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

Abstract

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.

Parathyroid adenoma: multimodal diagnosis capabilities: A retrospective study

“…Среди различных методов визуализации по локализации аденом околощитовидных желез ПЭТ/КТ с 18 F-дезоксиглюкозой и особенно с 18 F-холином показали превосходство над ультразвуковым методом и сцинтиграфией, поскольку последние не позволяют обнаружить гиперфункционирующие аденомы у каждого 5-го пациента [16,26].…”

Parathyroidectomy in Hemodialysis Patients

“…Tecnesyum-99-MIBI sintigrafi+yüksek çözünürlüklü ultrasonografinin duyarlılığı ise % 95 olarak bildirilmiştir (16). Single-photon emission computed tomography (SPECT); diğer bir metod olup özellikle daha önce paratiroid operasyonu geçiren ve re-operasyon planlanan hastalarda ektopik paratiroid dokusunun varlığını görüntülemek amaçlı kullanılan bir yöntemdir (17). Rutin değerlendirmede önerilmeyip, sensitivitesi %70-80 civarıdır.…”

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

“…The currently most widespread preoperative imaging procedure is the combination of [ 99m Tc]Tc-MIBI scintigraphy and cervical ultrasonography (US), yielding a sensitivity of 84–88% [ 10 , 11 , 12 ], which is mainly contributed by [ 99m Tc]Tc-MIBI scintigraphy when combined with single-photon emission computed tomography/computed tomography (SPECT/CT). This implies that, in up to 20% of cases, a pathological parathyroid gland can be detected by neither ultrasound nor scintigraphy [ 13 ]. Of note, especially in cases of unsuccessful surgical exploration of the neck in pHPT (persistent pHPT) and in cases of recurrent pHPT, an exact localization diagnosis is urgently needed because surgical re-exploration is a difficult procedure with increased risks, such as recurrent paresis and hypoparathyroidism.…”