Publications (2)10.43 Total impact
-
Article: Role of pre-operative imaging using 99mTc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy.
[show abstract] [hide abstract]
ABSTRACT: The purpose of this study was to assess whether pre-operative (99m)Tc-methoxyisobutylisonitrile (MIBI) scintigraphy and neck ultrasound (US) are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidism. Forty-eight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent "blinded" subtotal parathyroid surgery, with 1-year follow-up to establish cure or relapse of their secondary hyperparathyroidism. Double-phase (99m)Tc-MIBI scintigraphy and neck US were performed pre-operatively in all patients. When the preserved gland showed (99m)Tc-MIBI uptake or an abnormal size on US, it was considered that "(99m)Tc-MIBI advice" and "US advice", respectively, had not been followed. Pre-operative and follow-up parathyroid hormone (PTH) levels were obtained in all patients. All data were evaluated on a patient by patient basis. Four parathyroid glands were identified in each patient at primary surgery, resulting in an operative success rate of 100%. Their weight ranged from 15 to 7,300 mg (mean 1,120+/-900 mg). Nine of the 48 patients (19%) showed a recurrence of their secondary hyperparathyroidism. The recurrence rate was 2% (1/48) and 10% (5/48), respectively, when (99m)Tc-MIBI and US advice was followed. The sensitivity, specificity, NPV and PPV for pre-operative imaging were 72%, 95%, 97% and 80% respectively for (99m)Tc-MIBI, and 55%, 67%, 87% and 28% for US. (99m)Tc-MIBI scintigraphy is a reliable non-invasive exploratory tool and its preoperative use results in a significant reduction in the number of recurrences in haemodialysis patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. The use of neck US did not significantly improve the results obtained with (99m)Tc-MIBI alone.European journal of nuclear medicine and molecular imaging 05/2006; 33(4):467-73. · 4.99 Impact Factor -
Article: Predicting the effect of intravenous calcitriol on parathyroid gland activity using double-phase technetium Tc 99m-sestamibi scintigraphy.
[show abstract] [hide abstract]
ABSTRACT: Although intravenous calcitriol is useful for decreasing intact parathyroid hormone (iPTH) blood levels in patients with secondary hyperparathyroidism (SHP) undergoing hemodialysis, approximately half these patients remain refractory to this treatment. The current study measures the diagnostic utility of double-phase technetium Tc 99m-sestamibi (MIBI) scintigraphy in predicting the response to calcitriol treatment. Sixty hemodialysis patients with SHP with iPTH blood levels between 240 and 600 pg/mL (ng/L) were selected. Initial intravenous calcitriol pulse therapy was 6 microg/wk (for iPTH levels of 400 to 600 pg/mL [ng/L]) or 3 microg/wk (for iPTH levels of 240 to 400 pg/mL [ng/L]). MIBI scintigraphy was performed before the onset of calcitriol therapy and repeated 1 year later. Patients were injected intravenously with 740 MBq of MIBI. Images were obtained at 15 minutes (thyroid phase) and 2 hours (parathyroid phase) after radiotracer administration. Focal areas of increased MIBI uptake were considered pathological parathyroid glands. Forty-eight patients completed the study. After 1 year, iPTH levels had decreased significantly in 95.2% (47 patients), whereas good control (iPTH < 240 pg/mL [ng/L]) was reached in 70.8% (34 patients) and only 4 patients had iPTH levels greater than 400 pg/mL (ng/L; all were patients with 3 MIBI-positive areas at baseline determination). At baseline, there were 30 patients (62.5%) with MIBI positive areas (1, 2, or 3 areas), which decreased to 14 patients (29%) at the end of the study period. No patient showed 4 positive areas at any time. The 18 patients (37.5%) with no MIBI-positive area at baseline remained unchanged. MIBI scintigraphy is a reliable exploratory tool in predicting the response to treatment with intravenous calcitriol in hemodialysis patients with SHP.American Journal of Kidney Diseases 09/2004; 44(3):476-80. · 5.43 Impact Factor
