Single Photon Emission Computed Tomography (SPECT) Should be Routinely Performed for the Detection of Parathyroid Abnormalities Utilizing Technetium-99m Sestamibi Parathyroid Scintigraphy

Abstract

DPS is significantly more sensitive, and at least as specific, compared with DPP in detecting parathyroid abnormalities in patients with primary hyperparathyroidism and should, therefore, be routinely used when DP Tc-99m MIBI is used in this setting. An algorithm for best utilization of this technique to determine the appropriate surgical approach in patients with primary hyperparathyroidism is presented.

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

“…Regarding the effect of lesion size on detection of parathyroid lesions, overall, larger lesions were more likely to be detected than smaller lesions, a finding which is in agreement with previous studies [29][30][31]. All imaging protocols had perfect sensitivity for detection of parathyroid adenomas but had reduced sensitivity for parathyroid hyperplasia, a finding supported by previous studies [8,9,18,20,25] and is likely because adenomas tend to be larger and have higher degree of Tc-99m sestamibi uptake than hyperplastic glands.…”

“…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].…”

“…The dual phase (DP) protocol compares two or more Tc-99m sestamibi images obtained at Original different time points and diagnosis is based on the observation that Tc-99m sestamibi washes out of the thyroid more rapidly than from hyperfunctioning parathyroid lesions [15]. Tomographic imaging including single photon emission computed tomography (SPECT) and single photon emission computed tomography/computed tomography (SPECT/CT) has been suggested to provide improved diagnostic accuracy over planar imaging [16][17][18][19]. The purpose of this study was to determine the diagnostic accuracy of various nuclear medicine parathyroid imaging techniques for preoperative localization of hyperfunctioning parathyroid glands.…”

Hiperparatiroidismo primario de origen multiglandular con glándula paratiroides intratiroídea hiperfuncionante

“…El tratamiento quirúrgico consiste en la exploración cervical y extirpación de la o las glándulas alteradas, con medición intraoperatoria de PTH [1][2][3][4][5][6] . Se comunica el caso de una paciente de 56 años, portadora de un HPP grave con enfermedad multiglandular y presencia de una glándula paratiroides intratiroídea hiperfuncionante de gran tamaño.…”

“…Se solicitó estudio ecográfi co cervical (Figura 1) que mostró un gran nódulo quístico del lóbulo izquierdo de la glándula tiroides de 5,85 cm de diámetro mayor y dos lesiones quísticas menores caudal y craneal a este mismo lóbulo (7,4 Se inició tratamiento preoperatorio de su cuadro metabólico con bisfosfonatos y aporte alto de solución salina, logrando un descenso de la calcemia hasta 10 mg/dl.…”