Sestamibi SPECT/CT versus SPECT only for preoperative localization in primary hyperparathyroidism: a single...

Area of Science:

• Endocrinology
• Nuclear Medicine
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) is predominantly caused by single-gland disease (85%) but can involve multiple glands (15%).
• Accurate preoperative localization of abnormal parathyroid glands is crucial for successful parathyroidectomy.
• Traditional imaging modalities like single-photon emission tomography (SPECT) have limitations in precisely identifying all affected glands.

Purpose of the Study:

• To evaluate if hybrid SPECT/computed tomography (CT) imaging improves the accuracy of parathyroid gland localization compared to traditional SPECT.
• To assess the impact of SPECT/CT on operative guidance for both single-gland and multiglandular primary hyperparathyroidism.

Main Methods:

• A prospective database of patients with sporadic primary hyperparathyroidism undergoing initial exploration (2006-2014) was analyzed.
• Patients were divided into two cohorts based on imaging: SPECT (pre-2010) and SPECT/CT (post-2010).
• Perioperative data and imaging results were compared between the two imaging techniques.

Main Results:

• No significant differences were observed in rates of single-gland disease, bilateral exploration, or negative imaging between SPECT and SPECT/CT cohorts.
• SPECT/CT demonstrated a superior positive predictive value (90% vs. 85%) and accuracy (83% vs. 77%) for single-gland disease.
• For multiglandular disease, SPECT/CT was more accurate (36% vs. 22%) in predicting the condition, although negative imaging rates were similar.

Conclusions:

• SPECT/CT provides more reliable operative guidance than SPECT for primary hyperparathyroidism, encompassing both single-gland and multiglandular presentations.
• The enhanced accuracy of SPECT/CT aids in surgical planning and potentially improves outcomes for patients with primary hyperparathyroidism.