PT  - JOURNAL ARTICLE
AU  - Korsten, Alex
AU  - van Os, Karen
AU  - Wille, Jan
AU  - Eland, Ingo
AU  - van Buul, Marie Monique
TI  - The value of parathyroid I-123/Tc-99m subtraction SPECT/CT in primary hyperparathyroidism
DP  - 2014 May 01
TA  - Journal of Nuclear Medicine
PG  - 477--477
VI  - 55
IP  - supplement 1
4099  - http://jnm.snmjournals.org/content/55/supplement_1/477.short
4100  - http://jnm.snmjournals.org/content/55/supplement_1/477.full
SO  - J Nucl Med2014 May 01; 55
AB  - 477 Objectives The use of early SPECT/CT in combination with dual-phase planar imaging in the detection and precise preoperative localization of parathyroid adenoma is widely accepted in routine diagnostic management of patients with suspected primary hyperparathyroidism (PHPT). This study evaluated the impact of simultaneously single acquisition dual-isotope I-123/Tc-99m sestamibi subtraction SPECT/CT (PDIS) on accuracy and confidence of the reviewers. Methods A consecutive series of 99 patients with clinically suspected PHPT underwent planar dual-phase dual isotope parathyroid imaging including PDIS. Two observers reviewed blinded and independently the planar images alone [A], subsequently combinated with conventional SPECT/CT [B],and with an interval of a half year, PDIS only [C] using a customized automated subtraction SPECT/CT viewing program. Sensitivity, certainty and agreement between observers were calculated and compared with histological findings. Results Using data of all 99 included patients, agreement between observers was unchanged between the three methods: [A] 86%, [B] 86% and [C] 81%, respectively. Degree of certainty increased significantly (p<0,05) from [A] 56%, [B] 53% to [C] 68% in reader 1 and from [A] 31%, [B] 54% to [C] 76% in reader 2. Forty-five out of 99 patients (M/F 8/37, age mean 63, range 19-84 y) underwent parathyroid adenoidectomy. In 42, parathyroid adenoma was found. Also sensitivities increased significantly (p<0,05): [A] 74%, [B] 81% and [C] 88%, respectively. Conclusions In the detection and precise preoperative localization of parathyroid adenoma in patients with clinically suspected PHPT, simultaneous I-123/Tc-99m parathyroid subtraction SPECT/CT only is significantly more sensitive than conventional planar dual-isotope dual-phase parathyroid imaging + SPECT/CT. Addition of this patient-friendly method also significantly increases the certainty of the reviewers, while the agreement between observers remained unchanged.