CT-MIBI image fusion: a new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism.
BACKGROUND
Successful minimally invasive or imaging-guided operations in patients with primary, recurrent, and persistent hyperparathyroidism are based on the reliability of preoperative parathyroid localization studies. The CT-MIBI image fusion promises a higher diagnostic accuracy than current imaging procedures. The aim of our study was to assess its reliability in correctly detecting enlarged parathyroid glands.


METHODS
In a prospective study 24 consecutive patients underwent CT-MIBI image fusion as preoperative parathyroid localization procedure. The results of technetium 99m sestamibi single photon emission computed tomography (MIBI-SPECT) alone, today the standard method in parathyroid imaging, and CT-MIBI image fusion were analyzed by a blinded reviewer, and the imaging results were compared with the intraoperative findings.


RESULTS
For CT-MIBI image fusion a sensitivity of 93% and a specificity of 100% in correctly detecting the position of enlarged parathyroid glands was calculated and compared with a sensitivity of MIBI-SPECT of 31% and a specificity of 87% (P<.001). This new imaging technique enabled us to successfully treat 22 of our patients (92%) with imaging-guided surgery. Twenty (83%) underwent unilateral or minimally invasive operations.


CONCLUSIONS
CT-MIBI image fusion appears to be superior to MIBI-SPECT in preoperative parathyroid imaging. CT-MIBI image fusion can be performed on existing CT- and MIBI-SPECT units. We recommend this method for preoperative localization in patients with primary, recurrent and persistent hyperparathyroidism.
Profanter
Christoph
C
Department of General and Transplantation Surgery, Nuclear Medicine, University of Innsbruck, Innsbruck, Austria.
Wetscher
Gerold J
GJ
Gabriel
Michael
M
Sauper
Tonja
T
Rieger
Michael
M
Kovacs
Peter
P
Bale
Reto
R
Prommegger
Rupert
R
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D012008:Recurrence; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*