Is dual-phase SPECT/CT with 99mTc-sestamibi better than single-phase SPECT/CT for lesion localization in patients with hyperparathyroidism?

Medicine (Baltimore). 2020 May;99(19):e19989. doi: 10.1097/MD.0000000000019989.

Abstract

This study aimed to establish an optimal protocol for Tc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT).We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes and 120 minutes) Tc-sestamibi parathyroid scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT). Twenty seven patients had primary HPT, and 8 had secondary or tertiary HPT. Three nuclear medicine physicians independently analyzed the parathyroid images for lesion localization at 9 predefined parathyroid locations using the following 4 different image sets blinded to the clinical information:All SPECT or SPECT/CT image sets were analyzed with dual-phase planar images. The image results were compared with the histopathological results after surgery.Dual-phase SPECT/CT showed the highest positive rate of 85.7% in the patient-based analysis and 13.7% in the location-based analysis. Of 35 patients, surgical pathological results were available in 21 (16 adenomas in 16 primary HPTs and 16 hyperplasias in 5 secondary or tertiary HPTs). Dual-phase SPECT/CT showed the sensitivity values of 100% and 84.4% in the patient-based and location-based analysis, respectively, which were the highest sensitivity values among all image sets. In the primary HPT subgroup, dual-phase SPECT/CT showed the highest sensitivity value of 93.8% in the location-based analyses, whereas dual-phase SPECT, early SPECT/CT, and delayed SPECT/CT showed the sensitivity values of 62.5%, 81.3%, and 81.3%, respectively. In the secondary or tertiary HPT subgroup, dual-phase SPECT/CT also showed the highest sensitivity value of 75.0%, whereas early SPECT/CT, delayed SPECT/CT, and dual-phase SPECT showed the sensitivity values of 43.8%, 56.3%, and 68.8%, respectively.Compared with dual-phase SPECT or single-phase SPECT/CT, the dual-phase SPECT/CT imaging protocol for Tc-sestamibi scintigraphy showed the highest positive rate and sensitivity, and was optimal for parathyroid lesion localization.

MeSH terms

  • Female
  • Humans
  • Hyperparathyroidism* / diagnosis
  • Hyperparathyroidism* / etiology
  • Hyperplasia* / diagnosis
  • Hyperplasia* / pathology
  • Hyperplasia* / surgery
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Neoplasms* / diagnosis
  • Parathyroid Neoplasms* / pathology
  • Parathyroid Neoplasms* / surgery
  • Radionuclide Imaging* / methods
  • Radionuclide Imaging* / standards
  • Radiopharmaceuticals / pharmacology
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Single Photon Emission Computed Tomography Computed Tomography / methods*
  • Technetium Tc 99m Sestamibi / pharmacology*

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi