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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: jnumed.108.054858v1 49/12/2012    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JNM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Neumann, D. R. Articles by DiFilippo, F. P. Search for Related Content PubMed PubMed Citation Articles by Neumann, D. R. Articles by DiFilippo, F. P.

Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

¹ Department of Nuclear Medicine, Cleveland Clinic Imaging Institute, Cleveland, Ohio; and ² Department of Diagnostic Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio

Correspondence: For correspondence or reprints contact: Donald R. Neumann, Department of Nuclear Medicine, Cleveland Clinic Imaging Institute, 9500 Euclid Ave., Cleveland, OH 44195. E-mail: neumand{at}ccf.org

The trend toward focused surgical parathyroidectomy requires precise preoperative localization of parathyroid lesions in patients with hyperparathyroidism. The purpose of this study was to directly compare the diagnostic accuracy of ^99mTc-sestamibi/¹²³I subtraction SPECT with SPECT/CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Methods: A total of 61 consecutive surgical patients with primary hyperparathyroidism underwent both ¹²³I/^99mTc-sestamibi subtraction SPECT and SPECT/CT scans preoperatively, using a hybrid SPECT/CT instrument that combined a dual-detector SPECT camera with a 6-slice multidetector spiral CT scanner. Four hours after being given ¹²³I-sodium iodide orally, each patient received ^99mTc-sestamibi intravenously, followed immediately by a simultaneous, dual-isotope SPECT scan of the neck and upper chest. Then, without moving the patient, we performed a non–contrast-enhanced CT scan of the same body region. Normalization and subtraction of the ¹²³I SPECT images from the ^99mTc SPECT images were performed. The subtraction SPECT and the coregistered fused SPECT/CT studies were interpreted separately, with images scored on a 5-point scale. Surgical and histopathologic findings were used as the standard of comparison. Results: Surgery was successful in 57 patients (solitary parathyroid adenoma in 48 patients, double parathyroid adenomas in 6 patients, and 10 hyperplastic parathyroid glands in 3 patients). The sensitivities of SPECT (50/70 = 71%) and SPECT/CT (49/70 = 70%) were similar (P = 0.779). The specificity of SPECT/CT (26/27 = 96%) was significantly greater than that of SPECT (13/27 = 48%; P = 0.006). The receiver-operating-characteristic area under the curve of SPECT/CT (0.833) was significantly greater than that of SPECT (0.632; P < 0.001). Conclusion: SPECT/CT is significantly more specific than dual-isotope subtraction SPECT for the preoperative identification of parathyroid lesions in patients with primary hyperparathyroidism.

Key Words: hyperparathyroidism • SPECT • SPECT/CT • hybrid imaging

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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