title: Value of 123I-subtraction and single-photon emission computed tomography in addition to planar 99mTc-MIBI scintigraphy before parathyroid surgery.
abstract: OBJECTIVE
  To find out if single-photon emission computed tomography (SPECT) and (123)I-subtraction can enhance the findings of (99m)Tc-methoxyisobutylisonitrile (MIBI) scintigraphy for the preoperative localization of parathyroid (PT) tumors.
  
  
  METHODS
  Among the 111 consecutive patients who underwent preoperative planar (99m)Tc-MIBI scintigraphy for hyperparathyroidism (HPT), 64 underwent delayed SPECT, and 17 underwent (123)I-subtraction. Two independent blinded experts scored the topographical localization, diagnostic confidence, and impact of each diagnostic modality on the surgical strategy.
  
  
  RESULTS
  For adenomas, (99m)Tc-MIBI scintigraphy had a sensitivity of 77% with a positive predictive value (PPV) of 83%. SPECT did not affect the sensitivity or PPV, but it increased the diagnostic confidence and changed the surgical strategy in 21% of the patients. (123)I-subtraction increased the sensitivity from 64% to 82%, but decreased the PPV from 88% to 82%. In hyperplastic glands, (99m)Tc-MIBI scintigraphy had a sensitivity of 47% and a PPV of 95%. When (99m)Tc-MIBI scintigraphy was combined with SPECT and (123)I-subtraction, the results were 44%/10% and 52%/92%, respectively. Both SPECT and (123)I-subtraction decreased the diagnostic confidence.
  
  
  CONCLUSIONS
  Adding SPECT to (99m)Tc-MIBI scintigraphy improved the surgical decision for parathyroid adenomas. The addition of (123)I-subtraction was of limited value. For hyperplastic glands, (99m)Tc-MIBI scintigraphy was relatively ineffective, even with the addition of SPECT or (123)I-subtraction.
authors.affiliation: Department of Surgical Oncology, University of Groningen, Groningen, The Netherlands.
authors.forename: Francisca H
authors.initials: FH
authors.lastname: Jorna
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
authors.forename: Tjin H
authors.initials: TH
authors.lastname: Que
authors.forename: Clara
authors.initials: C
authors.lastname: Lemstra
authors.forename: John T M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013382:Subtraction Technique; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi