Title: Dual phase Tc-99m sestamibi planar, SPECT and SPECT/CT for localization of parathyroid adenoma in patients with primary hyperparathyroidism
Abstract: 47 Objectives: Pre-operative parathyroid imaging in patients with primary hyperparathyroidism is increasingly being used to localize parathyroid adenoma and to guide surgeons during minimally invasive parathyroidectomy. Although different protocols are in use, few direct comparisons exist. This study sought to determine the optimal imaging protocol for pre-operative parathyroid adenoma localization comparing single and combined early and delayed Tc-99m sestamibi planar, SPECT and SPECT/CT methods. Methods: Between 4/2003 and 7/2005, 210 patients had Tc-99m sestamibi parathyroid scintigraphy; 108 diagnosed with primary hyperparathyroidism who had no prior neck surgery were analyzed. At 15 minutes and 2 hours post-injection, 10 minute anterior, 35 degree RAO and 35 degree LAO planar images were acquired; planar imaging was immediately followed by SPECT/CT. Studies were acquired on a GE Millenium VG or Infinia. Six image sets were anonymized: early and delayed planar, early and delayed SPECT and early and delayed SPECT/CT. Two experienced nuclear medicine physicians interpreted the 6 single image sets and combinations of 2 image sets (19 different readings) to determine the presence or absence of an adenoma at 13 locations. Each image set or combination was scored using a 5 point scale for certainty of focus and certainty of location. Surgical location was the gold standard. Data were analyzed for sensitivity, specificity, accuracy (AUC of ROC curve), PPV and NPV, and correlation with patient characteristics. Scores of 1-3 were considered negative and 4-5 positive. Results: There were 33 males and 75 females; mean age was 60.0 yrs (28.2-94.0). Overall kappa value was 0.69; lowest kappa values were for planar images while highest kappa values were for combinations. Overall lateralization AUC, PPV and NPV were 80.5%, 96.7% and 69.8%, respectively. Overall precise localization AUC, PPV and NPV were 73.3%, 78.9% and 95.1%, respectively. When inferior and inferior-posterior locations were combined, overall precise localization AUC, PPV and NPV were 77.3%, 89.9% and 95.0%, respectively. Highest AUC and PPV were found in dual phase image sets which included combinations of early SPECT/CT with any late image set. Significant correlations were found between certainty of focus and adenoma mass (p Conclusions: Addition of SPECT/CT imaging to dual phase parathyroid planar scintigraphy using Tc-99m sestamibi demonstrates significant increases in accuracy and PPV when compared to single time point planar and SPECT studies.
Publication Year: 2006
Publication Date: 2006-05-01
Language: en
Type: article
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