title: Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism.
abstract: BACKGROUND
  The usefulness of the combination of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) parathyroid scintigraphy and ultrasonography to detect parathyroid glands (PTGs) in secondary hyperparathyroidism (SHPT) is still controversial.
  
  
  METHODS
  In all, 21 patients with SHPT underwent parathyroidectomy. The sensitivity and specificity of ultrasonography and scintigraphy related to site, size, hyperplasia type of PTG, concomitant thyroid disease, and the frequency of intraoperative frozen sections were determined.
  
  
  RESULTS
  The sensitivities of scintigraphy and ultrasonography were 62% and 55%, and the specificity was 95% for both procedures. The sensitivity of combined techniques was 73%. The scintigraphy detected 7/9 (78%) ectopic PTGs, whereas ultrasonography was always negative. A PTG maximum longitudinal diameter <8 mm, the presence of diffuse hyperplasia, the upper localization of glands, and the presence of concomitant thyroid disease reduced the sensitivity and specificity of imaging techniques. In cases of positive imaging, the rate of intraoperative frozen sections was significantly lower.
  
  
  CONCLUSIONS
  The ultrasonography and sestamibi scintigraphy, which showed a higher sensitivity than that of either ultrasonography or scintigraphy alone, led to a reduction of intraoperative frozen sections and to preoperative diagnosis of ectopic (29%) or supernumerary PTGs (10%) and concomitant nodular thyroid disease (24%).
authors.affiliation: Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy. c.vulpio@alice.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Vulpio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.forename: Annamaria
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Giulia
authors.initials: G
authors.lastname: Maresca
authors.forename: Isabella
authors.initials: I
authors.lastname: Bruno
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
authors.forename: Francesca
authors.initials: F
authors.lastname: Morassi
authors.forename: Sabina C
authors.initials: SC
authors.lastname: Magalini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.forename: Marco
authors.initials: M
authors.lastname: Castagneto
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011877:Radionuclide Imaging / Q000379:methods; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D014511:Uremia / Q000150:complications* / Q000628:therapy
chemical_list: D017256:Technetium Tc 99m Sestamibi