Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT.
OBJECTIVE
To evaluate the ability to detect and localize parathyroid adenomas with technetium-99m sestamibi single photon emission computed tomography (SPECT).


METHODS
Forty-seven adult patients underwent Tc-99m sestamibi SPECT. Early (15-30 minutes after injection) and delayed (2-4 hours after injection) images were acquired. Thirty-three patients were examined for initial parathyroid surgery; the remaining 14, for repeat surgery because of persistent or recurrent hyperparathyroidism. SPECT reprojection images viewed in a rotating cine-display mode were read independently by two nuclear medicine physicians who were blinded to the results of other localization studies. Thirty-seven patients underwent subsequent neck exploration. SPECT findings were compared with surgical and histopathologic findings.


RESULTS
In the 37 patients who underwent surgery, parathyroid adenomas were confirmed in 34 (92%) and hyperplasia in three (8%). In 31 patients, adenomas were correctly detected and localized with early SPECT images (sensitivity, 91%). In contrast, the sensitivity of delayed SPECT images was 74% (25 of 34 patients) for detection and 32% (11 of 34 patients) for localization. Early SPECT images were significantly better for localization (P < .001) and detection (P = .03).


CONCLUSIONS
For Tc-99m sestamibi parathyroid imaging, early SPECT images were the most accurate in the detection and localization of parathyroid adenomas.
Perez-Monte
J E
JE
Department of Radiology, University of Pittsburgh Medical Center, PA 15213-2582, USA.
Brown
M L
ML
Shah
A N
AN
Ranger
N T
NT
Watson
C G
CG
Carty
S E
SE
Clarke
M R
MR
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D017256:Technetium Tc 99m Sestamibi