alexa Correlation between serum calcium levels and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy in primary hyperparathyroidism.


Journal of Surgery

Author(s): Mshelia DS, Hatutale AN, Mokgoro NP, Nchabaleng ME, Buscombe JR,

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Abstract AIM: The goal of the study is to correlate serum calcium levels with the results of dual-phase (99m)Tc-sestamibi parathyroid scintigraphy to find the best cut-off level of the serum calcium that correlates with a positive presurgery. METHODS: In 111 patients, serum calcium and plasma parathormone (PTH) levels were compared with the results of the (99m)Tc-MIBI scintigraphy and with this data determined the level of calcium above which the (99m)Tc-MIBI scintigraphy was likely to be positive and below which the study was likely to be negative. RESULTS: In total, 11 men (18\%) and 50 women (82\%) had a positive (99m)Tc-MIBI study. Overall 67\% of those patients with a positive (99m)Tc-MIBI study had a PTH >200 ng l(-1) compared to only 9\% of those with a negative (99m)Tc-MIBI scintigraphy; however, for those with a positive study on an early (99m)Tc-MIBI scintigraphy, this rose to 85\%. Overall a serum calcium of >2·70 mmol l(-1) was found in 82\% of patients with a positive (99m)Tc-MIBI study but only 14\% of those with a negative (99m)Tc-MIBI study, this is rose to 97\% of patients with a parathyroid adenoma identified on early images. It is also shown that patients whose serum total calcium <2·51 mmol l(-1) rarely have positive (99m)Tc-MIBI scintigraphy. CONCLUSION: (99m)Tc-MIBI parathyroid scintigraphy is most likely to yield identification and localization of a parathyroid adenoma when both PTH and calcium are elevated; however, although there is no lower limit of PTH which can predict a negative study, we cannot recommend (99m)Tc-MIBI parathyroid scintigraphy if the serum calcium is <2·51 mmol l(-1). © 2011 The Authors. Clinical Physiology and Functional Imaging © 2011 Scandinavian Society of Clinical Physiology and Nuclear Medicine. This article was published in Clin Physiol Funct Imaging and referenced in Journal of Surgery

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