Abstract
Background: We evaluated the incremental value of [99mTc]sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism.Methods: Forty-six patients with biochemical evidence of hyperparathyroidism and inconclusive ultrasound underwent sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Decision tree analysis was performed to evaluate the value of SPECT/CT over planar scintigraphy for classifying patients with or without hyperfunctioning parathyroid tissue. The added value of SPECT/CT was also evaluated by decision curve analysis.Results: Planar scintigraphy was positive for presence of hyperfunctioning parathyroid in 52% of patients, with sensitivity of 63% and specificity of 100%. SPECT/CT was positive in 80% of patients with sensitivity of 97% and specificity of 100%. At decision tree analysis, after an initial split on planar imaging results, no further split was performed in patients with positive results, while those with negative results were further stratified by SPECT/CT. At decision curve analysis, the model including SPECT/CT was associated with the highest net benefit compared to the model including only planar technique and to a strategy considering that all patients should be treated.Conclusion: Sestamibi SPECT/CT provides incremental value over dual-phase scintigraphy in preoperative localization of hyperfunctioning parathyroid tissue in subjects with inconclusive ultrasound. Hybrid technique allows a better identification of pathological lesion to perform minimally invasive surgery and showed the highest net benefit, improving selection of surgical approach.
Highlights
Primary hyperparathyroidism is an endocrine disorder with high prevalence characterized by an increased production of parathyroid hormone (PTH) from autonomous parathyroid tissue no longer responsive to physiological feed-back from serum calcium levels [1]
The aim of this study was to evaluate the incremental value and the clinical implications of sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) imaging over planar dual-phase technique for pre-surgical localization of abnormal parathyroid glands in patients with primary hyperparathyroidism and inconclusive ultrasound
After an initial split based on planar imaging results, in patients with positive results no further split was performed, while those with negative results were further stratified by SPECT/CT
Summary
Primary hyperparathyroidism is an endocrine disorder with high prevalence characterized by an increased production of parathyroid hormone (PTH) from autonomous parathyroid tissue no longer responsive to physiological feed-back from serum calcium levels [1]. It is frequently coupled with an augmented level of total serum calcium and PTH. The success of minimally invasive parathyroid surgery depends on an experienced surgeon, and on a sensitive and accurate imaging technique for parathyroid tissue localization [6]. We evaluated the incremental value of [99mTc]sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism
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