title: Sensitivity and Specificity of Dual-Isotope 99mTc-Tetrofosmin and 123I Sodium Iodide Single Photon Emission Computed Tomography (SPECT) in Hyperparathyroidism.
abstract: OBJECTIVE
  Despite recommendations for 99mTc-tetrofosmin dual tracer imaging for hyperparathyroidism in current guidelines, no report was published on dual-isotope 99mTc-tetrofosmin and 123I sodium iodide single-photon-emission-computed-tomography (SPECT). We evaluated diagnostic accuracy and the impact of preoperative SPECT on the surgical procedures and disease outcomes.
  
  
  METHODS
  Analysis of 70 consecutive patients with primary hyperparathyroidism and 20 consecutive patients with tertiary hyperparathyroidism. Imaging findings were correlated with surgical results. Concomitant thyroid disease, pre- and postoperative laboratory measurements, histopathological results, type and duration of surgery were assessed.
  
  
  RESULTS
  In primary hyperparathyroidism, SPECT had a sensitivity of 80% and a positive predictive value of 93% in patient-based analysis. Specificity was 99% in lesion-based analysis. Patients with positive SPECT elicit higher levels of parathyroid hormone and higher weight of resected parathyroids than SPECT-negative patients. Duration of parathyroid surgery was on average, approximately 40 minutes shorter in SPECT-positive than in SPECT-negative patients (89 ± 46 vs. 129 ± 41 minutes, p = 0.006); 86% of SPECT-positive and 50% of SPECT-negative patients had minimal invasive surgery (p = 0.021). SPECT had lower sensitivity (60%) in patients with tertiary hyperparathyroidism; however, 90% of these patients had multiple lesions and all of these patients had bilateral lesions.
  
  
  CONCLUSIONS
  Dual-isotope SPECT with 99mTc-tetrofosmin and 123I sodium iodide has a high diagnostic value in patients with primary hyperparathyroidism and allows for saving of operation time. Higher levels of parathyroid hormone and higher glandular weight facilitated detection of parathyroid lesion. Diagnostic accuracy of preoperative imaging was lower in patients with tertiary hyperparathyroidism.
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Sommerauer
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Carmen
authors.initials: C
authors.lastname: Graf
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Niklaus
authors.initials: N
authors.lastname: Schäfer
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Huber
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Schneider
authors.affiliation: Division of Nephrology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Wüthrich
authors.affiliation: Division of Endocrinology and Diabetology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Steinert
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000601:surgery; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D057234:Preoperative Period; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012974:Sodium Iodide; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C078700:technetium tc-99m tetrofosmin; D012974:Sodium Iodide