Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism.
OBJECTIVE
To compare the sensitivity and positive predictive value of magnetic resonance (MR) imaging and technetium 99m 2-methoxyisobutyl-isonitrile (MIBI) scintigraphy for the detection of hyperfunctioning parathyroid tissue when used alone and in combination in a large patient population with recurrent or persistent hyperparathyroidism (HPT).


METHODS
In 98 consecutive patients with biochemically proved recurrent or persistent HPT after surgery, MR imaging and 99mTc MIBI study findings were retrospectively reviewed and compared with surgical and histopathologic findings. The sensitivity and positive predictive value of MR imaging and 99mTc MIBI scintigraphy were compared with each other and in combination.


RESULTS
In these patients, 130 abnormal parathyroid glands were identified at surgery. The sensitivity and positive predictive value of MR imaging were 82% (95% CI: 75%, 89%) and 89%, respectively; those for (99m)Tc MIBI scintigraphy were 85% (95% CI: 79%, 91%) and 89%. No significant difference was found between MR imaging and 99mTc MIBI scintigraphy for sensitivity (P =.7). The sensitivity and positive predictive value for the detection of abnormal parathyroid tissue on a per-gland basis increased to 94% (95% CI: 90%, 98%) and 98%, respectively, when only one of the two tests was required to be positive.


CONCLUSIONS
MR imaging and 99mTc MIBI scintigraphy have similarly good sensitivity and positive predictive value for the detection of hyperfunctioning parathyroid tissue in patients after surgery. The combination of the two tests provided a substantial increase in sensitivity and positive predictive value.
Thoracic Imaging Section, Department of Radiology, University of California, San Francisco General Hospital, 1001 Potrero Ave, Rm 1X 55A, Box 1325, San Francisco, CA 94110, USA. michael.gotway@radiology.ucsf.edu
M B
MB
Gotway
G P
GP
Reddy
W R
WR
Webb
E T
ET
Morita
O H
OH
Clark
C B
CB
Higgins
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012008:Recurrence; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi