The value of SPECT/ CT Technetium-99m-MIBI in primary hyperparathyroidism

Objectives Parathyroidectomy requires precise preoperative localization of the parathyroid adenoma in patients with primary hyperparathyroidism (PHPT). The present study assessed the impact of hybrid imaging (SPECT/CT), using 99mTc-sestamibi (MIBI), on the outcome of surgical management of these patients.

Methods Thirty-six patients with PHPT were retrospectively assessed, all had SPECT/ CT. Imaging data was compared with intra-operative findings, and the value of SPECT/CT to lesion localization and surgical procedure was evaluated.

Results Three patients with both negative planar and SPECT/CT studies subsequently underwent bilateral neck exploration, with hyperplasia diagnosed in two patients and a parathyroid adenoma in one. Of 33 patients with a positive MIBI study, parathyroid adenoma was confined to the neck in 23 patients (19 primary explorations, 4 re explorations)and to the lower neck-mediastinum in 10. SPECT/CT facilitated the surgical exploration of all 10 ectopic parathyroid adenomas.

Conclusions SPECT/CT contributed to the localization of parathyroid adenomas in patients with PHPT and to planning of the surgical exploration in 14 of 36 (39%) patients, predominantly those with ectopic parathyroid adenomas or who had distorted neck anatomy