Factors That Affect the Sensitivity of Imaging Modalities in Primary Hyperparathyroidism

Abstract

Background. Cervical ultrasound, 99mTc-sestamibi single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT), and cervical CT are routinely used in preoperative localization of primary hyperparathyroidism (PHPT). However, false-negative imaging results are also frequently encountered in clinical practice. Exploring the factors that affect the sensitivity of these imaging modalities is important for the surgical management of PHPT patients. Methods. Clinical data of 352 PHPT patients hospitalized in our center from January 2011 to December 2015 were retrospectively collected to evaluate the sensitivity of 3 imaging modalities in the preoperative localization of parathyroid lesions. The ROC curve analysis was used to explore the clinical factors affecting the sensitivity of localization, and the cut-point(s) of related factors were determined. Results. 99mTc-MIBI SPECT/CT has the highest sensitivity among the localization modalities commonly used, reaching 91.1% (86.0%–94.8%). When the lengths of parathyroid lesions were ≤1.3 cm, the sensitivity of neck ultrasonography significantly decreased, while the sensitivity of 99mTc-MIBI SPECT/CT decreased with parathyroid lesions ≤1.3 cm or serum PTH≤252 pg/ml. 99mTc-MIBI SPECT/CT was less effective in localizing the hyperplasia lesions. Neck ultrasonography combined with 99mTc-MIBI SPECT/CT can effectively improve the accuracy of preoperative localization of parathyroid lesions to 96.2% (92.7%–98.1%). Conclusions. Small parathyroid lesion and mild elevation of serum PTH would reduce the accuracy of parathyroid localization in PHPT patients.

Preoperative imaging in primary hyperparathyroidism: Are 11C‐Choline PET/CT and 99mTc‐MIBI/123Iodide subtraction SPECT/CT interchangeable or do they supplement each other?

“…A hampering effect on imaging by nodular thyroids has been reported while others do not find this.,A lower sensitivity in patients with hyperplasia than adenoma and among patients with multi gland disease than uniglandular disease has been reported for Di‐SPECT, while Choline has not been investigated 29,30 …”

“…A hampering effect on imaging by nodular thyroids has been reported while others do not find this.,A lower sensitivity in patients with hyperplasia than adenoma and among patients with multi gland disease than uniglandular disease has been reported for Di-SPECT, while Choline has not been investigated. 29,30 In patients with at least one HPG of 'low reader certainty' on Choline PET, decreased sensitivity is not surprising and the corresponding lower sensitivity on Di-SPECT demonstrates that HPGs in these patients are in fact more difficult to locate. Therefore, patients would not likely benefit from additional imaging using Di-SPECT before PTx.…”

Localization Strategy Prior to Radiofrequency Ablation for Primary and Secondary Hyperparathyroidism

“…Accurate preoperative localization is an important step for RFA. The commonly applied modalities for preoperative evaluation are ultrasound and technetium 99m–sestamibi single-photon-emission-computed tomography/computed tomography (sestamibi SPECT/CT) [ 17 , 22 , 23 , 24 , 25 , 26 ]. One meta-analysis revealed the variability of sensitivity for each imaging modality (ultrasound 70.4–81.4%, sestamibi SPECT/CT 64–90.6%) [ 23 ].…”