Abstract
Background: Adding subtraction single-photon emission computed tomography/computed tomography (SPECT/CT) to dual isotope (I-123 and Tc-99m-sestamibi) subtraction parathyroid scintigraphy is not widely implemented. We aimed to assess the added value of dual isotope subtraction SPECT/CT over single isotope SPECT/CT as an adjunct to dual isotope planar pinhole subtraction scintigraphy. Methods: Parathyroid scintigraphies from 106 patients with an estimated total of 415 parathyroid glands who (1) were diagnosed with primary hyperparathyroidism, (2) underwent dual isotope subtraction scintigraphy in the Department of Nuclear Medicine, Gentofte Hospital, Denmark throughout 2017 and (3) underwent subsequent parathyroidectomy, were included. The original dual isotope planar pinhole subtraction plus dual isotope subtraction SPECT/CT (dual/dual method) exams were retrospectively re-evaluated using only Tc-99m-sestamibi SPECT/CT (dual/single method). Statistics were calculated per parathyroid. Surgical results confirmed by pathology served as reference standard. Results: The dual/dual method had higher sensitivity than the dual/single method (82% (95%CI 74%–88%) vs. 69% (95%CI 60%–77%)) while specificity, positive and negative predictive values (PPV and NPV) were similar (specificity 96% vs. 93%, PPV’s 87% vs. 82% and NPV’s 89% vs. 93%). Reader confidence was higher when employing the dual/dual method (p = 0.001). Conclusions: The dual/dual method can be considered superior to the dual/single method in the preoperative imaging in primary hyperparathyroidism.
Highlights
Each year, 600–700 Danish patients are diagnosed with primary hyperparathyroidism (PHPT) [1,2].PHPT is diagnosed on the basis of elevated serum calcium and elevated parathyroid hormone (PTH) secreted from one or more hyperfunctioning parathyroid gland(s) [1,2,3].Symptoms include musculoskeletal, cardiovascular, gastrointestinal, renal and neurological problems, and the only curative treatment is parathyroidectomy (PTx) [1,2,3,4].Preoperative imaging is a prerequisite for minimally invasive surgery
This study aimed to evaluate the potential added information obtained from dual isotope subtraction SPECT/CT, i.e., we intended to assess and compare two methods of dual isotope subtraction scintigraphy, namely: (1)
The ability to locate hyperfunctioning parathyroid gland (HPG) preoperatively is far more important than the ability to dismiss healthy parathyroid glands, we find that our important than the ability to dismiss healthy parathyroid glands, we find that primary effect measure must be the sensitivities
Summary
600–700 Danish patients are diagnosed with primary hyperparathyroidism (PHPT) [1,2].PHPT is diagnosed on the basis of elevated serum calcium and elevated (or high in the normal range) parathyroid hormone (PTH) secreted from one or more hyperfunctioning parathyroid gland(s) [1,2,3].Symptoms include musculoskeletal, cardiovascular, gastrointestinal, renal and neurological problems, and the only curative treatment is parathyroidectomy (PTx) [1,2,3,4].Preoperative imaging is a prerequisite for minimally invasive surgery. Parathyroid dual isotope subtraction scintigraphy is a sensitive and specific preoperative imaging modality with reported sensitivities ranging between 86%–93%, specificities 98%–100% [4,5,6]. Adding subtraction single-photon emission computed tomography/computed tomography (SPECT/CT) to dual isotope (I-123 and Tc-99m-sestamibi) subtraction parathyroid scintigraphy is not widely implemented. We aimed to assess the added value of dual isotope subtraction SPECT/CT over single isotope SPECT/CT as an adjunct to dual isotope planar pinhole subtraction scintigraphy. Methods: Parathyroid scintigraphies from 106 patients with an estimated total of 415 parathyroid glands who (1) were diagnosed with primary hyperparathyroidism,. (2) underwent dual isotope subtraction scintigraphy in the Department of Nuclear Medicine, Gentofte Hospital, Denmark throughout 2017 and (3) underwent subsequent parathyroidectomy, were included. Results: The dual/dual method had higher sensitivity than the dual/single method (82% (95%CI 74%–88%) vs. 69% (95%CI 60%–77%)) while specificity, positive and negative predictive values (PPV and NPV) were similar
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
