title: Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy.
abstract: BACKGROUND
  The current procedure guideline for performing dual-phase (DP) parathyroid scintigraphy, using technetium-99m sestamibi (Tc-99m MIBI) does not mandate the use of single photon emission computed tomography (SPECT) imaging for the detection of parathyroid adenoma (PA) or hyperplasia (PH). The aim of our study was to determine whether DP SPECT (DPS) is significantly superior to DP planar (DPP) imaging in the detection of these abnormalities, justifying its routine use with Tc-99m MIBI parathyroid scintigraphy.
  
  
  METHODS
  Thirty-six consecutive patients with biochemically-proven hyperparathyroidism who subsequently underwent surgical evaluation were studied. All patients underwent early and delayed planar and SPECT imaging at 15 and 90 minutes postinjection of 1.11 GBq (30 mCi) of Tc-99m MIBI. The sensitivity and false-positive rate of DPP and DPS Tc-99m MIBI scintigraphy were compared by retrospectively and blindly interpreting the images and comparing the results with surgical findings.
  
  
  RESULTS
  All 36 patients were shown to have either 1 PA (n=27), 2 PAs (n=1), or PH (n=8). Overall, 29 adenomas and 24 hyperplastic glands were found at surgery. On a per patient basis, the sensitivity for the detection of PA or PH for DPP was 42% (15/36) compared with 67% (24/36) for DPS (P = 0.03). For the detection of PAs, the sensitivity of DPP was 54% (15/28) versus 79% (22/28) for DPS (P = 0.05), whereas for the detection of PH, the sensitivities were 0% (0/8) for DPP versus 25% (2/8) for DPS (P = 0.13). There were 2 false-positive scans using DPP versus only 1 false-positive scan with DPS, resulting in false-positive rates of 7% and 4%, respectively. The combination of DPP and DPS did not add any advantage in detecting either PA or PH compared with DPS alone.
  
  
  CONCLUSIONS
  DPS is significantly more sensitive, and at least as specific, compared with DPP in detecting parathyroid abnormalities in patients with primary hyperparathyroidism and should, therefore, be routinely used when DP Tc-99m MIBI is used in this setting. An algorithm for best utilization of this technique to determine the appropriate surgical approach in patients with primary hyperparathyroidism is presented.
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52246, USA.
authors.forename: Damita L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Twyla
authors.initials: T
authors.lastname: Bartel
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Menda
authors.forename: James
authors.initials: J
authors.lastname: Howe
authors.forename: Michael M
authors.initials: MM
authors.lastname: Graham
authors.forename: Malik E
authors.initials: ME
authors.lastname: Juweid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000473:pathology; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi