title: [Localisation of parathyroid glands using planar (99m)Tc-sestamibi scintigraphy. Comparison between subtraction- and dual-phase technique].
abstract: OBJECTIVE
  In the context of presurgical localisation of parathyroid adenomas in primary hyper-parathyreoidism (pHPT) using (99m)Tc-sestamibi scintigraphy, subtraction- and dualphase technique are compared with each other and with the surgical findings.
  
  
  METHODS
  Prospectively, 126 patients with pHPT were investigated presurgically. For visualisation of parathyroid adenomas, an image of the thyroid ((99m)Tc-pertechnetat) was subtracted from a perfusion image ((99m)Tc-sestamibi) and 2 h p. i. another image was acquired for identification of retention of activity. Considering both techniques the clinical findings were reported promptly. Retrospectively, the evaluations were presented separately to four experienced raters.
  
  
  RESULTS
  In clinical routine for 109 patients correct findings were reported presurgically (87%). From 129 resected parathyroid adenomas 118 were localised correctly (sensitivity 91%, positive predictive value 94%). Concerning the retrospective analysis, in 75% of the cases both techniques provided the correct site, in 14% only the dual-phase technique and in 7% only the subtraction-technique was correct. With the help of the dual-phase technique significantly more investigations were correctly rated than with the help of the subtraction technique (88.7 +/- 3.2% vs. 81.6 +/- 1.2%, p < 0.01, two-sided t-test).
  
  
  CONCLUSIONS
  The presurgical scintigraphic localisation of hyperactive parathyroid glands in pHPT assists minimal invasive surgery serving a high rate of correct findings. According to our data the dual-phase technique seems to be more sensitive than the subtraction technique. In some cases, however, the correct site may only be found using the subtraction technique. For an optimal surgical strategy we suggest the combination of both techniques.
authors.affiliation: Nuklearmedizinische Klinik, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf. schommar@uni-duesseldorf.de
authors.forename: B
authors.initials: B
authors.lastname: Schommartz
authors.forename: K
authors.initials: K
authors.lastname: Cupisti
authors.forename: C
authors.initials: C
authors.lastname: Antke
authors.forename: D
authors.initials: D
authors.lastname: Schmidt
authors.forename: W-T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: H-W
authors.initials: HW
authors.lastname: Müller
mesh_terms: D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi