The Changing Clinical Patterns Of PHPT In China And Rational Use Of Localization Imaging Modalities

Objective To study the changes in the clinical patterns of primary hyperparathyroidism and explore the advantages and disadvantages of localization imaging methods commonly used.Patients and Methods Clinical data of 597 PHPT patients hospitalized in our center from January 2000 to December 2015 were retrospectively collected and analyzed to compare of epidemiological and clinical characteristics of PHPT between 2000-2010 and 2011-2015.A battery of psychometric and neurocognitive instruments was used to assess the cognition of PHPT patients and compare with normal controls to explore the effect of PHPT on central nervous system.The imaging data of 352 PHPT patients hospitalized in 2011-2015 were collected to calculate the sensitivity of 4 imaging modalities in the preoperative localization of parathyroid lesions.The ROC curve analysis was used to explore the clinical factors affecting the sensitivity of localization diagnosis,and the cut-point of related factors was determined.Results The incidence of classical PHPT clinical symptoms were less regularly seen in 2011-2015 compared to 2000-2010,along with significantly decreased serum calcium(p<0.001),decreased PTH(p<0.001)and smaller parathyroid lesions(p<0.001),but the neuro-psychological symptoms increased significantly.Poorer visuospatial abilities and quality of life were seen in PHPT patients compared to normal controls.Tc-sestamibi(MIBI)scintigraphy has the highest sensitivity among the localization modalities commonly used,reaching the sensitivity of 95.56%(91.12%-97.92%).When the parathyroid lesions were ?1.3cm,sensitivity of neck ultrasonography was significantly decreased,while MIBI meet its dramatically decreased sensitivity when parathyroid lesions ? 1.3cm or serum PTH ? 252.1pg/ml.MIBI scintigraphy was ineffective in localizing the hyperplasia lesions.Neck ultrasonography combined with MIBI scintigraphy can effectively improve the accuracy of preoperative localization of parathyroid lesions.Conclusions The clinical presentations of PHPT continue to become milder in China.MIBI scintigraphy is concerned the most preferred imaging examination with sensitivity concerned.Small parathyroid lesion or relatively mild elevation of serum PTH can reduce the accuracy of parathyroid localization.