SPECT/CT’s Advantage for Preoperative Localization of Small Parathyroid Adenomas in Primary Hyperparathyroidism

Abstract

SPECT/CT yields fewer false-positive findings than SPECT alone. The advantage of SPECT/CT over SPECT alone was most apparent for correct lateralization of small adenomas (<210 mg).

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

“…This could be because the previous study used diagnostic quality CT as opposed to low-dose CT as was used in the current study, or could be due to chance Original given the small number of patients who underwent SPECT and SPECT/CT in this study. 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.…”

“…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]. This could be because the previous study used diagnostic quality CT as opposed to low-dose CT as was used in the current study, or could be due to chance Original given the small number of patients who underwent SPECT and SPECT/CT in this study.…”

Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario

“…A pesar de su alta sensibilidad y especificidad, el SPECT está limitado por una baja resolución espacial e incapacidad para proporcionar detalles anatómicos. Los sistemas de modalidad dual (SPECT-CT) permiten realizar imágenes tanto funcionales como estructurales, que mejoran la calidad y entregan más detalles sobre ubicación, tamaño y morfología de la lesión, siendo la imagen SPECT-CT superior a SPECT, especialmente en glándulas <10 mm y adenomas < 200 mg 6,[19][20][21] . Sin embargo, el SPECT-CT requiere disponibilidad del equipo, tiempo de imagen adicional y mayor radiación 8 .…”

“…La causa más frecuente es adenoma único (80%), menos frecuente hiperplasia de las 4 glándulas (2 a 5%) y carcinoma de paratiroides (0,7%) 1,4 . En los casos con indicación quirúrgica, es imprescindible localizar correctamente la glándula afectada, con el fin de realizar cirugía mínimamen-te invasiva, disminuyendo el tiempo operatorio y complicaciones, con alta hospitalaria temprana 5,6 . El cintigrama SPECT (tomografía de emisión de fotón único) de paratiroides Tc99m-sestamibi es un método útil para la detección y localización preoperatoria de glándulas anormales, inclusive ectópicas 5 .…”

Two decades of SPECT/CT – the coming of age of a technology: An updated review of literature evidence

“…8). The detectability of PTA by SPECT/CT ranged from 90 to 96% [165,166], particularly helpful for small lesions less than 10 mm in diameter [54,166] or weighing less than 210 mg [167]. 99m Tc-MIBI SPECT/CT results were found to correlate with serum parathyroid hormone (PTH) and calcium levels [162,168].…”