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SPECT/CT's Advantage for Preoperative Localization of Small Parathyroid Adenomas in Primary Hyperparathyroidism
Karolinska Univ Hosp, Dept Med Radiat Phys & Nucl Med, Stockholm, Sweden.; Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.; Karolinska Univ Hosp, Dept Endocrine Surg, Stockholm, Sweden.
Karolinska Univ Hosp, Dept Med Radiat Phys & Nucl Med, Stockholm, Sweden.; Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
Karolinska Univ Hosp, Dept Med Radiat Phys & Nucl Med, Stockholm, Sweden.
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2017 (English)In: Clinical Nuclear Medicine, ISSN 0363-9762, E-ISSN 1536-0229, Vol. 42, no 2, 109-114 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSES: The aims of this study were to assess the performance of Tc-sestamibi SPECT/CT, with diagnostic CT quality, compared with SPECT alone for preoperative localization of parathyroid adenomas and to assess the influence of adenoma weight on the correct adenoma lateralization with SPECT/CT and with SPECT alone.

METHODS: Two hundred forty-nine consecutive patients, biochemically diagnosed with primary hyperparathyroidism, were examined with a combined SPECT/CT scanner. Subsequently, 200 patients with confirmed histopathology and biochemical cure after parathyroidectomy were included in this study (16 with multiglandular disease). For each patient, the SPECT-alone data were analyzed first. Thereafter, the CT information was added, and a new evaluation was performed with the combined data. In addition, for each patient, the diagnostic confidence with each method was graded on a scale based on the presence of different image features. The preoperative diagnostic findings were then compared with the surgical and histopathologic reports.

RESULTS: The distribution of adenoma weights showed a peak at 210 mg, with a median at 338 mg. The sensitivity and specificity (multiglandular disease included) for correct classification of adenomas were significantly higher for SPECT/CT, 83% and 96%, respectively, than for SPECT alone, 80% and 93% (P < 0.01). Below 210 mg, the differences between SPECT/CT and SPECT alone in accurate adenoma lateralization were more prominent. Sixty-seven percent of all adenomas were graded with the highest confidence score with SPECT/CT compared with 53% with SPECT.

CONCLUSIONS: SPECT/CT yields fewer false-positive findings than SPECT alone. The advantage of SPECT/CT over SPECT alone was most apparent for correct lateralization of small adenomas (<210 mg).

Place, publisher, year, edition, pages
2017. Vol. 42, no 2, 109-114 p.
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-308415DOI: 10.1097/RLU.0000000000001447ISI: 000392924900005PubMedID: 27819859OAI: oai:DiVA.org:uu-308415DiVA: diva2:1049714
Available from: 2016-11-25 Created: 2016-11-25 Last updated: 2017-03-20Bibliographically approved

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