title: Dual-isotope 99mTc-MIBI/123I parathyroid scintigraphy in primary hyperparathyroidism: comparison of subtraction SPECT/CT and pinhole planar scan.
abstract: OBJECTIVE
  In patients with primary hyperparathyroidism, the preoperative imaging objective is to locate accurately and reliably uniglandular or multiglandular hyperfunctioning parathyroid, to guide surgery, particularly for minimally invasive method. Subtraction planar scintigraphy with dual-isotope (I/Tc-MIBI) is an efficient examination to specify abnormal parathyroid location, but without accurate anatomic reference. This lack should be avoided by a hybrid SPECT/CT image acquisition.
  
  
  METHODS
  We compared planar scans (neck and mediastinum parallel-hole, associated with anterior neck pinhole) to neck and mediastinum SPECT/CT, all with subtraction (I/Tc-MIBI) method, in exact location of abnormal parathyroid in 50 patients with sporadic primary hyperparathyroidism. Surgical and histological findings were used as the standard of comparison.
  
  
  RESULTS
  Sensitivity is equivalent for the 2 protocols (86% and 75% for SPECT/CT and planar protocol, respectively, P = 0.15), but SPECT/CT was highly specific (specificity 100% and 90% for SPECT/CT and planar protocol, respectively, P = 0.04). In patients with concomitant thyroid disease, subtraction SPECT/CT appeared to be more sensitive than planar protocol (88% and 62% for SPECT/CT and planar protocol, respectively, P = 0.04).
  
  
  CONCLUSIONS
  In preoperative assessment of primary hyperparathyroidism and to guide surgery, we propose to perform first subtraction SPECT/CT and to complete it with neck pinhole, only if tomoscintigraphy is negative.
authors.affiliation: From the *Service de Médecine Nucléaire, CLCC Paul Strauss, Strasbourg, France; †Service de Médecine Nucléaire, Institut Salah Azaiez, Tunis, Tunisia; and ‡Service de Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Hassler
authors.forename: Dorra
authors.initials: D
authors.lastname: Ben-Sellem
authors.forename: Fabrice
authors.initials: F
authors.lastname: Hubele
authors.forename: Andre
authors.initials: A
authors.lastname: Constantinesco
authors.forename: Christian
authors.initials: C
authors.lastname: Goetz
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging*; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D007457:Iodine Radioisotopes; D008875:Middle Aged; D064847:Multimodal Imaging; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D013382:Subtraction Technique; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D017256:Technetium Tc 99m Sestamibi