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

Primary hyperparathyroidism is caused by single gland disease in 85% of cases and by multiglandular disease in 15%. Our aim was to discover if the addition of computed tomography acquisition/fusion on a hybrid scanner to traditional dual-phase single-photon emission tomography improves localization accuracy.

A prospective database was queried for the perioperative data of patients with sporadic primary hyperparathyroidism who had initial exploration from 2006-2014 with ≥6 month follow-up to define anatomy. Prior to 2010, patients had single-photon emission tomography (n = 633); after 2010, they had single-photon emission tomography/computed tomography (n= 755).

In 1,388 patients, the rates of single gland disease (P=.8), bilateral exploration (P=.4), and negative imaging (145 patients, P=.33) were equal between imaging cohorts. In 1,186 patients with single gland disease, the positive predictive value of single-photon emission tomography/computed tomography was somewhat greater (90% vs 85%) and the accuracy of single-photon emission tomography/computed tomography was superior (83% vs 77%, P=.02). In the 202 patients with multiglandular disease, 20% had negative imaging results with no difference by type (single-photon emission tomography/computed tomography 17%, single-photon emission tomography 23%, P=.3), but single-photon emission tomography/computed tomography was more accurate (36%) than single-photon emission tomography (22%, P=.04) in predicting multiglandular disease.

In a large cohort study of patients with sporadic primary hyperparathyroidism undergoing parathyroidectomy, positive single-photon emission tomography/computed tomography results provided more reliable operative guidance than single-photon emission tomography for both single gland disease and multiglandular disease.