[Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism]

Area of Science:

• Nuclear Medicine
• Radiology
• Endocrinology

Background:

• Accurate localization of parathyroid nodules is crucial for surgical planning in primary hyperparathyroidism.
• Various imaging modalities exist, but their comparative accuracy for nodule localization requires further evaluation.

Purpose of the Study:

• To assess the diagnostic accuracy of different imaging techniques for localizing parathyroid nodules.
• To compare the effectiveness of ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy, and 99mTc MIBI scintigraphy.

Main Methods:

• Prospective enrollment of 71 patients undergoing surgery for primary hyperparathyroidism.
• Evaluation of ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy, and 99mTc MIBI scintigraphy.
• Analysis of sensitivity, specificity, and positive predictive value for each technique and combinations.

Main Results:

• Combined 201Tl/99mTc scintigraphy and US showed 72.27% sensitivity and 89.22% specificity for parathyroid adenomas.
• The combination of 99mTc MIBI scintigraphy and US yielded higher specificity (93.67%) and positive predictive value (80.39%).
• Imaging accuracy was reduced in patients with parathyroid hyperplasia compared to adenomas.

Conclusions:

• The combination of scintigraphy and ultrasonography represents the optimal strategy for parathyroid nodule localization.
• These imaging modalities often act as complementary tools, enhancing diagnostic confidence.
• The combined approach is particularly valuable for identifying parathyroid adenomas.