18F-Fluorocholine PET/CT, Tc-99m-MIBI and TC-99m-MDP SPECT/CT in Tertiary Hyperparathyroidism with Renal Osteodystrophy

• Published in: Diagnostics (Basel) Vol. 10; no. 10; p. 851
• Main Authors: Ferrari, Cristina, Lavelli, Valentina, Santo, Giulia, Frugis, Maria Teresa, Iuele, Francesca, Rubini, Giuseppe, Sardaro, Angela
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 20-10-2020; MDPI
• Subjects: 18F-fluorocholine; Conflicts of interest; dual-phase Tc-99m-MIBI; Interesting Images; Metabolism; Nuclear medicine; positron emission tomography/computed tomography; renal osteodystrophy; Scintigraphy; Tc-99m-MDP; tertiary hyperparathyroidism; Thyroid gland; Tomography
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics10100851

Tertiary hyperparathyroidism (HPT) is a metabolic disorder characterized by the semi-autonomous hypersecretion of parathyroid hormone (PTH), leading to hypercalcemia. It can be the end result of persistent secondary hyperparathyroidism and is most commonly observed in patients with long-standing chronic kidney disease (CKD) and often after renal transplantation. Untreated HPT can lead to progressive bone disease, fibrocystic osteitis, and soft-tissue calcifications, along with other severe complications. In the 2009 Kidney Disease Improving Global Outcomes (KDIGO) guidelines, CKD-Mineral and Bone Disorder (CKD-MBD) is used to describe the broader clinical syndrome encompassing mineral, bone, and calcific cardiovascular abnormalities that develop as a complication of CKD. We report a 62-year-old female with a severe HPT evolved from advanced chronic kidney disease (stage 5D, KDIGO). Patient was evaluated with multimodality nuclear medicine functional imaging to assess hyperfunctioning parathyroid glands and bone lesions. Tc-99m-methoxyisobutylisonitrile (MIBI) dual-phase scintigraphy, Tc-99m-methylenediphosphonate (MDP) bone scan and 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) were performed before surgery.