title: Impact of image fusion and attenuation correction by SPECT-CT on the scintigraphic detection of parathyroid adenomas.
abstract: OBJECTIVE
  In addition to planar parathyroid scintigraphy, SPECT and image fusion with CT/MR improve adenoma detection in primary hyperparathyroidism (pHPT). This study evaluated the use of a hybrid SPECT-CT device concerning image fusion and attenuation correction (AC).
  
  
  METHODS
  The data of 26 patients with pHPT, preoperatively examined by (99m)Tc-sestamibi dual-phase scintigraphy plus SPECT-CT (low-dose CT), was retrospectively evaluated by two observers in a consensus reading. The images of planar scintigraphy, non-attenuation corrected SPECT (SPECT(NAC)), attenuation corrected SPECT (SPECT(AC)) and SPECT(AC)-CT were interpreted and compared to the results of surgery. The effect of AC on focus intensity was semiquantified by determination of the tumor-to-background (TB) ratio for SPECT(AC) and SPECT(NAC). Finally, the TB(AC)/TB(NAC)-ratio was calculated for each focus and correlated to the distance of a focus from the body surface.
  
  
  RESULTS
  20/26 (77%) patients were positive in planar scintigraphy. One focus was detected by SPECT only. AC of SPECT-data increased image contrast but had no impact on the detection rate. Additional SPECT(AC)-CT image fusion facilitated the localization of three mediastinal foci. In the semiquantitative analysis an increase in TB after AC was observed, although there was no strong correlation between depth of the focus (16-60 mm) and the TB(AC)/TB(NAC)-ratio (r = 0.213, p = 0.353).
  
  
  CONCLUSIONS
  The detection rate of planar scintigraphy is only slightly improved by SPECT imaging. Due to the low spatial resolution of the CT component, the benefit of image fusion is limited to mediastinal foci. However, as TB and image contrast is measurably improved after AC there is a potential to improve the sensitivity of parathyroid SPECT.
authors.affiliation: Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin. juri.ruf@charite.de
authors.forename: J
authors.initials: J
authors.lastname: Ruf
authors.forename: D
authors.initials: D
authors.lastname: Seehofer
authors.forename: T
authors.initials: T
authors.lastname: Denecke
authors.forename: L
authors.initials: L
authors.lastname: Stelter
authors.forename: N
authors.initials: N
authors.lastname: Rayes
authors.forename: R
authors.initials: R
authors.lastname: Felix
authors.forename: H
authors.initials: H
authors.lastname: Amthauer
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome