Authors: David Fuster Juan Ybarra Jaime Ortin JoséVicente Torregrosa Rosa Gilabert Xavier Setoain Pilar Paredes Joan Duch Francesca Pons
Publish Date: 2006/01/11
Volume: 33, Issue: 4, Pages: 467-473
Abstract
The purpose of this study was to assess whether preoperative 99mTcmethoxyisobutylisonitrile MIBI scintigraphy and neck ultrasound US are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidismFortyeight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent “blinded” subtotal parathyroid surgery with 1year followup to establish cure or relapse of their secondary hyperparathyroidism Doublephase 99mTcMIBI scintigraphy and neck US were performed preoperatively in all patients When the preserved gland showed 99mTcMIBI uptake or an abnormal size on US it was considered that “99mTcMIBI advice” and “US advice” respectively had not been followed Preoperative and followup parathyroid hormone PTH levels were obtained in all patients All data were evaluated on a patient by patient basisFour parathyroid glands were identified in each patient at primary surgery resulting in an operative success rate of 100 Their weight ranged from 15 to 7300 mg mean 1120±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 99mTcMIBI and US advice was followed The sensitivity specificity NPV and PPV for preoperative imaging were 72 95 97 and 80 respectively for 99mTcMIBI and 55 67 87 and 28 for US99mTcMIBI scintigraphy is a reliable noninvasive 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 99mTcMIBI alone
Keywords: