title: Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism.
abstract: The novel trend toward focused parathyroidectomy requires precise preoperative localization of the parathyroid adenoma in patients with primary hyperparathyroidism (PHPT). The present study evaluated the impact of hybrid single photon emission computed tomography/computed tomography (SPECT/CT), using 99mTc-sestamibi (MIBI), on the surgical management of these patients. In a retrospective study of 36 patients with PHPT, SPECT/CT was undertaken when planar 99mTc-MIBI scintigraphy was negative or when an ill-defined focus in the neck or an ectopic site on planar views was visualized. Imaging data were compared with intraoperative findings, and the incremental value of SPECT/CT to lesion localization and surgical procedure was assessed. Three patients with both negative planar and SPECT/CT studies subsequently underwent bilateral neck exploration, with multiglandular hyperplasia diagnosed in two patients and a parathyroid adenoma in one. Of 33 patients with a positive MIBI study, parathyroid adenoma was confined to the neck in 23 patients and to the lower neck-mediastinum in 10. SPECT/CT facilitated the surgical exploration of all 10 ectopic parathyroid adenomas and 4 of 23 cervical parathyroid adenomas, the latter four either at reexploration or in patients with nonvisualization of the thyroid after thyroidectomy. SPECT/CT contributed to the localization of parathyroid adenomas in patients with PHPT and to planning the surgical exploration in 14 of 36 (39%) patients, predominantly those with ectopic parathyroid adenomas or who had distorted neck anatomy.
authors.affiliation: Department of Medical Biophysics and Nuclear Medicine, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel. yodphat@hadassah.org.il
authors.forename: Yodphat
authors.initials: Y
authors.lastname: Krausz
authors.forename: Lise
authors.initials: L
authors.lastname: Bettman
authors.forename: Luda
authors.initials: L
authors.lastname: Guralnik
authors.forename: Galina
authors.initials: G
authors.lastname: Yosilevsky
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
authors.forename: Rachel
authors.initials: R
authors.lastname: Bar-Shalom
authors.forename: Einat
authors.initials: E
authors.lastname: Even-Sapir
authors.forename: Roland
authors.initials: R
authors.lastname: Chisin
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi