RT Journal Article
SR Electronic
T1 Planar Scintigraphy with <sup>123</sup>I/<sup>99m</sup>Tc-Sestamibi, <sup>99m</sup>Tc-Sestamibi SPECT/CT, <sup>11</sup>C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 739
OP 747
DO 10.2967/jnumed.112.109561
VO 54
IS 5
A1 Camilla Schalin-Jäntti
A1 Eeva Ryhänen
A1 Ilkka Heiskanen
A1 Marko Seppänen
A1 Johanna Arola
A1 Jukka Schildt
A1 Mika Väisänen
A1 Lassi Nelimarkka
A1 Irina Lisinen
A1 Ville Aalto
A1 Pirjo Nuutila
A1 Matti J. Välimäki
YR 2013
UL http://jnm.snmjournals.org/content/54/5/739.abstract
AB All patients with primary hyperparathyroidism should undergo localization studies before reoperation, but it is not known which method is most accurate. The purpose of this prospective study was to compare the performance of planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT (SPECT/CT), 11C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism. Methods: Twenty-one patients referred for reoperation of persistent hyperparathyroidism were included and investigated with 123I/99mTc-sestamibi, SPECT/CT (n = 19), 11C-methionine PET/CT, and SVS (n = 18) before reoperation. All patients had been operated on 1–2 times previously because of hyperparathyroidism. The results of the localization studies were compared with operative findings, histology, and biochemical cure. Results: Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%–79%) for 123I/99mTc-sestamibi, 19% (95% CI, 5%–42%) for SPECT/CT, 65% (95% CI, 43%–84%) for 11C-methionine PET/CT, and 40% (95% CI, 19%–65%) for SVS (P &lt; 0.01 for 123I/99mTc-sestamibi vs. SPECT/CT). The corresponding accuracy for the correct quadrant or more specific site was 48% (95% CI, 27%–69%) for 123I/99mTc-sestamibi, 14% (95% CI, 3%–36%) for SPECT/CT, 61% (95% CI, 39%–80%) for 11C-methionine PET/CT, and 25% (95% CI, 9%–49%) for SVS (P &lt; 0.02 for 123I/99mTc-sestamibi vs. SPECT/CT). In the 3 patients not cured, preoperative 123I/99mTc-sestamibi and SPECT/CT remained negative, SVS was false predictive in all, and 11C-methionine PET/CT in 1. 11C-methionine PET/CT accurately revealed the pathologic gland in 4 of 8 (50%) patients with a negative 123I/99mTc-sestamibi scan result, all of whom were biochemically cured after reoperation. Conclusion: Planar scintigraphy with 123I/99mTc-sestamibi performs well in complicated primary hyperparathyroidism and is recommended as first-line imaging before reoperation. 11C-methionine PET/CT provides valuable additional information if 123I/99mTc-sestamibi scan results remain negative. 99mTc-sestamibi SPECT/CT and SVS provide no additional information, compared with the combined results of 123I/99mTc-sestamibi and 11C-methionine PET/CT imaging.