Comparison of pinhole and SPECT 99mTc-MIBI imaging in primary hyperparathyroidism

ObjectiveThis study aims to compare dual tracer, dual phase pinhole technetium-99m labelled 2-methoxyisobutylisonitrile (99mTc-MIBI) imaging (including oblique imaging), with single photon emission computed tomography (SPECT) and dual phase planar 99mTc-MIBI images, and combined SPECT, dual phase planar 99mTc-MIBI images and anterior pinhole thyroid images for the localization of parathyroid adenomas in the neck in primary hyperparathyroidism. MethodsSixty-two patients underwent 99mTc-MIBI dual phase, anterior and anterior oblique pinhole images of the neck, anterior planar images of the neck and chest and early phase neck/chest SPECT followed by [99mTc] pertechnetate anterior and anterior oblique pinhole thyroid images. Images were reviewed by consensus in three combinations – dual phase anterior and anterior oblique pinhole 99mTc-MIBI images and pinhole thyroid images; SPECT and dual phase planar 99mTc-MIBI images and combined SPECT, dual phase planar 99mTc-MIBI images and anterior pinhole thyroid images. ResultsFor 52 parathyroid adenomas in 50 patients, the sensitivity of dual phase anterior and anterior oblique pinhole 99mTc-images and pinhole thyroid images was 81%. Significantly lower sensitivities were observed with SPECT and dual phase planar 99mTc-MIBI images (54%, P=0.0005) and combined SPECT, dual phase planar 99mTc-MIBI images and anterior pinhole thyroid images (65%, P=0.0209). The positive predictive value for all imaging combinations was 88–92%. ConclusionDual phase anterior and anterior oblique pinhole 99mTc-MIBI images and pinhole thyroid images are significantly more sensitive than imaging combinations that included SPECT and remains the optimal imaging protocol for the localization of parathyroid adenomas in the neck in primary hyperparathyroidism.

[1]  K. Tatsch,et al.  EANM’15 , 2014, European Journal of Nuclear Medicine and Molecular Imaging.

[2]  B. Lang,et al.  A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. , 2007, American journal of surgery.

[3]  J. Brøchner-Mortensen,et al.  Preoperative Dual-Phase Parathyroid Imaging With Tc-99m-Sestamibi: Accuracy and Reproducibility of the Pinhole Collimator With and Without Oblique Images , 2007, Clinical nuclear medicine.

[4]  T. Athanasoulis.  Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery , 2007, European Journal of Nuclear Medicine and Molecular Imaging.

[5]  Dale L Bailey,et al.  SPECT/CT imaging using a spiral CT scanner for anatomical localization: Impact on diagnostic accuracy and reporter confidence in clinical practice , 2006, Nuclear medicine communications.

[6]  D. Schuster,et al.  Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality? , 2006, Surgery.

[7]  L. Freudenberg,et al.  Optimizing preoperative imaging in primary hyperparathyroidism , 2006, Langenbeck's Archives of Surgery.

[8]  D. Bailey,et al.  Use of fusion imaging to localize an ectopic thoracic parathyroid adenoma. , 2006, The Annals of thoracic surgery.

[9]  M. Pelizzo,et al.  Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery , 2006, European Journal of Nuclear Medicine and Molecular Imaging.

[10]  G. Melton,et al.  Interpretation of 99mTc sestamibi parathyroid SPECT scan is improved when read by the surgeon and nuclear medicine physician together , 2005, Nuclear medicine communications.

[11]  T. Ezri,et al.  Preoperative technetium Tc 99m sestamibi SPECT imaging in the management of primary hyperparathyroidism in patients with concomitant multinodular goiter. , 2005, Archives of surgery.

[12]  C. Hollenbeak,et al.  Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. , 2005, Archives of otolaryngology--head & neck surgery.

[13]  D. Farley,et al.  Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. , 2005, Archives of surgery.

[14]  Brendan C. Stack,et al.  A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003 , 2005, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[15]  William D Erwin,et al.  The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[16]  F. Gleeson,et al.  Increased Sensitivity and Confidence of SPECT Over Planar Imaging in Dual-Phase Sestamibi for Parathyroid Adenoma Detection , 2005, Clinical nuclear medicine.

[17]  Brendan C. Stack,et al.  systematic review of the diagnosis and treatment of primary hyperparathyroidism from to . , 2005 .

[18]  Ora Israel,et al.  Technetium-99m-MIBI SPECT/CT in Primary Hyperparathyroidism , 2005, World Journal of Surgery.

[19]  L. Delbridge,et al.  Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism. , 2004, The Surgical clinics of North America.

[20]  M. Lorberboym,et al.  Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[21]  J. Rastad,et al.  Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. , 2002, The Journal of clinical endocrinology and metabolism.

[22]  ANNE KIRSTINE ARVESCHOUG,et al.  Presurgical Localization of Abnormal Parathyroid Glands Using a Single Injection of Tc-99m Sestamibi: Comparison of High-Resolution Parallel-Hole and Pinhole Collimators, and Interobserver and Intraobserver Variation , 2002, Clinical nuclear medicine.

[23]  A. Civelek,et al.  Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. , 2002, Surgery.

[24]  L. Delbridge,et al.  Optimal Pinhole Techniques for Preoperative Localization with Tc-99m MIBI for Primary Hyperparathyroidism , 2001, Clinical nuclear medicine.

[25]  L. Delbridge,et al.  The value of oblique pinhole images in pre-operative localisation with 99mTc-MIBI for primary hyperparathyroidism , 2001, European Journal of Nuclear Medicine.

[26]  M. Dietlein,et al.  Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas. , 2000, Surgery.

[27]  E. Siris,et al.  A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. , 1999, The New England journal of medicine.

[28]  R. Utiger.  Treatment of primary hyperparathyroidism. , 1999, The New England journal of medicine.

[29]  N. Obuchowski,et al.  Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. , 1997, AJR. American journal of roentgenology.

[30]  L. Holder,et al.  Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT. , 1997, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[31]  M. Brown,et al.  Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT. , 1996, Radiology.