Performances de la scintigraphie parathyroïdienne au 99mTc-Sestamibi dans l’hyperparathyroïdie secondaire (à propos de 20 cas)

Aim of the studyTo evaluate the performance of the ^99mTc-Sestamibi parathyroid scintigraphy and to compare it with the performance of cervical ultrasonography in patients with secondary hyperparathyroidism who are candidates for parathyroidectomy.Patients and methodsWe performed a retrospective study including 20 patients with severe secondary hyperparathyroidism who underwent parathyroid scintigraphy in the nuclear medicine department of Sfax, during the period between January 2009 and June 2012. Our two days protocol included dual-phase, MIBI/Tc subtraction and single photon emission photons (SPECT) techniques. We analyzed the results obtained from each technique alone, then from combinations thereof. For all patients, we have collected the surgical and histopathological data as well cervical ultrasound if available.ResultsThe subtraction technique was the best performing with a sensitivity of 47% and an accuracy of 55%. The combination of subtraction scintigraphy and SPECT has improved the sensitivity to 53%and accuracy to 57%. The combined lecture of ultrasound and scintigraphy has given the best performance with a sensitivity of 58%, a specificity of 83% and an accuracy of 66%.ConclusionParathyroid scintigraphy combining subtraction and SPECT showed better reliability. The coupling with ultrasound is essential to improve results. The poor performance of scintigraphy in secondary hyperparathyroidism implies that it should be required only to search for ectopic or supernumerary glands.