1. Dobutamine Modulated Tc-99m MIBI Scintigraphy in Secondary Hyperparathyroidism in Uremic Patients
- Author
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Juan Pablo Gambini, Juan Hermida, Patricia Guissoli, Omar Alonso, Adriana Quagliata, and Juan J. López
- Subjects
Adult ,Male ,Technetium Tc 99m Sestamibi ,Thorax ,Tc-99m MIBI ,Scintigraphy ,Sensitivity and Specificity ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Radionuclide Imaging ,Aged ,Uremia ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Tracer uptake ,Chronic renal failure ,Female ,Hyperparathyroidism, Secondary ,Secondary hyperparathyroidism ,Dobutamine ,Radiopharmaceuticals ,business ,Nuclear medicine ,medicine.drug - Abstract
The aim of this study was to determine if low-dose dobutamine infusion can enhance Tc-99m methoxy isobutyl isonitrile (MIBI) uptake of hyperfunctioning parathyroid glands of patients with secondary hyperparathyroidism (SHP). We studied 24 patients with chronic renal failure and SHP. Median age of the sample was 47.5 years. A single-tracer, double-phase technique was performed, acquiring planar images of the neck and thorax after the injection of 740 to 1110 MBq (20-30 mCi) of Tc-99m MIBI. After 2 to 7 days, the study was repeated after the infusion of low-dose dobutamine of 2.0 microg . kg . min for 60 minutes. The scan was considered positive for hyperfunctioning parathyroid tissue when an area of increased uptake that persisted on late imaging was found. Parathyroid-to-thyroid count rates (PT/T) were calculated for each abnormal focus. Hyperplasic parathyroid tissue was confirmed in 12 of 24 patients who underwent neck surgery whereas the remaining group had persistent or worsening disease, verified by clinical follow-up between 6 and 25 months after the nuclear studies (median: 12 months). An MIBI baseline study was positive in 21 of 24 patients (87%), whereas the dobutamine study was positive in all patients. Thirty-five abnormal foci were seen on baseline MIBI studies and 43 on dobutamine scans (1.46 +/- 1.02 vs. 1.79 +/- 0.88, mean +/- SD, respectively, P = 0.043). Dobutamine PT/T ratios were significantly higher than those from the baseline study (1.49 +/- 0.30 vs. 1.38 +/- 0.28, mean +/- SD, respectively, P = 0.0002, n = 43). We concluded that low-dose dobutamine Tc-99m MIBI scintigraphy has the potential of enhancing tracer uptake and retention in patients with SHP.
- Published
- 2007