Primary hyperparathyroidism caused by enormous unilateral water-clear cell parathyroid hyperplasia.

BACKGROUND: Parathyroid water-clear cell hyperplasia (WCCH) and water-clear cell adenoma (WCCA) are rare causes of primary hyperparathyroidism. The frequency of WCCH seems to be less than 1% of all primary hyperplasia. CASE PRESENTATION: We report a 53-year-old woman with a large unilateral water clear cell parathyroid hyperplasia associated with primary hyperparathyroidism and severe osteoporosis. Ultrasonography showed a 5.4 cm multilobulated hypoechoic well defined mass localized in the lower half of the left thyroid lobe. Technetium sestamibi scanning showed a persistent very large area of increased activity possibly corresponding to a left inferior double parathyroid adenoma. At surgery, two large merged lobulated parathyroid glands were removed from the left superior and inferior aspects of the adjacent thyroid extending to the sub-clavicular area. Histopathology showed polygonal hyperplastic vacuolated cells with abundant water clear cytoplasm. The lesion had lack of capsule or rim of parathyroid tissue and immunohistochemistry was positive for PTH staining. These findings were consistent with diffused water clear cell hyperplasia. After parathyroidectomy, iPTH and calcium levels dropped immediately. CONCLUSION: The clinical presentation of the patients with water clear cells parathyroid content and hyperparathyroidism is indistinguishable from that of the more common causes of primary hyperparathyroidism of adenoma or hyperplasia and the diagnosis is made only on pathological examination. In conclusion, the distinction of water clear cell hyperplasia from water clear cell adenoma can be challenging in many cases, although clinically significant as far as treatment and follow-up.

Clinical usefulness of attenuation and scatter correction in Tl-201 SPECT studies using coronary angiography as a reference.

INTRODUCTION: The aim of this investigation was to evaluate the clinical usefulness of both attenuation and scatter correction in 201Tl SPECT studies. METHODS: We studied 102 patients (76 males, 26 females, mean age 54 years) who underwent coronary angiography prior to or after a scintigraphic examination. A 201Tl one-day protocol was used. Simultaneous transmission-emission images were obtained by a gamma-camera equipped with an attenuation and scatter correction system based on two moving collimated 153Gd rod sources. Stress and delay reconstructed images, uncorrected for attenuation and scatter, were diagnosed. One month later, stress and delay reconstructed images corrected for attenuation and scatter were diagnosed by the same readers. The results were compared using the coronary angiography findings as reference. A stenosis 50% or larger was considered significant. RESULTS: Attenuation and scatter corrected images demonstrated a significant increase in specificity for findings in the right coronary artery territory, i.e. 89% vs. 41% for uncorrected images (p < 0.05), with a non-significant loss in sensitivity from 96% to 89%. When we split the population on a gender basis, statistically significant differences in specificity between corrected and non-corrected images were observed in the left anterior descending territory for the females (100% vs. 42%) and in the right coronary artery territory for males (87% vs. 26%). CONCLUSION: Attenuation and scatter correction in 201Tl SPECT studies may significantly decrease false positive lesions in the inferior wall as well as in the anterior in females.

[Semiquantification of pulmonary and hepatic uptake of technetium-99m-tetrofosmin in myocardial perfusion imaging using multiple regions of interest. Multifactorial correlation].

Various regions of interest (ROI) are used to semiquantify lung-to-heart (LHR) and liver-to-heart uptake ratios (LH) in myocardial perfusion imaging (MPI) with technetium-99m analogues. However, in bibliography, these ratios are correlated to a moderate number of clinicolaboratory indices for coronary artery disease (CAD). The aim of this study was: a) to find the best ROI positioning among one hepatic and multiple pulmonary ROI used to semiquantify technetium-99m tetrofosmin, single photon emission tomography myocardial perfusion scan (99mTc-TF SPET), LHR and LH ratios, b) to compare the diagnostic potential of the better selected ROI in correlation with: SPET scores, rest left verticular ejection fraction, five risk factors (RF) of CAD, (smoking, diabetes mellitus, hypertension, hyperlipemia and abnormal exercise-ECG) and coronary angiography (CAR), regarding the latter as the "gold standard" for the severity of CAD and c) to study the multivariate correlations among all the aforementioned diagnostic parameters, so that to rank them according their ability to screen and stratify the existence and the severity of CAD. We have studied 73 patients (54 men and 19 women, mean aged 58.5+/-10.3 and 59.8+/-8.7 years respectively), who underwent stress-rest 99mTc-TF SPET scan. All patients were classified according the following criteria: (a) CAR criteria: Group I: 34 patients with low likelihood of CAD, Group II: 19 patients with moderate CAD, Group III: 7 patients with severe CAD, Group IV: 13 patients with myocardial infarction. (b) RF criteria: Group A: 24 patients with 0-1 RF and Group B: 49 patients with >or=2 RF. (c) LVEF criteria: Group 0: 25 patients with LVEF>50, Group 1: 31 patients with LVEF=40-50, and Group 2: 4 patients with LVEF<40. (d) Regarding the existence (yes/no) of each RF (10 more subgroups). All patients underwent anterior planar imaging before the SPET scan acquisition. ROIs were placed on the following regions: Over the whole myocardium, peripherally, around the upper part of the previous ROI, on the lower right lung field, encompassing the whole right lung, on the middle mediastinum and around the upper part of the liver. Our results by multivariate regression analysis, showed that in 99mTc-TF SPET scan a modified technique of a peripheral ROI, drawn around the upper part of the heart, should be proposed as the optimal method for the calculation of LHR. This index, with normal cutoff or=2 RF. Due to the large variability of the hepatic uptake among the various groups, the diagnostic potential of LH ratio was not important.

Scintigraphy with technetium-99m methoxyisobutylisonitrile in multiple myeloma patients: correlation with the International Staging System.

(99m)Tc-2-methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy has been suggested in multiple myeloma (MM) patients. According to the International Staging System (ISS), serum b2-microglobulin (Sbeta(2)M) and serum albumin (SA) are dominant predictive factors and different cut-off values of these factors can separate patients into various stages of the disease. The purpose of this study was to assess the relationship between ISS staging, by Sbeta(2)M and SA, and the (99m)Tc-MIBI scan findings. Twenty-five MM patients have been studied. Eighteen patients were at stage I, three at stage II and four at stage III of MM. (99m)Tc-MIBI scans were obtained and scored according to intensity (I) and extent (E) of the radiotracer uptake. A summed score (S) for the (99m)Tc-MIBI scan was calculated for each patient. A statistically significant negative correlation between E, I and S uptake scores versus the SA levels (P=0.004, 0.049 and 0.018 respectively), as well as a statistically significant positive correlation between E and S scores and the Sbeta(2)M levels (P=0.012 and 0.032) were detected. A statistically significant difference between the E and S uptake scores among the MM patients examined for every stage separately was also found (P=0.007 and 0.024 respectively). The gradual increase of the E and S scores across the three stages of MM was also significant (P=0.003 and 0.021 respectively), despite the relatively small number of patients in stages II and III. In seven patients who died at the end of the follow-up period all three scores were significantly increased as compared to the scores of the patients who remained alive at that time. In conclusion, this study provides additional evidence that (99m)Tc-MIBI scan not only reflects myeloma disease activity in bone marrow but it is also well correlated with the Sbeta(2)M and SA levels according to ISS.

Active inflammatory bowel disease: evaluation with 99mTc (V) DMSA scintigraphy.

PURPOSE: To evaluate the use of pentavalent (V) technetium 99m (99mTc) dimercaptosuccinic acid (DMSA) scintigraphy for the assessment of disease activity in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS: 99mTc (V) DMSA scintigraphy was performed in 76 patients. There were 36 patients with active IBD (11 with ulcerative colitis, 25 with Crohn disease), 28 patients with inactive disease (eight with ulcerative colitis, 20 with Crohn disease), and 12 patients with miscellaneous bowel disease. Sensitivity and specificity of 99mTc (V) DMSA scintigraphy in the diagnosis of IBD were calculated. In the group with active IBD, the disease activity and laboratory indices, as well as the endoscopic and histologic activity, were compared with the scanning activity index. Correlation coefficients between them were calculated with the Spearman rank test. RESULTS: 99mTc (V) DMSA scintigraphy had a 92% (33 of 36) sensitivity and an 86% (24 of 28) specificity in the detection of active IBD. A significant correlation between disease activity indices and scintigraphy score was demonstrated. Endoscopic and histologic activity was significantly correlated (P =.005 and.02, respectively, overall disease activity) with the scanning activity score. Of the group of patients with miscellaneous bowel disease, three with ischemic colitis had negative findings at scintigraphy. CONCLUSION: 99mTc (V) DMSA scintigraphy provides a noninvasive, practical, and accurate assessment of IBD activity.