open access
Optimal timing of SPECT/CT to demonstrate parathyroid adenomas in 99mTc-sestamibi scintigraphy
- Tallaght University Hospital, Dublin, Ireland
open access
Abstract
Background: Accurate preoperative localisation of the parathyroid adenoma is essential to achieve a minimally invasive parathyroidectomy. The purpose of this study was to validate and improve our single-isotope dual-phase parathyroid imaging protocol utilising 99mTechnetium-Sestamibi ([99mTc]MIBI). There has been no accepted gold standard evidence-based protocol regarding timing of single-photon emission computed tomography/computed tomography (SPECT/CT) acquisition in parathyroid imaging with resultant variation between centres. We sought to determine the optimum timing of SPECT/CT post administration of [99mTc]MIBI in the identification of parathyroid adenomas. We aimed to evaluate the efficacy of early and late SPECT/CT and to establish whether SPECT/CT demonstrates increased sensitivity over planar imaging. Material and methods: A sample of 36 patients with primary hyperparathyroidism underwent planar and SPECT/CT acquisition 15 minutes (early) and two hours (late) post [99mTc]MIBI administration. Two radionuclide radiologists reviewed the images and Fisher’s exact Chi-squared statistic was used to evaluate the diagnostic performances of early versus late SPECT/CT acquisition and SPECT/CT versus planar imaging. Results: Twenty-one likely parathyroid adenomas were identified with a statistically superior diagnosis rate in the late SPECT/CT acquisition compared with both early SPECT/CT and planar imaging (p < 0.05). All adenomas diagnosed on early SPECT/CT acquisition were also identified on late SPECT/CT images. Conclusions: Single late phase SPECT/CT is significantly superior to early SPECT/CT in the identification of parathyroid adenomas. Late SPECT/CT improves diagnostic accuracy over planar acquisition. Imaging protocols should be revised to include late SPECT/CT acquisition. Early SPECT/CT acquisition can be eliminated from scan protocols with associated implications regarding reduced scan time and increased patient throughput.
Abstract
Background: Accurate preoperative localisation of the parathyroid adenoma is essential to achieve a minimally invasive parathyroidectomy. The purpose of this study was to validate and improve our single-isotope dual-phase parathyroid imaging protocol utilising 99mTechnetium-Sestamibi ([99mTc]MIBI). There has been no accepted gold standard evidence-based protocol regarding timing of single-photon emission computed tomography/computed tomography (SPECT/CT) acquisition in parathyroid imaging with resultant variation between centres. We sought to determine the optimum timing of SPECT/CT post administration of [99mTc]MIBI in the identification of parathyroid adenomas. We aimed to evaluate the efficacy of early and late SPECT/CT and to establish whether SPECT/CT demonstrates increased sensitivity over planar imaging. Material and methods: A sample of 36 patients with primary hyperparathyroidism underwent planar and SPECT/CT acquisition 15 minutes (early) and two hours (late) post [99mTc]MIBI administration. Two radionuclide radiologists reviewed the images and Fisher’s exact Chi-squared statistic was used to evaluate the diagnostic performances of early versus late SPECT/CT acquisition and SPECT/CT versus planar imaging. Results: Twenty-one likely parathyroid adenomas were identified with a statistically superior diagnosis rate in the late SPECT/CT acquisition compared with both early SPECT/CT and planar imaging (p < 0.05). All adenomas diagnosed on early SPECT/CT acquisition were also identified on late SPECT/CT images. Conclusions: Single late phase SPECT/CT is significantly superior to early SPECT/CT in the identification of parathyroid adenomas. Late SPECT/CT improves diagnostic accuracy over planar acquisition. Imaging protocols should be revised to include late SPECT/CT acquisition. Early SPECT/CT acquisition can be eliminated from scan protocols with associated implications regarding reduced scan time and increased patient throughput.
Keywords
parathyroid scintigraphy; [99mTc]MIBI; sestamibi; SPECT/CT
Title
Optimal timing of SPECT/CT to demonstrate parathyroid adenomas in 99mTc-sestamibi scintigraphy
Journal
Issue
Article type
Research paper
Pages
89-94
Published online
2022-07-11
Page views
4323
Article views/downloads
569
DOI
Pubmed
Bibliographic record
Nucl. Med. Rev 2022;25(2):89-94.
Keywords
parathyroid scintigraphy
[99mTc]MIBI
sestamibi
SPECT/CT
Authors
Kate Hunter
Niamh Gavin
Colin McQuade
Brendan Hogan
John Feeney
- Brown SJ, Ruppe MD, Tabatabai LS. The parathyroid gland and heart disease. Methodist Debakey Cardiovasc J. 2017; 13(2): 49–54.
- Shindo M, Lee JA, Lubitz CC, et al. The changing landscape of primary, secondary, and tertiary hyperparathyroidism: highlights from the American College of Surgeons panel, "What's new for the surgeon caring for patients with hyperparathyroidism". J Am Coll Surg. 2016; 222(6): 1240–1250.
- Liddy S, Worsley D, Torreggiani W, et al. Preoperative imaging in primary hyperparathyroidism: literature review and recommendations. Can Assoc Radiol J. 2017; 68(1): 47–55.
- Kunstman JW, Udelsman R. Superiority of minimally invasive parathyroidectomy. Adv Surg. 2012; 46: 171–189.
- Chan RK, Ruan DT, Gawande AA, et al. Surgery for hyperparathyroidism in image-negative patients. Arch Surg. 2008; 143(4): 335–337.
- Minisola S, Cipriani C, Diacinti D, et al. Imaging of the parathyroid glands in primary hyperparathyroidism. Eur J Endocrinol. 2016; 174(1): D1–D8.
- Hindié E, Ugur O, Fuster D, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009; 36(7): 1201–1216.
- Caveny SA, Klingensmith WC, Martin WE. Parathyroid imaging: the importance of dual-radiopharmaceutical simultaneous acquisition with 99mTc-sestamibi and 123I. J Nuclear Med Technol. 2012; 40(2): 104–110.
- Erbil Y, Barbaros U, Yanik BT, et al. Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas. Laryngoscope. 2006; 116(4): 580–585.
- Martin WH, Sandler MP, Gross MD. Thyroid, parathyroid, and adrenal gland imaging. In: Sharp PF, Gemmell HG, Murray DM. ed. Practical Nuclear Medicine 3rd edition. Springer, London 2005: 247–272.
- Payne SJ, Smucker JE, Bruno MA, et al. Radiographic evaluation of non-localizing parathyroid adenomas. Am J Otolaryngol. 2015; 36(2): 217–222.
- Monzen Y, Tamura A, Okazaki H, et al. SPECT/CT fusion in the diagnosis of hyperparathyroidism. Asia Ocean J Nucl Med Biol. 2015; 3(1): 61–65.
- 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.
- Qiu ZL, Wu Bo, Shen CT, et al. Dual-phase (99m)Tc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables. Ann Nucl Med. 2014; 28(8): 725–735.
- Hwang SH, Rhee Y, Yun M, et al. Usefulness of SPECT/CT in parathyroid lesion detection in patients with thyroid parenchymal Tc-sestamibi retention. Nucl Med Mol Imaging. 2017; 51(1): 32–39.