title: Contribution of early SPECT/CT to99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters.
abstract: OBJECTIVE
  To evaluate the value of99mTc-MIBI double-phase scintigraphy (DPS) and early SPECT/CT in the pre-surgical assessment of patients with primary hyperparathyroidism (PHPT). Also, to calculate the correlation between uptake and some biological parameters.
  
  
  METHODS
  Forty patients with PHPT were included: 37 solitary adenomas, 1 hyperplasia, and 2 double adenomas. Fifteen patients had ectopic glands. DPS and early SPECT/CT were acquired in all patients. Ultrasound was performed in 31/40. All patients underwent surgery, intra-operative iPTH measurements, and histopathological examinations. Qualitative DPS uptake was assessed and correlated to pre-surgical calcium, iPTH levels, gland weight, and maximum diameter.
  
  
  RESULTS
  In the planar study, there were 23 positive cases, 8 doubtful, and 9 negatives. With the SPECT/CT, 8/9 negatives cases were located. All doubtful cases were confirmed as positives. Gland location improved in 16 cases (12 ectopic). DPS+SPECT/CT failed to detect a solitary adenoma and at least one gland in three cases of multiglandular disease (MGD). The sensitivity by patient was: DPS 72.5%, DPS+SPECT/CT 90%, and ultrasound 42%. Ultrasound and scintigraphy (DPS+SPECT/CT) were concordant in 16/31 patients. For the rest of them, scintigraphy proved correct in 14/15, and both techniques failed in one case. There was a significant correlation between level of uptake and iPTH level, gland weight, and maximum diameter.
  
  
  CONCLUSIONS
  Early SPECT/CT improves sensitivity and the locating of parathyroid pathological glands and increases diagnostic confidence. iPTH level, glandular size, and weight are related to the qualitative assessment of99mTc-MIBI uptake in early DPS.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, Spain. Electronic address: palomagtalavera@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: García-Talavera
authors.affiliation: Servicio de Endocrinología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Díaz-Soto
authors.affiliation: Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: A A
authors.initials: AA
authors.lastname: Montes
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: J G
authors.initials: JG
authors.lastname: Villanueva
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cobo
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gamazo
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Ruiz
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: González-Selma
mesh_terms: D042241:Early Diagnosis; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D017256:Technetium Tc 99m Sestamibi / Q000493:pharmacokinetics
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: (99m)Tc-MIBI double-phase scintigraphy; Early SPECT/CT; Gammagrafía de doble fase con (99m)Tc-MIBI; Glandular size; Hiperparatiroidimo primario; PTHi; Primary hyperparathyroidism; SPECT/TC precoz; Tamaño glandular; iPTH