The application of SPECT/CT for preoperative planning in patients with secondary hyperparathyroidism

Secondary hyperparathyroidism (SHPT) is a frequent and challenging issue in patients undergoing dialysis for chronic kidney disease. Surgical intervention in the form of parathyroidectomy is generally considered only in cases of severe SHPT. However, identification of the exact location of the parathyroid glands (PTGs) before parathyroidectomy is a challenge. The aim of this study was to evaluate the role of 99mTc sestamibi single-photon emission computed tomography (SPECT)/computed tomography (CT) in the detection of parathyroids to guide operative therapy in patients with SHPT.

Ninety patients with SHPT who were on hemodialysis were evaluated preoperatively with double-phase 99mTc sestamibi static planar and SPECT/CT parathyroid scintigraphy to evaluate for parathyroids before parathyroidectomy. The sensitivity, specificity, and accuracy of 99mTc sestamibi static planar and SPECT/CT scintigraphy were determined.

Compared with static planar scintigraphy, 99mTc sestamibi SPECT/CT was able to detect a larger number of PTGs per study, as well as PTGs of smaller diameter and PTGs of smaller size. The sensitivity, specificity, and accuracy of 99mTc sestamibi SPECT/CT in detecting PTGs were 78.9, 100, and 78.9%, respectively, compared with 55.6, 100, and 55.6% for static planar 99mTc sestamibi.

Our study indicates that 99mTc sestamibi SPECT/CT has a higher sensitivity compared with static planar scintigraphy in the preoperative evaluation of hemodialysis patients with SHPT because of chronic kidney disease. SPECT/CT can not only detect a larger number of PTGs but can also depict the precise location of PTGs more accurately when compared with static planar scintigraphy.