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Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism
Affiliations- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Thailand, 123, Mittraparb road, 40000 Khon Kaen, Thailand
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Abstract
BACKGROUND
Several parathyroid scintigraphy protocols have been used for preoperative localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism. The aim of this study is to compare the diagnostic accuracy of various parathyroid scintigraphy protocols.
MATERIAL AND METHODS
A retrospective diagnostic accuracy study with histopathology as the reference standard was done. Five imaging protocols were investigated including planar dual tracer Tc-99m pertechnetate/Tc-99m sestamibi (DT), planar dual phase Tc-99m sestamibi (DP), and combined dual tracer dual phase (DTDP) protocols, as well as add-on single photon emission computed tomography (SPECT), and single photon emission computed tomography/computed tomography (SPECT/CT).
RESULTS
A total of 63 patients underwent parathyroid scintigraphy and subsequent parathyroid surgery with a total of 106 excised lesions with histopathological diagnosis. On a lesion-based analysis, sensitivity and specificity (with 95% confidence interval) of protocols were as follows. DT protocol: 69.4% (53.1–82.0%) and 80.0% (49.0–94.3%); DP protocol: 78.6% (52.4–92.4%) and 33.3% (9.7–70.0%); DTDP protocol: 64.7% (47.9–78.5%) and 50.0% (18.8–81.2%); SPECT: 92.3% (66.7–98.6%) and 75.0% (30.1–95.4%); SPECT/CT: 80.0% (49.0–94.3%) and 75.0% (30.1–95.4%). All protocols had perfect sensitivity for detection of parathyroid adenoma whereas SPECT was the most sensitive method for detection of hyperplastic parathyroid glands.
CONCLUSION
Planar parathyroid scintigraphy using the DT protocol has a trend towards being more accurate than DP and DTDP protocols. Additional imaging with SPECT and SPECT/CT had a trend towards being more accurate than planar imaging.
Abstract
BACKGROUND
Several parathyroid scintigraphy protocols have been used for preoperative localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism. The aim of this study is to compare the diagnostic accuracy of various parathyroid scintigraphy protocols.
MATERIAL AND METHODS
A retrospective diagnostic accuracy study with histopathology as the reference standard was done. Five imaging protocols were investigated including planar dual tracer Tc-99m pertechnetate/Tc-99m sestamibi (DT), planar dual phase Tc-99m sestamibi (DP), and combined dual tracer dual phase (DTDP) protocols, as well as add-on single photon emission computed tomography (SPECT), and single photon emission computed tomography/computed tomography (SPECT/CT).
RESULTS
A total of 63 patients underwent parathyroid scintigraphy and subsequent parathyroid surgery with a total of 106 excised lesions with histopathological diagnosis. On a lesion-based analysis, sensitivity and specificity (with 95% confidence interval) of protocols were as follows. DT protocol: 69.4% (53.1–82.0%) and 80.0% (49.0–94.3%); DP protocol: 78.6% (52.4–92.4%) and 33.3% (9.7–70.0%); DTDP protocol: 64.7% (47.9–78.5%) and 50.0% (18.8–81.2%); SPECT: 92.3% (66.7–98.6%) and 75.0% (30.1–95.4%); SPECT/CT: 80.0% (49.0–94.3%) and 75.0% (30.1–95.4%). All protocols had perfect sensitivity for detection of parathyroid adenoma whereas SPECT was the most sensitive method for detection of hyperplastic parathyroid glands.
CONCLUSION
Planar parathyroid scintigraphy using the DT protocol has a trend towards being more accurate than DP and DTDP protocols. Additional imaging with SPECT and SPECT/CT had a trend towards being more accurate than planar imaging.
Keywords
radionuclide imaging; parathyroid scintigraphy; SPECT; SPECT/CT; parathyroid glands; hyperparathyroidism
About this articleTitle
Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism
Journal
Issue
Article type
Research paper
Pages
20-25
Published online
2017-09-25
Page views
2210
Article views/downloads
1768
DOI
Pubmed
Bibliographic record
Nucl. Med. Rev 2018;21(1):20-25.
Keywords
radionuclide imaging
parathyroid scintigraphy
SPECT
SPECT/CT
parathyroid glands
hyperparathyroidism
Authors
Yutapong Raruenrom
Daris Theerakulpisut
Nantaporn Wongsurawat
Charoonsak Somboonporn
References (31)- Yeh M, Ituarte P, Zhou H, et al. Incidence and Prevalence of Primary Hyperparathyroidism in a Racially Mixed Population. J Clin Endocrinol Metab. 2013; 98(3): 1122–1129.
- Duan K, Hernandez KG, Mete O. Clinicopathological correlates of hyperparathyroidism. J Clin Pathol. 2015; 68(10): 771–787.
- Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007; 71(1): 31–38.
- Deo R, Katz R, Shlipak MG, et al. Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study. Hypertension. 2011; 58(6): 1021–1028.
- Cheung K, Wang TS, Farrokhyar F, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012; 19(2): 577–583.
- Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol. 2007; 188(6): 1706–1715.
- Kobylecka M, Płazińska MT, Chudziński W, et al. Comparison of scintigraphy and ultrasound imaging in patients with primary, secondary and tertiary hyperparathyroidism - own experience. J Ultrason. 2017; 17(68): 17–22.
- Light VL, McHenry CR, Jarjoura D, et al. Prospective comparison of dual-phase technetium-99m-sestamibi scintigraphy and high resolution ultrasonography in the evaluation of abnormal parathyroid glands. Am Surg. 1996; 62(7): 562–7; discussion 567.
- Ishibashi M, Nishida H, Hiromatsu Y, et al. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 1998; 39(2): 320–324.
- McDermott VG, Fernandez RJ, Meakem TJ, et al. Preoperative MR imaging in hyperparathyroidism: results and factors affecting parathyroid detection. AJR Am J Roentgenol. 1996; 166(3): 705–710.
- Caldarella C, Treglia G, Isgrò MA, et al. Diagnostic performance of positron emission tomography using ¹¹C-methionine in patients with suspected parathyroid adenoma: a meta-analysis. Endocrine. 2013; 43(1): 78–83.
- Weber T, Gottstein M, Schwenzer S, et al. Is C-11 Methionine PET/CT Able to Localise Sestamibi-Negative Parathyroid Adenomas? World J Surg. 2017; 41(4): 980–985.
- Kluijfhout WP, Pasternak JD, Gosnell JE, et al. (18)F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study. Radiology. 2017; 284(2): 460–467.
- Kluijfhout WP, Vorselaars WM, van den Berk SAM, et al. Fluorine-18 fluorocholine PET-CT localizes hyperparathyroidism in patients with inconclusive conventional imaging: a multicenter study from the Netherlands. Nucl Med Commun. 2016; 37(12): 1246–1252.
- Greenspan BS, Dillehay G, Intenzo C, et al. SNM practice guideline for parathyroid scintigraphy 4.0. J Nucl Med Technol. 2012; 40(2): 111–118.
- Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007; 48(7): 1084–1089.
- Lorberboym M, Minski I, Macadziob S, et al. Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med. 2003; 44(6): 904–908.
- Thomas DL, Bartel T, Menda Y, et al. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 2009; 34(10): 651–655.
- Wei WJ, Shen CT, Song HJ, et al. Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis. Hell J Nucl Med. 2015; 18(2): 127–135.
- Chen CC, Holder LE, Scovill WA, et al. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT. J Nucl Med. 1997; 38(6): 834–839.
- Caveny SA, Klingensmith WC, Martin WE, et al. Parathyroid imaging: the importance of dual-radiopharmaceutical simultaneous acquisition with 99mTc-sestamibi and 123I. J Nucl Med Technol. 2012; 40(2): 104–110.
- Jain A. Incremental value of 99mTc-Pertechnetate-SestaMIBI dual tracer (subtraction) protocol over 99mTc-SestaMIBI dual phase protocol for pre-surgical localization of parathyroid adenoma in patients with primary and tertiary hyperparathyroidism. J Nucl Med. 2010; 51(supplement 2): 1561–1561.
- Keane DF, Roberts G, Smith R, et al. Planar parathyroid localization scintigraphy: a comparison of subtraction and 1-, 2- and 3-h washout protocols. Nucl Med Commun. 2013; 34(6): 582–589.
- Krakauer M, Wieslander B, Myschetzky PS, et al. A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism. Clin Nucl Med. 2016; 41(2): 93–100.
- Leslie WD, Dupont JO, Bybel B, et al. Parathyroid 99mTc-sestamibi scintigraphy: dual-tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging. 2002; 29(12): 1566–1570.
- Stanic S, Goldsmith S. Parathyroid scintigraphy: comparison of dual-tracer [Tc99m MIBI - pertechnetate] and dual-phase Tc99m MIBI imaging. J Nucl Med. 2008; 49(supplement 1): 242–242.
- Thakral P, Jain A, Sen I, et al. Comparison of 99mTc-pertechnetate-sestaMIBI subtraction scan with dual phase 99m Tc-sestaMIBI scan for pre-surgical localization of parathyroid adenoma in patients with primary hyperparathyroidism. J Nucl Med. 2007; 48(supplement 2): 453–453.
- Hwang SH, Rhee Y, Yun M, et al. Usefulness of SPECT/CT in Parathyroid Lesion Detection in Patients with Thyroid Parenchymal (99m)Tc-Sestamibi Retention. Nucl Med Mol Imaging. 2017; 51(1): 32–39.
- Sandqvist P, Nilsson IL, Grybäck P, et al. SPECT/CT's Advantage for Preoperative Localization of Small Parathyroid Adenomas in Primary Hyperparathyroidism. Clin Nucl Med. 2017; 42(2): e109–e114.
- Dugonjić S, Cerović S, Janković Z, et al. Correlation of subtraction parathyroid scintigraphy with weight, pathohistologic finding and oxyphil cell content of parathyroid glands in parathyroid hyperplasia. Vojnosanit Pregl. 2012; 69(4): 345–352.
- Saengsuda Y. The accuracy of 99m Tc-MIBI scintigraphy for preoperative parathyroid localization in primary and secondary-tertiary hyperparathyroidism. J Med Assoc Thai. 2012; 95 Suppl 3: S81–S91.
