title: A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: ultrasonography, 99mTc sestamibi, single photon emission computed tomography, and magnetic resonance imaging.
abstract: OBJECTIVE
  This study compares the accuracy rates achieved in ultrasonography (US), 99mTc-sestamibi (MIBI), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) as imaging methods used in the pre-operative localization of the enlarged parathyroid glands.
  
  
  METHODS
  For the purposes of this study, US, MIBI, SPECT, and MRI were performed on 98 patients with primary hyperparathyroidism (pHPT). All patients underwent parathyroidectomy.
  
  
  RESULTS
  Pre-operative localization of an abnormal parathyroid gland was successfully performed in 82 of the cases scanned with US (83.7%), while the result was 66 in the cases scanned with MIBI (67.3%), 71 of the cases were successfully localized with SPECT (72.4%), while MRI revealed the diseased gland in only 60 of the total cases (61.2%). In MIBI-positive and -negative patients there was a statistically significant difference among cases in terms of adenoma volume (1.30±1.51 vs 0.58±0.91, p<0.05). Sensitivity, specificity and diagnostic accuracy values were 87.2%, 25.0%, and 83.0%; 70.2%, 50.0%, and 69.4%; 75.5%, 50.0%, and 74.5%; 63.8%, 50.0%, and 63.3% for US, MIBI, SPECT, and MRI, respectively. The respective values for sensitivity, specificity, and diagnostic accuracy were 94.9%, 25.0%, and 91.1% when US was combined with MIBI.
  
  
  CONCLUSIONS
  Combining US and MIBI as imaging methods for pre-operative imaging of pHPT often produces more satisfactory results. While the accuracy of US is relatively low in the ectopic localizations, the size of the lesion can be an important factor in the accuracy achieved with MIBI.
authors.affiliation: Department of Endocrinology and Metabolism, Ankara Numune Research and Training Hospital, Ministry of Health, No.28 Dikmen, Ankara, Turkey. gulhanakcil@yahoo.com.tr
authors.forename: G
authors.initials: G
authors.lastname: Akbaba
authors.forename: D
authors.initials: D
authors.lastname: Berker
authors.forename: S
authors.initials: S
authors.lastname: Isik
authors.forename: Y
authors.initials: Y
authors.lastname: Aydin
authors.forename: D
authors.initials: D
authors.lastname: Ciliz
authors.forename: I
authors.initials: I
authors.lastname: Peksoy
authors.forename: U
authors.initials: U
authors.lastname: Ozuguz
authors.forename: Y A
authors.initials: YA
authors.lastname: Tutuncu
authors.forename: S
authors.initials: S
authors.lastname: Guler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D017256:Technetium Tc 99m Sestamibi