A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism

Abstract

Ultrasound and sestamibi-SPECT are similar in ability to preoperatively localize abnormal parathyroid glands in pHPT. Accuracy may be improved with 4D-CT; however, further investigation is required. Choice of preoperative imaging strategy depends on numerous patient, institutional, and economic factors of which the surgeon must be aware.

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

“…This could be because patients who underwent DTDP imaging were patients who initially underwent DT imaging and findings from the initial Tc-99m sestamibi and Tc-99m pertechnetate images were deemed insufficient for diagnosis by the nuclear medicine physician on duty thus prompting further delayed imaging, so patients in the DTDP group represented 'difficult' patients which findings were likely to be inconclusive to begin with. Both add-on SPECT and SPECT/CT improved the diagnostic accuracy over planar imaging alone which concurs with previous studies [5,[16][17][18][19]28]. However, SPECT imaging appeared to have a higher diagnostic accuracy than SPECT/CT which is unexpected and contradicts a previous study which demonstrated the superiority of SPECT/CT over SPECT alone [29].…”

“…Preoperative localization of hyperfunctioning parathyroid glands can be done by various imaging modalities including ultrasound [5][6][7][8], magnetic resonance imaging [5,9,10], and computed tomography [5]. However, the modality most utilized is nuclear medicine isotopic imaging using various radiopharmaceuticals.…”

4D-CT for Preoperative Localization of Abnormal Parathyroid Glands in Patients with Hyperparathyroidism: Accuracy and Ability to Stratify Patients by Unilateral versus Bilateral Disease in Surgery-Naïve and Re-Exploration Patients

“…8 4D-CT has been proposed as an alternative or adjunctive method for preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. [9][10][11][12][13] Multiple recent studies have indicated that 4D-CT may be especially useful for preoperative localization in patients with negative or inconclusive results on sonography and technetium Tc99m sestamibi studies, reoperative parathyroid patients, patients with mild hypercalcemia, and in patients with multigland disease. [14][15][16][17][18] However, previously published reports have predominantly evaluated cohorts with small numbers of patients and have focused on specific patient populations with strict exclusion criteria.…”

Minimally Invasive Parathyroidectomy for Primary Hyperparathyroidism - Current Views, Issues and Controversies

“…When comparing the accuracy in detecting abnormal parathyroid glands between MIBI and USG, some have found that MIBI is more accurate than USG while other studies have found the opposite or similar accuracies. (Cheung et al, 2011) In our experience, MIBI has a higher overall sensitivity, accuracy and positive predicted value (PPV) in detecting abnormal parathyroid glands than USG (85%, 97% vs 94% vs. 57% vs 89%, 56%, respectively). (Lo et al, 2007) In fact, at our institution, we would rely more on the findings of the MIBI than USG.…”

“…Therefore, the authors concluded that MIBI-SPECT and USG had similar localization ability but 4D-CT may have improved accuracy. (Cheung et al, 2011) …”