Baskaran, Nimala (2022) Quantitative Evaluation Of 99mтс Міві Parathyroid Spect-ct: In Correlation With Disease Severity And Outcome In Primary Hyperparathyroidism. Masters thesis, Universiti Sains Malaysia.
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Abstract
Introduction: Primary hyperparathyroidism is the third most common endocrine disorder, caused by the autonomous hypersecretion of parathyroid hormone by abnormal parathyroid gland(s), most often due to presence of parathyroid adenoma. Parathyroid scintigraphy has been proven as the most effective imaging modality for preoperative localization of parathyroid adenomas prior to minimally invasive parathyroidectomy. However, the maximum potential of quantitative analysis of 99mTc MIBI Parathyroid SPECT-CT has yet to be fully established. Objective: To employ the use of quantitative indices in parathyroid scintigraphy to add objectivity and reliability to qualitative interpretation in the diagnostic application of parathyroid scintigraphy. Subjects and Methods: Records of 11 patients with primary hyperparathyroidism, positive parathyroid scintigraphy findings and histopathologically confirmed parathyroid lesion after undergoing parathyroid SPECT-CT were retrospectively retrieved from the PACS image database of UMMC. Our institutional standard protocols were followed when performing planar and SPECT-CT with 99mTc MIBI. Disease severity markers such as serum calcium, parathyroid hormone (PTH) and serum creatinine were obtained from online/written medical records. An isocontour approach was used to measure metabolic volume (VM) SPECT-СТ. adenoma and on parathyroid Maximum uptake of parathyroid mean uptake of contralateral thyroid tissue were measured to calculate the parathyroid adenoma-to-background ratio on parathyroid SPECT-CТ (PBRSCT) and planar scan (PBRPL). Patients who had parathyroidectomy had their pathological volume (Vp) of the adenoma quantified. Surrogate outcome of disease severity markers, up to 6 months from the time of surgery was evaluated. Results: PBRPL correlates significantly with serum PTH (rho = 0.697; p = 0.017). For metabolic volume, Vm, there was a significant strong correlation with serum PTH (rho = 0.838; p = 0.001) and a significant moderate correlation with serum calcium (rho = 0.687; p = 0.020). For pathological volume, Vp, there was a significant moderate correlation with serum calcium (rho = 0.732; p = 0.010). PBRPL shows a strong significant correlation with PBRSCT (rho = 0.909; p < 0.001). All the quantitative indices tested showed excellent interobserver agreement and reliability. Regarding the factors affecting quantitative indices in relation to patient demographics, comorbidities and use of calcium lowering agents, only gender was found to affect PBRSCT (p = 0.042). In terms of surrogate outcome, pre- and postsurgery disease severity marker was significantly different for serum calcium (p = 0.001) and serum PTH (p = 0.003). Conclusion: Quantitative indices of parathyroid SPECT-CT significantly correlate with serum calcium and serum PTH. There is excellent interobserver agreement between all quantitative indices tested. The valuable significant difference of PBRSCT between genders also potentiates the vision of exploring the epigenetics of gender associated differences in the assessment of quantitative indices in 99mTc MIBI parathyroid scintigraphy, particularly pertaining to the pathogenesis of sporadic parathyroid adenomas. Hence, this shows that parathyroid SPECT-CT can be utilized to increase objectivity and reliability in evaluating disease severity of primary hyperparathyroidism.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine |
| Divisions: | Institut Perubatan & Pergigian Termaju (Advanced Medical & Dental Institute (AMDI)) > Thesis |
| Depositing User: | NOR HASHIMY BIN ABDULLAH |
| Date Deposited: | 16 Apr 2026 04:45 |
| Last Modified: | 16 Apr 2026 04:45 |
| URI: | http://eprints.usm.my/id/eprint/63927 |
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