Comparison of FDG-PET and sestamibi-SPECT in primary hyperparathyroidism.
Preoperative localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism has been a longstanding diagnostic challenge. This study directly compared FDG-PET and sestamibi-SPECT for preoperative detection of abnormal parathyroid tissue.


METHODS
Twenty-one consecutive patients with primary hyperparathyroidism were studied prospectively before surgical neck exploration. SPECT of the neck and chest was performed at 15 min and 2 hr after intravenous 99mTc-sestamibi. Regional body PET was performed 45 min after intravenous FDG.


RESULTS
Surgery revealed 19 solitary parathyroid adenomas, 2 parathyroid adenomas in one patient; and 3 hyperplastic parathyroid glands in one patient, and 51 normal parathyroid glands. The diagnostic sensitivities for detection of parathyroid adenomas of 43% (9 of 21) for dual-phase sestamibi-SPECT and 86% (18 of 21) for FDG-PET were significantly different (p < 0.001). The difference in diagnostic specificities of 78% (40 of 51) for FDG-PET and 90% (46 of 51) for dual-phase sestamibi-SPECT approached statistical significance (p = 0.063).


CONCLUSIONS
This study demonstrates that FDG-PET is more sensitive than sestamibi-SPECT in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism.
Department of Nuclear Medicine, Cleveland Clinic Foundation, OH 44195-5074, USA.
D R
DR
Neumann
C B
CB
Esselstyn
W J
WJ
Maclntyre
R T
RT
Go
N A
NA
Obuchowski
E Q
EQ
Chen
A A
AA
Licata
D000236:Adenoma / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003847:Deoxyglucose / Q000031:analogs & derivatives*; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon
D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi; D003847:Deoxyglucose