title: Diagnostic performance of planar scintigraphy using ⁹⁹mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis.
abstract: OBJECTIVE
  Parathyroid scintigraphy using (99m)Tc-MIBI is not currently considered a valuable diagnostic tool for the localization of involved glands in patients with secondary hyperparathyroidism (SHPT). However, published data about its diagnostic accuracy are discordant and a meta-analysis about this topic is still lacking. The aim of our study is to meta-analyze the published data about the diagnostic performance of (99m)Tc-MIBI parathyroid scintigraphy in patients with SHPT.
  
  
  METHODS
  A comprehensive computer literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through September 2011 and regarding the diagnostic accuracy of (99m)Tc-MIBI parathyroid scintigraphy in patients with SHPT was carried out. Only articles in English language in which at least 10 patients with SHPT underwent planar (99m)Tc-MIBI parathyroid scintigraphy were selected. Pooled sensitivity, pooled specificity and area under the ROC curve on a per lesion-based analysis were calculated to measure the diagnostic accuracy of (99m)Tc-MIBI parathyroid scintigraphy in SHPT patients.
  
  
  RESULTS
  Twenty-four studies comprising 471 patients were included in this meta-analysis. The pooled sensitivity and specificity of (99m)Tc-MIBI parathyroid scintigraphy in detecting hyperplastic glands in SHPT patients were 58 % [95 % confidence interval (95 % CI) 52-65 %] and 93 % (95 % CI 85-100 %), respectively, on a per lesion-based analysis. Area under ROC curve was 0.75.
  
  
  CONCLUSIONS
  In patients with SHPT and diffuse or nodular hyperplasia, planar parathyroid scintigraphy using (99m)Tc-MIBI has demonstrated an inadequate diagnostic accuracy. Therefore, it should not be considered as a first-line diagnostic imaging method in the pre-surgical detection of hyperplastic parathyroid glands.
authors.affiliation: Department of Bioimaging and Radiological Sciences, Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy. carmelocaldarella@yahoo.it
authors.forename: Carmelo
authors.initials: C
authors.lastname: Caldarella
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pontecorvi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
mesh_terms: D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging*; D011786:Quality Control; D011877:Radionuclide Imaging / Q000379:methods*; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi