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Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT
T H Vu1, D Schellingerhout2, N Guha-Thakurta2
1From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.) thinh.vu@mdanderson.org.
AJNR. American Journal of Neuroradiology
|December 8, 2018
Summary
Comparing imaging for minimally invasive parathyroid surgery, multiphase multidetector 4D CT and technetium Tc99m sestamibi SPECT combined offer superior quadrant localization accuracy. This combined approach enhances diagnostic confidence for parathyroid adenoma localization.
Area of Science:
- Radiology
- Nuclear Medicine
- Surgical Oncology
Background:
- Minimally invasive parathyroid surgery requires effective image guidance.
- Limited comparative data exist for various imaging modalities used in parathyroid surgery.
Purpose of the Study:
- To perform a blinded comparison of imaging modalities for parathyroid adenoma localization.
- Evaluate technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and their combination.
Main Methods:
- Retrospective review of 31 patients with primary hyperparathyroidism.
- Preoperative imaging included technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT.
- Surgical resection provided pathological confirmation and served as the reference standard.
Main Results:
- Left/right localization accuracy: SPECT 93.5%, 4D CT 96.8%, combined 96.8%.
- Quadrant localization accuracy: SPECT 67.7%, 4D CT 87.1%, combined 93.5%.
- Diagnostic confidence was highest for the combined modality.
Conclusions:
- All modalities showed equivalent accuracy for left/right parathyroid adenoma localization.
- The combination of technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT is superior for quadrant localization.
- Combined imaging improves diagnostic confidence in minimally invasive parathyroid surgery.
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