title: 99mTc-MIBI pinhole SPECT in primary hyperparathyroidism: comparison with conventional SPECT, planar scintigraphy and ultrasonography.
abstract: OBJECTIVE
  A pinhole collimator is routinely used to increase the resolution of scintigraphy. This prospective study was conducted to determine the interest of (99m)Tc-MIBI pinhole single-photon emission computed tomography (SPECT) for the preoperative localisation of parathyroid lesions in primary hyperparathyroidism.
  
  
  METHODS
  All patients underwent a neck ultrasonography (US), (99m)TcO4- and (99m)Tc-MIBI planar images and two consecutive SPECT with a parallel (C-SPECT) and a pinhole collimator (P-SPECT). P-SPECT was performed with a tilted detector equipped with a pinhole collimator and reconstructed with a dedicated OSEM algorithm. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extra-thyroidal location of suspected lesions: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive. The results of these preoperative localisation studies were compared with surgical, pathological and 6-month biological findings.
  
  
  RESULTS
  Fifty-one patients cured after surgery were included. Surgery revealed 55 lesions (median weight 0.5 g, 11 in ectopy). Sensitivities of US, planar imaging, C-SPECT and P-SPECT were, respectively, 51, 76, 82 and 87%. Nine glands were only detected by tomography and five glands only by P-SPECT. 99mTc-MIBI/99mTcO4- planar scans and P-SPECT were complementary and, when combined together, showed the highest sensitivity (93%). Compared with planar imaging and C-SPECT, P-SPECT increased CS for 42 and 53% of lesions, respectively, and contributed to markedly reduce the number of uncertain results.
  
  
  CONCLUSIONS
  A combination of planar 99mTc-MIBI/99mTcO4- scintigraphy and P-SPECT appears to be a highly accurate preoperative imaging procedure in primary hyperparathyroidism.
authors.affiliation: Nuclear Medicine Department, Hôtel Dieu University Hospital, Nantes, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Carlier
authors.forename: Aurore
authors.initials: A
authors.lastname: Oudoux
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallié
authors.forename: Alain
authors.initials: A
authors.lastname: Seret
authors.forename: Isabelle
authors.initials: I
authors.lastname: Daumy
authors.forename: Christophe
authors.initials: C
authors.lastname: Leux
authors.forename: Caroline
authors.initials: C
authors.lastname: Bodet-Milin
authors.forename: Françoise
authors.initials: F
authors.lastname: Kraeber-Bodéré
authors.forename: Catherine
authors.initials: C
authors.lastname: Ansquer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi