Parathyroid Imaging: The Importance of Pinhole Collimation with Both Single- and Dual-Tracer Acquisition

Klingensmith, William C.; Koo, Phillip J.; Summerlin, Adam L.; Fehrenbach, Bradley; Karki, Ramesh; Shulman, Benjamin; Raeburn, Christopher D.; McIntyre, Robert C.

doi:10.2967/jnmt.112.118208

Cited by 26 publications

(17 citation statements)

References 20 publications

(25 reference statements)

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“…Recently, Kunstman et al (17) have suggested that a single-positive or suggestive imaging modality (PS or US) may be a sufficient indication for focused approaches. Our results show that dualradiopharmaceutical 123 I/ 99m Tc-sestamibi subtraction pinhole imaging followed by SPECT acquisition is more accurate than US for directing a focused approach (4,7,11,12). Our protocol avoids motion artifacts because it is based on a simultaneous acquisition of the two photopeaks (4,6,8,18 As in previous series, adenomas missed by US were predominantly posterior in our study (19).…”

Section: European Journal Of Endocrinologysupporting

confidence: 66%

“…The use of a pinhole collimator provides a higher sensitivity compared with parallel holes. The combination of a dual-tracer method using 123 I/ 99m Tc-sestamibi and pinhole acquisition is currently the most sensitive protocol for parathyroid imaging (4,7,11,12). Additional SPECT and SPECT/CT acquisitions enable localization of the detected adenomas in all 3D.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Guérin

Lowery

Gabriel

et al. 2015

European Journal of Endocrinology

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Objective: Surgical treatment for primary hyperparathyroidism (pHPT) has undergone a major paradigm shift during the last decades from bilateral cervicotomy with four-gland neck exploration to image-guided focused approaches. The primary objective of the present study was to compare the performances of parathyroid scintigraphy (PS), parathyroid ultrasonography (US), and the combination of both procedures for guiding a focused approach on the basis of modified interpretation criteria. Methods: Data from 199 patients operated for apparent sporadic pHPT and evaluated with US and PS using dual-isotope 123 I/ 99m Tc-sestamibi planar pinhole and single-photon emission computed tomography (SPECT) acqusitions were evaluated. Results: A total of 127 patients underwent a focused approach and the remainder had bilateral cervicotomy. In 42 cases, a focused approach was not performed due to the absence of concordant results between US and PS for a single-gland abnormality. Four patients had persistent disease and three had recurrent disease. A localizing preoperative PS had a sensitivity of 93.3%, positive predictive value of 85.8%, negative predictive value of 73.0%, and accuracy of 83.4% for predicting uniglandular disease. Additional SPECT images accurately localize posterior adenomas that are often missed by US. Compared with PS, US had a lower sensitivity (P!0.01). Our imaging protocol also enabled diagnosis of multiglandular disease in 60.6%. Conclusions: PS using a highly sensitive dual-tracer subtraction method is the most accurate technique for directing a focused approach. PS could be sufficient for directing a focused approach in the presence of a negative US in two major circumstances: posterior locations due to acquired ectopia that could be missed by US, and previous history of thyroidectomy due to interpretation difficulties.

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Section: European Journal Of Endocrinologysupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Guérin

Lowery

Gabriel

et al. 2015

European Journal of Endocrinology

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“…In addition, the SPECT images of the SPECT/CT protocol are reconstructed from parallel-hole collimation images whose spatial resolution is less than the pinhole collimation images of the pinhole protocol and this fact may contribute to a lower localization accuracy of the SPECT/CT protocol relative to the pinhole protocol (7). Additionally, this study does not address the relative accuracy of other SPECT/CT protocols, for example, single-isotope dual-time-point imaging at 15 and 90 min, that also currently exist in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…There was no correction for cross talk. The subtractions were done manually by increasing the amount of subtraction of the 123 I thyroid image from the 99m Tc-sestamibi image until the thyroid was essentially no longer visible (4,7). The CT images were used to correct the SPECT images for attenuation correction.…”

Section: Image Processingmentioning

confidence: 99%

“…The protocols vary depending on whether pinhole or parallel-hole collimation is used, whether SPECT tomography with or without CT is used, whether 1 or 2 radiopharmaceuticals with or without simultaneous acquisition and perfectly coregistered subtraction is used, and whether imaging is performed at 1 or 2 times after administration of the radiopharmaceuticals (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The literature suggests that pinhole collimation is superior to parallel-hole collimation (7), that SPECT/CT is superior to SPECT alone (1,5,6), that dual-radiopharmaceutical imaging with simultaneous acquisition and perfectly coregistered subtraction is superior to single radiopharmaceutical imaging (1,3,4,7), and that imaging can be performed at only 1 time point without any loss in accuracy (3,4).…”

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Parathyroid Imaging with Simultaneous Acquisition of ^99mTc-Sestamibi and ¹²³I: The Relative Merits of Pinhole Collimation and SPECT/CT

Bhatt

Klingensmith

Bagrosky

et al. 2015

J. Nucl. Med. Technol.

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The objective of this study was to determine the relative utility of 3 state-of-the-art parathyroid imaging protocols: single-time-point simultaneous acquisition of 99m Tc-sestamibi and 123 I images with pinhole collimation in the anterior and bilateral anterior oblique projections, single-time-point simultaneous acquisition of 99m Tcsestamibi and 123 I images with SPECT/CT, and the combination of the first and second protocols. Methods: Fifty-nine patients with surgical proof of parathyroid adenomas were evaluated retrospectively. All 3 protocols included perfectly coregistered subtraction images created by subtracting the 123 I images from the 99m Tcsestamibi images, plus an anterior parallel-hole collimator image of the neck and upper chest. The pinhole protocol was performed first, followed by the SPECT/CT protocol. Three image sets were derived from each study in each patient according to the above protocols. Two experienced observers recorded the size, location, and degree of certainty of any identified lesion. Results: The 59 patients had 61 adenomas. For the 2 observers combined, the localization success rate was 88% for the pinhole protocol, 69% for the SPECT/CT protocol, and 81% for the combined protocol. The pinhole protocol detected more adenomas than the SPECT/ CT protocol and missed fewer adenomas than either the SPECT/ CT protocol or the combined pinhole and SPECT/CT protocol (P , 0.01). The 2 protocols that included SPECT/CT provided superior anatomic information relative to the location and size of the parathyroid adenomas. Conclusion: The pinhole protocol localized significantly more adenomas than the SPECT/CT protocol. However, the protocols that included SPECT/CT provided more anatomic information than pinhole imaging alone.Key Words: camera-based high energy imaging; endocrine; SPECT/CT; I-123; parathyroid imaging; pinhole collimation; Tc-99m-sestamibi Hyperparat hyroidism is a relatively common condition, with an incidence of approximately 1 per 1,000 adults (1). At least 80% of cases of hyperparathyroidism are caused by 1 or occasionally more parathyroid adenomas. Most of the remaining cases of hyperparathyroidism are secondary and are caused by renal insufficiency. Preoperative identification and localization of the adenomas allow the surgeon to perform imageguided minimally invasive surgery with improved success rates, shorter operating times, and less morbidity (2). Consequently, it is important to optimize the accuracy of preoperative imaging in determining the presence, size, and location of parathyroid adenomas.A wide variety of nuclear medicine protocols have been reported for imaging parathyroid glands. The protocols vary depending on whether pinhole or parallel-hole collimation is used, whether SPECT tomography with or without CT is used, whether 1 or 2 radiopharmaceuticals with or without simultaneous acquisition and perfectly coregistered subtraction is used, and whether imaging is performed at 1 or 2 times after administration of the radiopharmaceuticals (1,3-12). The literatur...

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Parathyroid Imaging in Patients with Renal Hyperparathyroidism

Hindié

Ureña-Torres

Taïeb

2020

Parathyroid Glands in Chronic Kidney Disease

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Parathyroid Imaging: The Importance of Pinhole Collimation with Both Single- and Dual-Tracer Acquisition

Abstract: In the anterior projection, pinhole collimation is superior to parallel-hole collimation for parathyroid imaging with either dual-phase (99m)Tc-sestamibi or dual-phase (99m)Tc-sestamibi plus dual-tracer ((99m)Tc-sestamibi and (123)I) simultaneous-acquisition subtraction.

Cited by 26 publications

References 20 publications

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Parathyroid Imaging with Simultaneous Acquisition of ^99mTc-Sestamibi and ¹²³I: The Relative Merits of Pinhole Collimation and SPECT/CT

Parathyroid Imaging in Patients with Renal Hyperparathyroidism

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Parathyroid Imaging: The Importance of Pinhole Collimation with Both Single- and Dual-Tracer Acquisition

Abstract: In the anterior projection, pinhole collimation is superior to parallel-hole collimation for parathyroid imaging with either dual-phase (99m)Tc-sestamibi or dual-phase (99m)Tc-sestamibi plus dual-tracer ((99m)Tc-sestamibi and (123)I) simultaneous-acquisition subtraction.

Cited by 26 publications

References 20 publications

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Parathyroid Imaging with Simultaneous Acquisition of 99mTc-Sestamibi and 123I: The Relative Merits of Pinhole Collimation and SPECT/CT

Parathyroid Imaging in Patients with Renal Hyperparathyroidism

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Parathyroid Imaging with Simultaneous Acquisition of ^99mTc-Sestamibi and ¹²³I: The Relative Merits of Pinhole Collimation and SPECT/CT