Preoperative parathyroid imaging in CKD-related secondary hyperparathyroidism: a systematic review and diagnostic test accuracy network meta-analysis.
8 affiliations
- 1Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy.
- 2Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 3Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 4Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 5Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 6Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 7Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 8Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Abstract
Background and aims
In secondary hyperparathyroidism (SHPT), imaging must characterize multifocal disease and identify ectopic or supernumerary tissue before surgery, but the comparative accuracy and optimal hierarchy of available modalities remain uncertain. We compared the main preoperative imaging techniques used for parathyroid localization in patients with chronic kidney disease (CKD).Methods
MEDLINE, Embase, and Web of Science were searched from inception through 31 May 2026 for gland-, lesion-, or site-level diagnostic accuracy studies in adults with CKD, kidney failure, or kidney transplantation, using surgical and/or histopathological confirmation. An arm-based Bayesian bivariate network meta-analysis jointly estimated sensitivity and specificity for ultrasonography (US), non-subtraction technetium-99m methoxyisobutylisonitrile (⁹⁹ᵐTc-MIBI) planar scintigraphy, ⁹⁹ᵐTc-MIBI single-photon emission computed tomography/computed tomography (SPECT/CT), and ¹⁸F-fluorocholine (¹⁸F-FCH) positron emission tomography/computed tomography (PET/CT). Balanced accuracy and comparative effects versus US were also estimated. Risk of bias was assessed using QUADAS-3.Results
Ten studies including 479 participants contributed 24 test arms. Estimated sensitivity was 89.6% [95% credible interval (CrI) 81.9-94.5] for ¹⁸F-FCH PET/CT, 68.8% (56.0-79.2) for MIBI SPECT/CT, 64.2% (51.0-75.6) for US, and 45.9% (32.8-59.4) for planar MIBI. Specificity estimates ranged from 76.4% to 83.8% and were imprecise. Compared with US, ¹⁸F-FCH PET/CT showed higher sensitivity (odds ratio 4.83, 95% CrI 3.20-7.48) and balanced accuracy (+11.9 percentage points, 95% CrI 0.1-20.6), with no clear specificity difference. Findings were directionally consistent in sensitivity analyses.Conclusions
¹⁸F-FCH PET/CT had the highest estimated sensitivity and balanced accuracy, although evidence was limited and specificity remained uncertain. A clinically guided hierarchy beginning with US and progressing to ¹⁸F-FCH PET/CT may improve comprehensive glandular mapping and support multidisciplinary operative planning in SHPT. 4D-CT and dual-isotope scintigraphic techniques also appear promising as alternative or complementary strategies, although SHPT-specific evidence remains limited and requires further dedicated comparative studies.
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BibTeX
@article{vetrano2026preoperative,
title = {{Preoperative parathyroid imaging in CKD-related secondary hyperparathyroidism: a systematic review and diagnostic test accuracy network meta-analysis.}},
author = {Daniele Vetrano and Simona Barbuto and Anna Mistretta and Guido Zavatta and Francesco Aguanno and Paolo Mastromauro and Giorgia Comai and Giulia Molinari and Guido Marzocchi and Giuseppe Mercante and Uberto Pagotto and Carla Serra and Stefano Fanti and Luigi Lovato and Gaetano La Manna and Giuseppe Cianciolo},
journal = {Clinical kidney journal},
year = {2026},
month = oct,
doi = {10.1093/ckj/sfag344},
url = {https://europepmc.org/article/MED/42924101},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Preoperative parathyroid imaging in CKD-related secondary hyperparathyroidism: a systematic review and diagnostic test accuracy network meta-analysis.
AU - Daniele Vetrano
AU - Simona Barbuto
AU - Anna Mistretta
AU - Guido Zavatta
AU - Francesco Aguanno
AU - Paolo Mastromauro
AU - Giorgia Comai
AU - Giulia Molinari
AU - Guido Marzocchi
AU - Giuseppe Mercante
AU - Uberto Pagotto
AU - Carla Serra
AU - Stefano Fanti
AU - Luigi Lovato
AU - Gaetano La Manna
AU - Giuseppe Cianciolo
PY - 2026
DA - 2026/10/01
JO - Clinical kidney journal
DO - 10.1093/ckj/sfag344
UR - https://europepmc.org/article/MED/42924101
AB - Background and aims In secondary hyperparathyroidism (SHPT), imaging must characterize multifocal disease and identify ectopic or supernumerary tissue before surgery, but the comparative accuracy and optimal hierarchy of available modalities remain uncertain. We compared the main preoperative imaging techniques used for parathyroid localization in patients with chronic kidney disease (CKD).Methods MEDLINE, Embase, and Web of Science were searched from inception through 31 May 2026 for gland-, lesion-, or site-level diagnostic accuracy studies in adults with CKD, kidney failure, or kidney transplantation, using surgical and/or histopathological confirmation. An arm-based Bayesian bivariate network meta-analysis jointly estimated sensitivity and specificity for ultrasonography (US), non-subtraction technetium-99m methoxyisobutylisonitrile (⁹⁹ᵐTc-MIBI) planar scintigraphy, ⁹⁹ᵐTc-MIBI single-photon emission computed tomography/computed tomography (SPECT/CT), and ¹⁸F-fluorocholine (¹⁸F-FCH) positron emission tomography/computed tomography (PET/CT). Balanced accuracy and comparative effects versus US were also estimated. Risk of bias was assessed using QUADAS-3.Results Ten studies including 479 participants contributed 24 test arms. Estimated sensitivity was 89.6% [95% credible interval (CrI) 81.9-94.5] for ¹⁸F-FCH PET/CT, 68.8% (56.0-79.2) for MIBI SPECT/CT, 64.2% (51.0-75.6) for US, and 45.9% (32.8-59.4) for planar MIBI. Specificity estimates ranged from 76.4% to 83.8% and were imprecise. Compared with US, ¹⁸F-FCH PET/CT showed higher sensitivity (odds ratio 4.83, 95% CrI 3.20-7.48) and balanced accuracy (+11.9 percentage points, 95% CrI 0.1-20.6), with no clear specificity difference. Findings were directionally consistent in sensitivity analyses.Conclusions ¹⁸F-FCH PET/CT had the highest estimated sensitivity and balanced accuracy, although evidence was limited and specificity remained uncertain. A clinically guided hierarchy beginning with US and progressing to ¹⁸F-FCH PET/CT may improve comprehensive glandular mapping and support multidisciplinary operative planning in SHPT. 4D-CT and dual-isotope scintigraphic techniques also appear promising as alternative or complementary strategies, although SHPT-specific evidence remains limited and requires further dedicated comparative studies.
SN - 2048-8505
SN - 2048-8513
ER -