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Comparison of SPECT/CT, SPECT, and Planar Imaging with Single- and Dual-Phase ^99mTc-Sestamibi Parathyroid Scintigraphy

¹ Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Johns Hopkins University, Baltimore, Maryland; ² Department of Oncology and Biostatistics, Johns Hopkins University, Baltimore, Maryland; and ³ Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland

Correspondence: For correspondence or reprints contact: Harvey A. Ziessman, MD, Johns Hopkins Outpatient Center, 601 N. Caroline St., JHOC Room 3231, Baltimore, MD 21287. E-mail: hziessm1{at}jhmi.edu

Various methodologies for ^99mTc-sestamibi parathyroid scintigraphy are in clinical use. There are few direct comparisons between the different methods and even less evidence supporting the superiority of one over another. Some reports suggest that SPECT is superior to planar imaging. The addition of CT to SPECT may further improve parathyroid adenoma localization. The purpose of our investigation was to compare hybrid SPECT/CT, SPECT, and planar imaging and to determine whether dual-phase imaging is advantageous for the 3 methodologies. Methods: Scintigraphy was performed on 110 patients with primary hyperparathyroidism and no prior neck surgery. Of these, 98 had single adenomas and are the subject of this review. Planar imaging and SPECT/CT were performed at 15 min and 2 h after injection. Six image sets (early and delayed planar imaging, SPECT, and SPECT/CT) and combinations of the 2 image sets were reviewed for adenoma localization at 13 possible sites. Each review was scored for location and certainty of focus by 2 reviewer groups. Surgical location served as the standard. Sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, and -values were determined for each method. Results: The overall -coefficient (certainty of adenoma focus) between reading groups was 0.68 (95% confidence interval, 0.66–0.70). The highest values were for dual-phase studies that included SPECT/CT. Dual-phase planar imaging, SPECT, and SPECT/CT were statistically significantly superior to single-phase early or delayed imaging in sensitivity, area under the curve, and positive predictive value. Neither single-phase nor dual-phase SPECT was statistically superior to dual-phase planar imaging. Early-phase SPECT/CT in combination with any delayed imaging method was superior to dual-phase planar imaging or SPECT for sensitivity, area under the curve, and positive predictive value. Conclusion: Early SPECT/CT in combination with any delayed imaging method was statistically significantly superior to any single- or dual-phase planar or SPECT study for parathyroid adenoma localization. Localization with dual-phase acquisition was more accurate than with single-phase ^99mTc-sestamibi scintigraphy for planar imaging, SPECT, and SPECT/CT.

Key Words: hyperparathyroidism • parathyroid adenoma • parathyroid scintigraphy • SPECT/CT • minimally invasive parathyroidectomy

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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