Accuracy of preoperative pinhole subtraction single photon emission computed tomography for patients with primary and recurrent hyperparathyroidism in an endemic goiter area.
OBJECTIVE
Bilateral parathyroid exploration is still the standard therapeutic procedure for primary and recurrent hyperparathyroidism (HPTH). Since a unilateral surgical strategy that reduces surgical complications should not increase the risk of missing enlarged parathyroid glands, reliable preoperative imaging is the first requirement for this approach. This study was conducted to assess the accuracy of preoperative (99m)TcO(4)-(201)T1 pinhole subtraction single photon emission computed tomography (SPECT) compared with sonography.


METHODS
The study population consisted of 15 patients with primary (n = 13) or recurrent (n = 2) HPTH who underwent preoperative (99m)TcO(4)-(201)T1 pinhole subtraction SPECT. Preoperative sonography was also done in 14 of these patients.


RESULTS
(99m)TcO(4)-(201)T1 pinhole subtraction SPECT was significantly more accurate than sonography. It had an overall accuracy of 80% in detection of enlarged parathyroid glands. The accuracy of localization increased to 92.3% in patients with solitary adenomas, and to 100% in those with solitary adenomas and no previous parathyroid exploration.


CONCLUSIONS
The high accuracy of preoperative localization with (99m)TcO(4)-(201)T1 pinhole subtraction SPECT in patients with primary and recurrent HPTH allows for an imaging-guided unilateral operative strategy in most patients, even those with concomitant nodular goiters. This may reduce the risk of surgical complications and expand the use of minimally invasive techniques in parathyroid surgery.
Profanter
Christoph
C
Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
Gabriel
Michael
M
Wetscher
Gerold J
GJ
Gadenstätter
Michael
M
Mittermair
Reinhard
R
Moncayo
Roy
R
Prommegger
Rupert
R
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006043:Goiter, Endemic / Q000150:complications*; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012008:Recurrence; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards*; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m