Comparison between single-photon emission computed tomography/computed tomography and ultrasound in preoperative detection of parathyroid adenoma: retrospective review of an institutional experience

Abstract

Objective The aim of this study was to evaluate the accuracy of technetium- 99m-methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) and ultrasound in preoperative localization of single parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (pHPT) who would be suitable for minimally invasive parathyroidectomy (MIP). Methods A retrospective study of 143 consecutive patients with biochemical evidence of hyperparathyroidism who underwent preoperative localization of parathyroid lesions using 99mTc-MIBI SPECT/CT and ultrasound, and proceeded to parathyroid surgery at our institution from January 2013 to January 2018. Of these, 125 had single adenomas and are the subject of this study. The sensitivity, positive predictive value (PPV) and accuracy of the two imaging techniques for the accurately identification and lateralization of PTAs were determined using histopathology as the criterion standard. Results Of 125 PTAs, the correct identification and lateralization were significantly higher by SPECT/CT than ultrasound. SPECT/CT and ultrasound detected lesions with histopathologically proven PTAs in 116 and 95 patients, respectively. The sensitivity, PPV and accuracy were 92.17, 94.64 and 87.60%, respectively, for SPECT/CT and 75.89, 90.43 and 70.25%, respectively, for ultrasound in lateralization analysis. Conclusions The results of our study indicate that 99mTc-MIBI SPECT/CT is more accurate than ultrasound for the preoperative identification of single PTAs in patients with pHPT who are candidates for MIP.

Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

“…Of 119 studies, 48 were performed in a prospective manner. The sensitivity on a per-patient–based analysis was available in 84 studies (Table 1), whereas the sensitivity on a per-lesion–based analysis was available in 39 studies (Table 2). Of the 84 patient-based studies, 47 were reported before 2009, and 37 were reported after 2010.…”

Diagnosis and localization of parathyroid adenomas using 16‐slice SPECT/CT: A clinicopathological correlation

“…Ultrasound has been shown to perform poorly for cases of ectopic adenomas, again highlighting the use of SPECT/CT for these patients. 7,12 As time progressed following the introduction of the SPECT/CT scanner, investigation pathways and imaging requests from clinicians demonstrated a shift with SPECT/ CT being requested as the primary imaging modality (Table 4). Our suggested pathway for the investigation of parathyroid adenomas may be to start with SPECT/CT scan and proceed to an ultrasound or 4D CT in equivocal or negative cases to confirm the SPECT/CT findings.…”

“…Ultrasound has the additional advantages of being noninvasive, lacking radiation exposure and being quick to perform, although accuracy of results is dependent on the skill of the operator. Ultrasound has been shown to perform poorly for cases of ectopic adenomas, again highlighting the use of SPECT/CT for these patients 7,12 …”

Evaluation of parathyroid hormon ıncrease after parathyroidectomy in primary hyperparathyroidism

“…Inabnet et al [16] implied systematic surgical exploration rather than minimal procedure since preoperative sestamibi screening and ultrasound could not fully localize. Okudan et al [17] reported that computed tomography was more accurate than ultrasound in determining preoperative single adenoma in with a patient with primary hyperparathyroidism.…”