Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism.
OBJECTIVE
Our purpose was to compare double-phase 99mTc-sestamibi single-photon emission computed tomography (SPECT) and simultaneous 123I-99mTc-sestamibi subtraction SPECT for preoperative localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism.


METHODS
Fifteen patients with primary hyperparathyroidism underwent preoperative double-phase 99mTc-sestamibi SPECT and simultaneous 123I-99mTc-sestamibi subtraction SPECT imaging. At surgery, the location, weight, and histopathologic evaluation of all identified parathyroid glands were recorded.


RESULTS
At surgery, 17 parathyroid adenomas and 37 normal parathyroid glands were identified. The sensitivity, specificity, and diagnostic accuracy for the detection of parathyroid adenomas were 88%, 97%, and 94%, respectively, for simultaneous 123I-99mTc-sestamibi subtraction SPECT and 53%, 86%, and 76%, respectively, for double-phase 99mTc-sestamibi SPECT. The differences in sensitivity and diagnostic accuracy were statistically significant (p = .031 and p = .016, respectively).


CONCLUSIONS
Compared with double-phase 99mTc-sestamibi SPECT, simultaneous 123I-99mTc-sestamibi subtraction SPECT is a superior imaging study for the preoperative localization of hyperfunctioning parathyroid tissue.
Neumann
D R
DR
Department of Nuclear Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Esselstyn
C B
CB
Go
R T
RT
Wong
C O
CO
Rice
T W
TW
Obuchowski
N A
NA
D000236:Adenoma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging*; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012974:Sodium Iodide; D013382:Subtraction Technique; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D012974:Sodium Iodide