Direct Comparison of Neck Pinhole Dual-Tracer and Dual-Phase MIBI Accuracies With and Without SPECT/CT for Parathyroid Adenoma Detection and Localization

Heiba, Sherif; Jiang, Manli; Rivera, Javier Elizondo; Genden, Eric M.; Inabnet, William B.; Macháč, Josef; Kostakoğlu, Lale

doi:10.1097/rlu.0000000000000778

Cited by 18 publications

(10 citation statements)

References 25 publications

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“…Heiba et al 22 compared neck pinhole dual-tracer and dualphase sestamibi with and without SPECT for localization of 153 parathyroid adenomas, and they found that pinhole dual-tracer SPECT had significantly higher sensitivity (93%) than dual-phase SPECT (68%), SPECT with only pinhole delay (39%), pinhole dual-tracer CT alone (25%), and dual-phase CT alone (18%). In a prospective study comparing dual-isotope subtraction pinhole scintigraphy, dual-phase SPECT, 4DCT, and sonography in 91 patients with 97 parathyroid adenomas, Krakauer et al 23 found that the sensitivity of dual-isotope subtraction pinhole scintigraphy was 93%.…”

Section: Discussionmentioning

confidence: 99%

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Vu¹,

Schellingerhout²,

Guha-Thakurta³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT). MATERIALS AND METHODS:We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference. RESULTS:Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT. CONCLUSIONS:For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT. ABBREVIATIONS:4DCT ϭ multiphase multidetector 4D CT; MIBI ϭ technetium Tc99m sestamibi

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Section: Discussionmentioning

confidence: 99%

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Vu¹,

Schellingerhout²,

Guha-Thakurta³

et al. 2018

AJNR Am J Neuroradiol

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“…[20][21][22][23]26 Multiple studies in the literature compare the performance of parathyroid scan to other anatomic imaging modalities. 10,24,25 Also in most institution, parathyroid scintigraphy is complemented with other anatomic imaging modalities; ultrasound, CT, and/or MRI for the localization of parathyroid adenomas. Our study aims to optimize the utility and interpretation of Tc-99m SPS with SPECT/CT for the diagnosis and localization of the abnormal parathyroid gland.…”

Section: Discussionmentioning

confidence: 99%

“…This is usually a combination of ultrasound and parathyroid scan. 24,25 Additional imaging modalities as MRI or 4D CT may be thought for discordant or inconclusive results between US and parathyroid scans. 10 Our study evaluated the accuracy and outcomes from a standardized simple method of interpretation and reporting of Tc-99m sestamibi dual-phase scan with SPECT/CT as the imaging modality for the diagnosis and localization of parathyroid adenoma in patients with PHPT.…”

Section: Introductionmentioning

confidence: 99%

Interpretation of Tc-99m sestamibi parathyroid SPECT-CT scans made easy for better surgical outcomes in patients with primary hyperparathyroidism

Gayed

Karni

Wan

et al. 2016

RMI

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This study aims to evaluate the accuracy of Tc-99m sestamibi parathyroid scan (SPS) with single-photon emission computerized tomography/computerized tomography (SPECT/CT) in patients with primary hyperparathyroidism after optimizing the interpretation of the scans with a systematic and simple method for localization of the abnormal parathyroid gland. Materials and methods: Consecutive patients, who underwent SPS followed by surgical intervention, were included. Data were collected retrospectively including patients' demographics, serum calcium and parathyroid hormone (PTH) levels, SPS findings, and surgical and pathological findings. Our optimized systematic method of interpretation of SPS starts by reviewing initial and 3 hours delayed planar images; subsequently we reviewed coronal and axial SPECT/CT images. A simple clockwise localization of the abnormal gland in relation to the trachea and its level in relation to the thyroid in a cranio-caudal level facilitates intraoperative localization of parathyroid adenomas. Results: A total of 53 patients were included; 9 males and 44 females with an average age of 58.3±14 years. The average preoperative serum calcium and PTH were 10.5 mg/dL and 165.4 pg/m, respectively. The median interval between the scan and operative resection was 50 days. Our SPS interpretation method correlated perfectly with the surgical finding in 48/53 patients (90.6%); it was on the correct side of the surgical finding but not the exact location in 3/53 (5.7%) and nonlocalizing in 2/53 (3.7%). The average intraoperative PTH after resection of the adenoma was 39.7 pg/mL. Conclusion: Our optimized method for interpretation of SPS demonstrated high accuracy with good surgical outcomes.

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“…For example, a meta‐analysis showed a range of sensitivities for sestamibi SPECT/CT from 28% to 98%, likely attributable to varying techniques, levels of expertise, and/or varying patient population. In addition, variable results even within single high‐volume centers have been reported, such as significantly different sensitivities on sestamibi scans for overlapping groups of patients from a similar time period (93% vs 74%) …”

Section: Practice Setting Realitymentioning

confidence: 99%

American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism

Zafereo

Angelos

et al. 2019

Head & Neck

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Health care consumer organizations and insurance companies increasingly are scrutinizing value when considering reimbursement policies for medical interventions. Recently, members of several American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) committees worked closely with one insurance company to refine reimbursement policies for preoperative localization imaging in patients undergoing surgery for primary hyperparathyroidism. This endeavor led to an AAO-HNS parathyroid imaging consensus statement (https://www.entnet.org/ content/parathyroid-imaging). The American Head and Neck Society Endocrine Surgery Section gathered an expert panel of authors to delineate imaging options

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Direct Comparison of Neck Pinhole Dual-Tracer and Dual-Phase MIBI Accuracies With and Without SPECT/CT for Parathyroid Adenoma Detection and Localization

Cited by 18 publications

References 25 publications

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Interpretation of Tc-99m sestamibi parathyroid SPECT-CT scans made easy for better surgical outcomes in patients with primary hyperparathyroidism

American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism

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