Parathyroid dual tracer subtraction scintigraphy: small regions method for quantitative assessment of parathyroid adenom
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ORIGINAL ARTICLE
Parathyroid dual tracer subtraction scintigraphy: small regions method for quantitative assessment of parathyroid adenoma uptake Ana Koljevic´ Markovic´ • Milica M. Jankovic´ • Ivan Markovic´ • Gordana Pupic´ • Radan Dzˇodic´ Angelika Bischof Delaloye
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Received: 1 April 2014 / Accepted: 29 May 2014 The Japanese Society of Nuclear Medicine 2014
Abstract Objective The aim was quantitative assessment of parathyroid adenoma (PTA) uptake in dual tracer dynamic scintigraphy. Methods In 78 patients, median age 58 (19–80) years, surgically treated for primary hyperparathyroidism (PHPT), with parathyroid hormone median 125 (70–658) pg/ml, we performed preoperative parathyroid scintigraphy, following EANM guidelines of subtraction and double-phase protocol (2009) using two tracers: Tc99m pertechnetate and Tc-99m MIBI. In addition to standard subtraction processing and visual interpretation of delayed MIBI planar images of neck and mediastinum in
A. Koljevic´ Markovic´ (&) Department of Nuclear Medicine, National Cancer Research Center of Serbia, Pasterova 14, 11000 Belgrade, Serbia e-mail: [email protected] M. M. Jankovic´ Department of Signals and Systems, University of Belgrade - Faculty of Electrical Engineering, Bulevar kralja Aleksandra 73, 11000 Belgrade, Serbia I. Markovic´ R. Dzˇodic´ Department of Surgery, National Cancer Research Center of Serbia, Pasterova 14, 11000 Belgrade, Serbia I. Markovic´ R. Dzˇodic´ Department of Surgery, Faculty of Medicine, University of Belgrade, Pasterova 14, 11000 Belgrade, Serbia G. Pupic´ Department of Pathology, National Cancer Research Center of Serbia, Belgrade, Serbia A. B. Delaloye Faculty of Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
oblique sections (positions according to ultrasound PTA localisation), we developed Submarine processing software that enables selecting custom regions grid sizes C6 mm (as this solution was not present in commercial software) to follow time activity curve changes in thyroid tissue and PTA. Histopathology in 53/78 patients revealed PHPT and in 25/78 patients thyroid nodular disease only, and thyroid malignancy occurred in total of 15/78 (19 %) patients. PHPT group included 44 solitary PTA, 8 patients with hyperplasia and one parathyroid carcinoma. The median macroscopic volume of PTA was 717.5 (15–6125) mm3. Concomitant PHPT and thyroid nodular disease occurred in 24/53 patients and among them 8 patients had thyroid malignancies. Results PTA showed typical pattern of late peak on time activity curves characterized by median start time on 15 (10–25) min, the peak amplitude mean 19 (±5) % above thyroid declining washout curve, and duration of peak 6 (4–10) min, allowing PTA to ‘‘emerge’’ like submarine, independent from thyroid tissue and lesions. The ratio of PTA-to-normal thyroid uptake at peak maximum was 1.35 (±0.21). The thyroid TACs results of normal 29/78 (37 %) patients, benign nodular 34/78 (44 %) patients, and malignancy in 15 (19 %) patients were all presented by declining
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