title: Accuracy of early-phase versus dual-phase single-photon emission computed tomography/computed tomography in the localization of parathyroid disease.
abstract: OBJECTIVE
  Preoperative localization for parathyroid disease has improved in recent years with the advent of dual-phase (99m) Tc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. However, dual-phase imaging is associated with increased cost, time, and radiation dose. The aim of this study was to investigate the need for late-phase imaging when using SPECT/CT for the preoperative localization of parathyroid disease.
  
  
  METHODS
  Retrospective chart analysis.
  
  
  METHODS
  A retrospective review of 75 patients who underwent preoperative imaging localization and subsequent surgical resection for parathyroid disease at a tertiary referral center was performed. Of these, 50 patients met study criteria including preoperative SPECT/CT imaging and specific reporting of early- and late-phase focal radiotracer uptake. Localization accuracy was verified with definitive surgical findings confirmed by histological analysis and evidence of biochemical cure.
  
  
  RESULTS
  Accurate localization of adenoma(s) was seen in 78.0% of patients using dual-phase SPECT/CT. Early-phase imaging alone localized 76.0%, whereas late-phase imaging alone localized 74.0%. Sensitivity and specificity for dual-phase imaging was 84.8% and 89.6%, respectively. In comparison, early-phase localization alone was found to have a sensitivity/specificity of 84.4%/89.4%; sensitivity/specificity of late-phase scanning alone was found to be 80.4%/89.1%. Dual-phase SPECT/CT scanning did not provide a statistically significant improvement in adenoma localization when compared to early-phase scanning alone.
  
  
  CONCLUSIONS
  Although further investigation is needed, the results of this study suggest that early-phase SPECT/CT scanning alone may obviate the need for dual-phase SPECT/CT scanning in the initial preoperative localization workup of parathyroid disease.
  
  
  METHODS
  4.
authors: Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, U.S.A.|Department of Surgery, Division of Otolaryngology, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors: Rajarsi
authors: R
authors: Mandal
authors: Department of Radiology, Division of Nuclear Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors: Ashok
authors: A
authors: Muthukrishnan
authors: Department of Surgery, Division of Otolaryngology, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors: Robert L
authors: RL
authors: Ferris
authors: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.
authors: John R
authors: JR
authors: de Almeida
authors: Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, U.S.A.|Department of Surgery, Division of Otolaryngology, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors: Umamaheswar
authors: U
authors: Duvvuri
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016105:Parathyroidectomy; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Parathyroid; minimally invasive parathyroidectomy; parathyroid preoperative localization; parathyroid single-photon emission computed tomography/computed tomography