Objective: Near-infrared autofluorescence (NIRAF) characteristics of parathyroid glands in primary hyperparathyroidism (pHPT) vary, with unclarity regarding the underlying mechanism. Similarly, Tc-sestamibi uptake in diseased parathyroid glands is variable. There is a suggestion that oxyphilic cell content may influence both imaging modalities. This study aims to analyze the relationship between NIRAF imaging characteristics, Tc-sestamibi uptake, and cellular composition in pHPT.
Study Design: Retrospective analysis of an Institutional Review Board-monitored prospective database.
Setting: Single tertiary referral center.
Methods: NIRAF characteristics of parathyroid glands of patients with pHPT between 2019 and 2024 were compared with Tc-sestamibi scan findings from a prospective database. Using third-party software, brightness intensity and heterogeneity index (HI) of the glands were calculated. A subgroup of parathyroid glands obtained from consecutive patients with pHPT in 2020 to 2021 underwent histological analysis.
Results: A total of 428 patients with 638 diseased parathyroid glands were analyzed. Forty-seven percent of the glands showed an uptake on Tc-sestamibi scans. The brightness intensity of the NIRAF signals from parathyroid glands that were seen versus not seen on sestamibi was 2.1 versus 2.3 (P = .002) and HI 0.18 versus 0.17 (P = .35), respectively. On multivariate analysis, low autofluorescence intensity, high gland volume, and single adenoma were associated with detectability on Tc-sestamibi scan (P < .0001). Intraglandular adipose tissue content was lower in diseased glands that were detected on Tc-sestamibi scans (0% vs 5%, P < .0001).
Conclusion: Our findings indicate an inverse relationship between autofluorescence intensity and detectability on Tc-sestamibi scans and a lack of correlation between different cell types and autofluorescence properties.
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