Dual-Isotope 99mTc-MIBI/123I Parathyroid Scintigraphy in Primary Hyperparathyroidism

Hassler, S.; Ben-Sellem, Dorra; Hubelé, F.; Constantinesco, A.; Goetz, Christian

doi:10.1097/rlu.0000000000000272

Cited by 45 publications

(53 citation statements)

References 22 publications

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“…Preoperative detection of an ectopic adenoma on SPECT/CT is unquestionably of value prior to surgery (278). SPECT/CT provides accurate assessment in patients with coexisting thyroid nodular disease (240,279,280), particularly when combined with neck ultrasound (280). However, for patients with multiglandular disease or double adenomas, and for those undergoing reoperative surgical procedures the sensitivity of SPECT/CT appears lower (246,281,282), when compared to selective venous sampling (281), and therefore it is not expected to have a major impact for these more challenging patient subgroups.…”

Section: Diagnostic Work-up Of Hyperparathyroidism and Role Of Parathmentioning

confidence: 99%

Endocrine Scintigraphy with Hybrid SPECT/CT

et al. 2014

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Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.

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Section: Diagnostic Work-up Of Hyperparathyroidism and Role Of Parathmentioning

confidence: 99%

Endocrine Scintigraphy with Hybrid SPECT/CT

et al. 2014

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“…Up to date, multiple different scintigraphic and SPECT-based methodologies for detecting pathological parathyroids have been described, including dual-phase, dual-isotope, planar and CT combined imaging approaches, with wide range of sensitivity and specificity for each method [4, 6, 11–14]. Different approaches in calculation of sensitivity and specificity were used with different references as gold standard.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and Specificity of Dual-Isotope 99mTc-Tetrofosmin and 123I Sodium Iodide Single Photon Emission Computed Tomography (SPECT) in Hyperparathyroidism

et al. 2015

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PurposeDespite recommendations for 99mTc-tetrofosmin dual tracer imaging for hyperparathyroidism in current guidelines, no report was published on dual-isotope 99mTc-tetrofosmin and 123I sodium iodide single-photon-emission-computed-tomography (SPECT). We evaluated diagnostic accuracy and the impact of preoperative SPECT on the surgical procedures and disease outcomes.MethodsAnalysis of 70 consecutive patients with primary hyperparathyroidism and 20 consecutive patients with tertiary hyperparathyroidism. Imaging findings were correlated with surgical results. Concomitant thyroid disease, pre- and postoperative laboratory measurements, histopathological results, type and duration of surgery were assessed.ResultsIn primary hyperparathyroidism, SPECT had a sensitivity of 80% and a positive predictive value of 93% in patient-based analysis. Specificity was 99% in lesion-based analysis. Patients with positive SPECT elicit higher levels of parathyroid hormone and higher weight of resected parathyroids than SPECT-negative patients. Duration of parathyroid surgery was on average, approximately 40 minutes shorter in SPECT-positive than in SPECT-negative patients (89±46 vs. 129±41 minutes, p=0.006); 86% of SPECT-positive and 50% of SPECT-negative patients had minimal invasive surgery (p = 0.021). SPECT had lower sensitivity (60%) in patients with tertiary hyperparathyroidism; however, 90% of these patients had multiple lesions and all of these patients had bilateral lesions.ConclusionDual-isotope SPECT with 99mTc-tetrofosmin and 123I sodium iodide has a high diagnostic value in patients with primary hyperparathyroidism and allows for saving of operation time. Higher levels of parathyroid hormone and higher glandular weight facilitated detection of parathyroid lesion. Diagnostic accuracy of preoperative imaging was lower in patients with tertiary hyperparathyroidism.

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“…SPECT/CT dual-tracer MIBI/ 123 I parathyroid scintigraphy was also tested by Hassler et al [41] in comparison with pinhole planar scanning. Each parathyroid uptake was allocated to a neck parathyroid site (left superior, left inferior, right superior, right inferior) or classed as ectopic.…”

Section: Spect/ct In Patients With Phptmentioning

confidence: 99%

SPECT/CT in hyperparathyroidism

Spanu

Schillaci

Piras

et al. 2014

Clin Transl Imaging

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Hybrid SPECT/CT imaging is playing an increasingly important role in nuclear medicine in several oncological and non-oncological fields. This review presents a literature survey on the use of SPECT/CT as an adjunct to parathyroid scintigraphy in patients with hyperparathyroidism (HPT), highlighting the certainties and the controversies that have so far emerged in this regard. SPECT/CT, providing both functional and anatomical data, has proved to be superior to conventional planar parathyroid scintigraphy and to SPECT for the precise localization and characterization of areas of marked uptake of radiotracers (MIBI or tetrofosmin) corresponding to abnormal parathyroid glands, thus facilitating their surgical treatment. The major benefits of SPECT/CT have been observed in patients with ectopic adenomas, mainly in the mediastinum, and in those with previous neck surgery. In some studies, SPECT/ CT has also demonstrated a higher sensitivity than conventional planar or SPECT scans particularly in the detection of low-weight parathyroid adenomas and in the presence of concomitant nodular goiter. In other studies, SPECT/CT has also been found to be more specific, with the anatomical data provided by the CT component shown to be of help in correctly categorizing MIBI-avid non-parathyroid lesions. No definitive conclusions on the clinical value of SPECT/CT in patients with secondary HPT and multiglandular disease can be done due to the small number of studies thus far conducted, but the current available data nevertheless seem to suggest that hybrid imaging is able to detect a significantly higher number of hyperplastic glands than planar scanning can.

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Dual-Isotope 99mTc-MIBI/123I Parathyroid Scintigraphy in Primary Hyperparathyroidism

Abstract: In preoperative assessment of primary hyperparathyroidism and to guide surgery, we propose to perform first subtraction SPECT/CT and to complete it with neck pinhole, only if tomoscintigraphy is negative.

Cited by 45 publications

References 22 publications

Endocrine Scintigraphy with Hybrid SPECT/CT

Endocrine Scintigraphy with Hybrid SPECT/CT

Sensitivity and Specificity of Dual-Isotope 99mTc-Tetrofosmin and 123I Sodium Iodide Single Photon Emission Computed Tomography (SPECT) in Hyperparathyroidism

SPECT/CT in hyperparathyroidism

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