title: Preoperative [99mTc]MIBI SPECT/CT Interpretation Criteria for Localization of Parathyroid Adenomas-Correlation with Surgical Findings.
abstract: Minimally invasive surgery for parathyroid adenomas (PTA) requires precise identification and localization of the diseased gland prior to exploration for optimal surgical planning. The Perrier classification allows for accurate, reproducible, and reliable description of PTA location and communication of clinically significant information to surgeons. The current study compares the Perrier localization of PTA on [99mTc]methoxyisobutylisonitrile ([99mTc]MIBI) single-photon emission computed tomography (SPECT)/X-ray computed tomography (CT) with the results of surgery.
  
  
  
  Eighty-eight patients (60 females), age 13-82 years, with primary hyperparathyroidism underwent [99mTc]MIBI SPECT/CT prior to surgery. Eight patients had parathyroid hyperplasia and underwent excision of 3.5 parathyroid glands, including five patients with a negative [99mTc]MIBI study and three patients with multiple foci of uptake, and were excluded from further analysis. Each PTA was localized to Perrier levels A-G. The surgeon located each PTA found on surgery using the same classification. PTA localization on SPECT/CT and at surgery was compared.
  
  
  
  Eighty patients with surgically confirmed PTA were analyzed. On [99mTc]MIBI SPECT/CT, 63 patients had a single and one patient had two PTAs for a total of 65 PTAs. At surgery, 85 PTAs were resected in 80 patients, including 75 patients with single and 5 with two PTAs. Twenty PTAs found on surgery were not detected on [99mTc]MIBI. The relatively lower weight of these 20 PTAs is probably the main reason for the false-negative results group. The same Perrier localization was determined on SPECT/CT and surgery in 52/65 PTAs (80 %). In the 13 incongruent cases, the PTAs were localized at different locations but on the same side of the thyroid gland.
  
  
  
  [99mTc]MIBI SPECT/CT accurately localized a PTA according to the Perrier classification in 80 % of cases. Reporting SPECT/CT results using anatomy-based PTA localization criteria accepted by surgeons can contribute significantly towards better interspecialty communication and will improve performance of minimally invasive surgical removal of PTAs.
authors.affiliation: Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel. zohar@keidar.net.|B&R Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. zohar@keidar.net.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
authors.affiliation: Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Elena
authors.initials: E
authors.lastname: Solomonov
authors.affiliation: Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Karry
authors.affiliation: Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Frenkel
authors.affiliation: Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.|B&R Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
authors.affiliation: Department of Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Mekel
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*; D017256:Technetium Tc 99m Sestamibi / Q000737:chemistry*; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi
keywords: Parathyroid adenoma; Perrier classification; [99mTc]MIBI SPECT/CT