Tc-99 m methoxyisobutylisonitrile (MIBI) SPECT/CT-derived SUVmax values and adenoma volume, histopathological characteristics, and biochemical parameters in patients with primary hyperparathyroidism (PHPT), and to compare the localization performance of ultrasonography (USG), planar scintigraphy, pinhole imaging, and SPECT/CT.
Methods:
Sixty patients with histopathologically confirmed solitary parathyroid adenomas who underwent preoperative Tc-99 m MIBI scintigraphy and subsequent surgery were retrospectively included. SUVmax values were obtained from quantitative SPECT/CT images using manually defined volumetric regions of interest. Associations between SUVmax and continuous clinicopathological variables were evaluated using Spearman correlation analysis, while comparisons among predominant cell-type groups were performed using the Kruskal-Wallis test. Detection rates of the imaging modalities were compared using Cochran's Q test.
Results:
SUVmax demonstrated significant positive correlations with adenoma volume (ρ = 0.523, p < 0.001), lesion diameter (ρ = 0.459, p < 0.001), and serum parathyroid hormone levels (ρ = 0.360, p = 0.005). Adenoma volume was also positively correlated with serum PTH (ρ = 0.356, p = 0.005) and calcium levels (ρ = 0.407, p = 0.001). Median SUVmax was numerically highest in oxyphil-predominant adenomas; however, the difference among cellular subtypes was not statistically significant (p = 0.441). When positive and suspicious findings were considered together, lesion detection rates were 88.3% for USG, 96.7% for planar scintigraphy, 95.0% for pinhole imaging, and 98.3% for SPECT/CT, without a statistically significant difference among modalities (Cochran's Q = 7.545, p = 0.056). All lesions that were negative on USG were localized by planar and pinhole imaging, while SPECT/CT identified six of seven such lesions.
Conclusion:
Tc-99 m MIBI SPECT/CT-derived SUVmax was significantly associated with adenoma volume in patients with PHPT. Oxyphil-predominant adenomas showed numerically higher SUVmax values, although differences among cellular subtypes were not statistically significant. Scintigraphic techniques provided complementary localization information in lesions not identified by ultrasonography. The clinical utility of quantitative SPECT/CT and its potential relationships with histopathological characteristics require further validation in larger prospective studies.
