A Prospective Comparative Study of Using Ultrasonography, 4D-CT and Parathyroid Dual-Phase Scintigraphy with SPECT in Patients with Primary Hyperparathyroidism

Thirty-one consecutive patients were included in this study who were planned for parathyroidectomy due to primary hyperparathyroidism. They were studied with US, 4D-CT and dual-phase scintigraphy including SPECT/CT, and possible adenomas were identified in each imaging modality. Imaging data were quantified with US, CT and SPECT. Parathyroidectomies were performed as minimally invasive according to preoperative imaging findings. A total of 16 adenomas were found in 15 patients, and the surgery was negative in four patients. The imaging results were compared with each other and correlated to histology findings and blood biochemistry (S-Ca and P-PTH). Quantitative SPECT found a strong correlation between the quantification methods—Conjugate Gradient with Attenuation and Scatter Correction with a zone map (CGZAS) and Conjugate Gradient with Attenuation and Scatter Correction (CGAS)—measured as SUVmax and kBq/mL. However, a statistically significant correlation between the quantitative parameters (CGZAS and CGAS) and serum biomarkers (S-PTH and S-Ca) was not observed. The sensitivities of the imaging methods were calculated using histopathology as a gold standard. SPECT/CT demonstrated 93% sensitivity, 4D-CT 93% sensitivity and ultrasonography 73% sensitivity. The imaging methods were compared with each other using parathyroid regions because findings and locations varied between the modalities. Our prospective study supports that quantitative SPECT/CT is useful for presurgical assessment of primary hyperparathyroidism.

[1]  R. Naples,et al.  Preoperative calcium and parathyroid hormone values are poor predictors of gland volume and multigland disease in primary hyperparathyroidism: A review of 2,000 consecutive patients. , 2021, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[2]  G. Pagenstert,et al.  Accuracy comparison of various quantitative [99mTc]Tc-DPD SPECT/CT reconstruction techniques in patients with symptomatic hip and knee joint prostheses , 2021, EJNMMI Research.

[3]  E. Hindié,et al.  The EANM practice guidelines for parathyroid imaging , 2021, European Journal of Nuclear Medicine and Molecular Imaging.

[4]  M. Parasiliti-Caprino,et al.  Comparison of the diagnostic accuracy of 18F-Fluorocholine PET and 11C-Methionine PET for parathyroid localization in primary hyperparathyroidism: a systematic review and meta-analysis. , 2021, European journal of endocrinology.

[5]  R. Guo,et al.  Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism , 2021, BMC Medical Imaging.

[6]  R. Naples,et al.  Preoperative Calcium and Parathyroid Hormone Values Are Poor Predictors of Gland Volume and Multigland Disease in Primary Hyperparathyroidism: A Review of 2,000 Consecutive Patients , 2020 .

[7]  Pankaj Sharma,et al.  A clinical perspective of parathyroid hormone related hypercalcaemia , 2019, Reviews in Endocrine and Metabolic Disorders.

[8]  A. Sundin,et al.  Multiphase Iodine Contrast-Enhanced SPECT/CT Outperforms Nonenhanced SPECT/CT for Preoperative Localization of Small Parathyroid Adenomas. , 2019, Clinical nuclear medicine.

[9]  T. Kuwert,et al.  ROC study and SUV threshold using quantitative multi-modal SPECT for bone imaging , 2019, European Journal of Hybrid Imaging.

[10]  K. Ramakrishnan,et al.  Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism , 2019, Ear, nose, & throat journal.

[11]  E. Rohren,et al.  Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT , 2018, American Journal of Neuroradiology.

[12]  O. Tsybrovskyy,et al.  18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients , 2018, European Journal of Nuclear Medicine and Molecular Imaging.

[13]  A. Kjaer,et al.  18F-FET-PET in Primary Hyperparathyroidism: A Pilot Study , 2016, Diagnostics.

[14]  L. Ceriani,et al.  Detection rate of 99mTc‐MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: A meta‐analysis , 2016, Head & neck.

[15]  B. Nygaard,et al.  A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism , 2016, Clinical nuclear medicine.

[16]  Quan-Yong Luo,et al.  Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis. , 2015, Hellenic journal of nuclear medicine.

[17]  J. Talbot,et al.  Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism? , 2014, The Journal of clinical endocrinology and metabolism.

[18]  Quan-Yong Luo,et al.  Dual-phase 99mTc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables , 2014, Annals of Nuclear Medicine.

[19]  R. Bale,et al.  CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism , 2009, Langenbeck's Archives of Surgery.

[20]  N. Obuchowski,et al.  Preoperative 123I/99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism , 2008, Journal of Nuclear Medicine.

[21]  A. Dackiw,et al.  Correlation of plasma 25-hydroxyvitamin D levels with severity of primary hyperparathyroidism and likelihood of parathyroid adenoma localization on sestamibi scan. , 2008, Archives of otolaryngology--head & neck surgery.

[22]  Z. Win,et al.  Multimodality imaging of the parathyroid glands in primary hyperparathyroidism. , 2008, Minerva endocrinologica.

[23]  Harvey A. Ziessman,et al.  Comparison of SPECT/CT, SPECT, and Planar Imaging with Single- and Dual-Phase 99mTc-Sestamibi Parathyroid Scintigraphy , 2007, Journal of Nuclear Medicine.

[24]  M. Oates,et al.  Radionuclide imaging of the parathyroid glands: patterns, pearls, and pitfalls. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[25]  K. Mighell Parameter Estimation in Astronomy with Poisson-Distributed Data. II. The Modified Chi-Square-Gamma Statistic , 2000, astro-ph/0007328.

[26]  M. Ishibashi,et al.  Technetium-99m tetrofosmin parathyroid imaging in patients with primary hyperparathyroidism. , 2000, Internal medicine.