A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism

Krakauer, Martin; Wieslander, Bente; Myschetzky, Peter Sand; Lundstrøm, Anke; Bacher, Theis; Sørensen, Christian Hjort; Trolle, Waldemar; Nygaard, Birte; Bennedbæk, Finn Noe

doi:10.1097/rlu.0000000000000988

Cited by 59 publications

(53 citation statements)

References 31 publications

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“…The DP protocol had higher sensitivity than the DT and DTDP protocols. This finding is contrary to most previous studies that reported that dual tracer had higher sensitivity than single tracer protocols [20][21][22][23][24][25][26][27]. The discrepant finding in the current study could, to some degree, be due to context bias since most of the patients sent for parathyroid scintigraphy at the authors' center have end-stage renal disease with pronounced hyperparathyroidism.…”

Section: Discussioncontrasting

confidence: 99%

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

et al. 2018

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Section: Discussioncontrasting

confidence: 99%

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

et al. 2018

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“…In contrast, the sensitivity of high‐resolution US was slightly lower in our study (51.8%) compared with the 78.5% to 85% sensitivity achieved by others, probably because the images were obtained by different radiologists, an issue that may contribute to greater interobserver variability. However, several studies found lower sensitivity for high‐resolution US, such as those by Kobylecka et al, Yao et al, and Krakauer et al, with values of 44%, 49%, and 57%, respectively.…”

Section: Discussionmentioning

confidence: 98%

Potential Utility of Contrast‐Enhanced Ultrasound in the Preoperative Evaluation of Primary Hyperparathyroidism

Ramírez

Hernando

Alcalá

et al. 2019

J of Ultrasound Medicine

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Objectives-We aimed to compare the effectiveness of contrast-enhanced ultrasound (CEUS), technetium Tc 99m methoxyisobutylisonitrile ( 99m Tc-MIBI) single-photon emission computed tomographic (SPECT) scintigraphy, and high-resolution ultrasound (US) in the detection of a pathologic parathyroid gland in patients with primary hyperparathyroidism (pHPT).Methods-Twenty-nine consecutive patients with pHPT were prospectively enrolled and underwent preoperative imaging with 99m Tc-MIBI SPECT scintigraphy, high-resolution US, and CEUS and subsequent parathyroidectomy. Contrast-enhanced US examinations were performed by an experienced examiner who was blinded to the results of scintigraphy and high-resolution US. The diagnostic performance of all of the imaging tests was analyzed in comparison with the pathologic anatomic findings. All investigations were performed at La Paz University Hospital.Results-In the 29 patients (22 female and 7 male), a total of 31 parathyroid adenomas were detected: single lesions in 27 patients and a double lesion in 2 patients. Contrast-enhanced US revealed sensitivity of 66.7% (95% confidence interval [CI], 46%-82.7%) for detection of single adenomas in comparison with 77.8 % (95% CI, 57.3%-90.6) for 99m Tc-MIBI SPECT scintigraphy and 51.8% (95% CI, 32.3%-70.8%) for high-resolution US (P = .100). With CEUS, double adenomas could be detected in both cases (sensitivity, 100%); however, scintigraphy and high-resolution US did not detect any cases of double adenomas. In addition, CEUS allowed the differentiation of lymphatic nodes from parathyroid glands in 2 patients. No side effects were observed for CEUS.Conclusions-In our study, CEUS facilitated the detection and diagnosis of double adenomas compared with high-resolution US and 99m Tc-MIBI SPECT scintigraphy. Additionally, CEUS was useful in the differentiation between parathyroid adenomas and lymph nodes.

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“…Heiba et al 22 compared neck pinhole dual-tracer and dualphase sestamibi with and without SPECT for localization of 153 parathyroid adenomas, and they found that pinhole dual-tracer SPECT had significantly higher sensitivity (93%) than dual-phase SPECT (68%), SPECT with only pinhole delay (39%), pinhole dual-tracer CT alone (25%), and dual-phase CT alone (18%). In a prospective study comparing dual-isotope subtraction pinhole scintigraphy, dual-phase SPECT, 4DCT, and sonography in 91 patients with 97 parathyroid adenomas, Krakauer et al 23 found that the sensitivity of dual-isotope subtraction pinhole scintigraphy was 93%. The sensitivity of dual-phase SPECT (65%), 4DCT (58%), and sonography (57%) was significantly lower.…”

Section: Discussionmentioning

confidence: 99%

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Vu¹,

Schellingerhout²,

Guha-Thakurta³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT). MATERIALS AND METHODS:We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference. RESULTS:Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT. CONCLUSIONS:For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT. ABBREVIATIONS:4DCT ϭ multiphase multidetector 4D CT; MIBI ϭ technetium Tc99m sestamibi

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A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism

Cited by 59 publications

References 31 publications

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

Potential Utility of Contrast‐Enhanced Ultrasound in the Preoperative Evaluation of Primary Hyperparathyroidism

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

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