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

Raruenrom, Yutapong; Theerakulpisut, Daris; Wongsurawat, Nantaporn; Somboonporn, Charoonsak

doi:10.5603/nmr.a2018.0003

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…We achieved superior specificity and very high PPV using our dual tracer dual-time-point imaging protocol with SPECT/CT in comparison with the recent study by Raruenrom et al that report sensitivity 80%, specificity 75%, PPV 88.9%, NPV 60% and accuracy 78.6% using the same comprehensive imaging (8). Neumann et al who performed 123 I-NaI/ 99m Tc-MIBI subtraction and SPECT/CT achieved higher patient-based 88% sensitivity and the same 96% specificity (9).…”

Section: Discussionsupporting

confidence: 61%

Dual Tracer 99mTc-Pertechnetate/99mTc-MIBI Dual-Time-Point SPECT/CT Parathyroid Gland Assessment Regarding to Parathyroid Gland Size and Biochemical Parameters – Two Years Single Imaging Centre Experience

Krčálová

Horáček

Nováková³

et al. 2019

Acta Med. (Hradec Kralove, Czech Repub.)

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Introduction: Preoperative parathyroid imaging is inevitable part of focused parathyroid surgery. The aim of our study was assessment of parathyroid scintigraphy diagnostic accuracy regarding to size and metabolic parameters of hyperfunctioning parathyroid tissue. Material and methods: Parathyroid scintigraphy for suspected primary hyperparathyroidism was performed in 95 patients during years 2015 and 2016. Of them, 75 patients with known clinical outcome (40 underwent surgery, 35 had documented laboratory follow-up) were further retrospectively evaluated. The performance of dual tracer 99mTc-pertechnetate and 99mTc-MIBI subtraction and dual-time-point 99mTc-MIBI imaging with SPECT/CT was analysed. Serum parathyroid hormone (PTH), calcaemia, ionized calcaemia and phosphataemia and ultrasound detected adenoma volume and largest diameter in false negative and true positive findings were compared using Mann-Whitney test. Results: Sensitivity and specificity of parathyroid scintigraphy was 74.5% and 95.8%, respectively. NPV was 63.8% and PPV 97.4%. Hyperfunctioning parathyroid tissue detectability was almost significantly associated with hypophosphataemia and PTH levels. Conclusion: Parathyroid scintigraphy provides high sensitivity and superior specificity in parathyroid adenoma location, nevertheless the diagnostic accuracy tends to decline in smaller adenomas and in less metabolically active parathyroid tissue causing only subtle biochemical changes. 18F-Fluorocholine PET/CT or 3D SPECT/CT subtraction should be a reasonable option for those cases.

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Section: Discussionsupporting

confidence: 61%

Dual Tracer 99mTc-Pertechnetate/99mTc-MIBI Dual-Time-Point SPECT/CT Parathyroid Gland Assessment Regarding to Parathyroid Gland Size and Biochemical Parameters – Two Years Single Imaging Centre Experience

Krčálová

Horáček

Nováková³

et al. 2019

Acta Med. (Hradec Kralove, Czech Repub.)

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“…A sensitivity of 92.6% and accuracy of 81.2% is comparable with the literature data [2,30]. A specificity of 40% is much lower than that achieved by other authors [2,6,9,30,35]. This could have been affected by including Type IV lesions in the calculation.…”

Section: Originalsupporting

confidence: 82%

The diagnostic value of dual-phase SPECT/CT scintigraphy based on transport kinetics of 99mTc-sestamibi confirmed with histopathological findings in patients with secondary hyperparathyroidism — practical consideration

et al. 2020

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BACKGROUND: Dual phase 99m Tc-sestamibi SPECT/CT preoperative parathyroid scintigraphy (PPS) is seldom discussed in terms of the transport kinetics of the tracer. Objectives: To assess the relationship between the characteristic type of tracer transport in particular PPS and histopathological findings in patients with secondary hyperparathyroidism (sHPT). MATERIAL AND METHODS: The study comprised 27 patients (13 females and 14 males) with sHPT. Based on tracer accumulation in early phase (EP) and delayed phase (DP), the following types of accumulation for PPS(+) lesions were identified: EP(-)/ /DP(+) (type I), EP(+)/DP(+) (type II), EP(+)/DP(-) (type III). EP(-)/DP(-) (type IV) lesions constituted PPS(-) group invisible in SPECT/CT. Overall, 69 lesions 59 PPS(+) and 10 PPS(-) were evaluated histopathologically.RESULTS: Among SPECT/CT PPS(+), types I, II and III occurred in 9 (15%), 49 (83%), and 1 (2%) lesions, respectively. The frequency of histopathological diagnosis of normal and abnormal (APG -adenoma or hyperplasia) parathyroid gland, as well as non-parathyroid (thyroid, lymph nodes, or fat) lesions differed significantly between type I, II, and III lesions (p = 0.036).APG histopathological diagnosis was significantly more frequent in lesions with type II uptake than in lesions with type I uptake (76% vs. 33%, p = 0.0197). Type II lesions had significantly higher odds for histopathological diagnosis of APG or NPG than type IV, PPS(-) lesions [odds ratio = 13.1 (95% CI: 2.75 to 63.27)]. CONCLUSIONS:For SHP patients evaluated with SPECT/CT PPS accumulation type I is a weak premise for surgeon to find parathyroid pathology. Only persistent 99m Tc-sestamibi accumulation in both phases -equivocal with accumulation type II -effectively differentiates parathyroid and non-parathyroid lesions as well as indicates with high probability the presence of adenoma or hyperplasia. Type III consistent with washout pattern is rare in sHPT.

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“…Specifity and sensitivity of the SPECT imaging of parathyroid gland depends on scintigraphy protocol [16][17][18].…”

Section: Preoperative Imaging Ultrasonography Planar Scintigraphy Spementioning

confidence: 99%

Estimation of Parameters of Parathyroid Glands Using Particle Swarm Optimization and Multivariate Generalized Gaussian Function Mixture

et al. 2019

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Featured Application: The analyzed technique allows the estimation of parameters of small objects from SPECT volumes. Data analysis was based on Particle Swarm Optimization that reduces error between assumed model and measurements. Analysis by Synthesis was used for the estimation of parameters. Abstract: The paper introduces a fitting method for Single-Photon Emission Computed Tomography (SPECT) images of parathyroid glands using generalized Gaussian function for quantitative assessment of preoperative parathyroid SPECT/CT scintigraphy results in a large patient cohort. Parathyroid glands are very small for SPECT acquisition and the overlapping of 3D distributions was observed. The application of multivariate generalized Gaussian function mixture allows modeling, but results depend on the optimization algorithm. Particle Swarm Optimization (PSO) with global best, ring, and random neighborhood topologies were compared. The obtained results show benefits of random neighborhood topology that gives a smaller error for 3D position and the position estimation was improved by about 3% voxel size, but the most important is the reduction of processing time to a few minutes, compared to a few hours in relation to the random walk algorithm. Moreover, the frequency of obtaining low MSE values was more than two times higher for this topology. The presented method based on random neighborhood topology allows quantifying activity in a specific voxel in a short time and could be applied it in clinical practice.

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

Abstract: BACKGROUND: Several parathyroid scintigraphy protocols have been used for preoperative localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism. The aim of this study is to compare the diagnostic accuracy of vari-

Cited by 15 publications

References 21 publications

Dual Tracer 99mTc-Pertechnetate/99mTc-MIBI Dual-Time-Point SPECT/CT Parathyroid Gland Assessment Regarding to Parathyroid Gland Size and Biochemical Parameters – Two Years Single Imaging Centre Experience

Dual Tracer 99mTc-Pertechnetate/99mTc-MIBI Dual-Time-Point SPECT/CT Parathyroid Gland Assessment Regarding to Parathyroid Gland Size and Biochemical Parameters – Two Years Single Imaging Centre Experience

The diagnostic value of dual-phase SPECT/CT scintigraphy based on transport kinetics of 99mTc-sestamibi confirmed with histopathological findings in patients with secondary hyperparathyroidism — practical consideration

Estimation of Parameters of Parathyroid Glands Using Particle Swarm Optimization and Multivariate Generalized Gaussian Function Mixture

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