title: Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia.
abstract: OBJECTIVE
  To compare the accuracy of planar scintigraphy, single photon emission computed tomography (SPECT), SPECT-CT, and positron emission tomography (PET) with C-11 methionine for the pre-operative detection of parathyroid adenomas.
  
  
  METHODS
  We retrospectively evaluated the pre-operative studies of 60 patients with primary (n=56) and secondary (n=4) hyperparathyroidism. In 25/60 patients (Group 1), only planar scans were obtained, and additional SPECT and SPECT-CT were carried out in 35/60 patients (Group 2). PET or PET-CT with C-11 methionine was conducted in 8/60 patients (Group 3).
  
  
  RESULTS
  The results of the planar scans (Group 1) were true positive in 19/25 patients and false negative in 6/25 patients (sensitivity per patient, 76%). Histopathology confirmed 27 adenomas and two hyperplasia. Planar imaging identified 20/29 of these pathologies, whereas 9/29 were missed (sensitivity per adenoma, 69%). SPECT (Group 2) results were true positive in 34/35 patients and false negative in only one case (sensitivity per patient, 97%). On a lesion-based analysis, 38 adenomas were identified, and two were missed (sensitivity per adenoma, 95%). The sensitivities of SPECT and SPECT-CT were equal; however, SPECT-CT provided superior topographic information. C-11 methionine PET (Group 3) results were true positive in all eight patients. In one case, surgery confirmed two ipsilateral adenomas, only one of which was identified by PET (sensitivity per patient, 100%; per adenoma, 88.9%).
  
  
  CONCLUSIONS
  SPECT is superior to planar imaging. SPECT-CT has identical sensitivity compared to SPECT alone, but it provides additional topographic information. The sensitivity of PET appears to be even higher compared to SPECT. In the case of negative scintigraphic findings and proven hyperparathyroidism, additional C-11 methionine PET or PET-CT is recommended.
authors.affiliation: Department of Radiology and Nuclear Medicine Basel University Hospital, Basel, Switzerland. oeksuezm@uhbs.ch
authors.forename: Mehmet Ozer
authors.initials: MO
authors.lastname: Oksüz
authors.forename: Helmut
authors.initials: H
authors.lastname: Dittmann
authors.forename: Corinna
authors.initials: C
authors.lastname: Wicke
authors.forename: Karsten
authors.initials: K
authors.lastname: Müssig
authors.forename: Roland
authors.initials: R
authors.lastname: Bares
authors.forename: Christina
authors.initials: C
authors.lastname: Pfannenberg
authors.forename: Susanne Martina
authors.initials: SM
authors.lastname: Eschmann
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging; D008297:Male; D008715:Methionine; D008875:Middle Aged; D064847:Multimodal Imaging; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology*; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; C086242:carbon-11 methionine; D008715:Methionine