Dual-tracer 99mTc-sestamibi/ 123I imaging in primary hyperparathyroidism

Area of Science:

• Nuclear Medicine
• Radiology
• Endocrine Surgery

Background:

• Primary hyperparathyroidism (PHPT) requires surgery for cure, necessitating accurate preoperative localization.
• Effective preoperative imaging is crucial for guiding minimally invasive parathyroidectomy (MIP) and avoiding complications.
• Detecting multiple gland disease (MGD) is vital for surgical success and preventing hypoparathyroidism.

Purpose of the Study:

• To evaluate the efficacy of dual-tracer ^99mTc-sestamibi/¹²³I imaging combined with SPECT/CT for MGD detection in PHPT.
• To compare the diagnostic performance of dual-tracer imaging against single-tracer protocols.
• To assess the role of ¹⁸F-fluorocholine PET/CT as a second-line imaging modality.

Main Methods:

• Utilized dual-tracer ^99mTc-sestamibi/¹²³I scintigraphy with simultaneous acquisition and neck pinhole imaging.
• Incorporated dual-tracer SPECT/CT for precise anatomical localization of parathyroid lesions.
• Employed contrast-enhanced ¹⁸F-fluorocholine PET/CT as a second-line tool when initial imaging was inconclusive.

Main Results:

• Dual-tracer ^99mTc-sestamibi/¹²³I imaging significantly improves MGD detection compared to single-tracer methods.
• Simultaneous acquisition and pinhole imaging enhance resolution and diagnostic accuracy.
• ¹⁸F-fluorocholine PET/CT effectively aids in localization for persistent or recurrent PHPT cases.

Conclusions:

• Dual-tracer ^99mTc-sestamibi/¹²³I scintigraphy with SPECT/CT is a superior first-line imaging strategy for PHPT, particularly for MGD.
• This protocol optimizes patient selection for MIP and reduces the need for extensive bilateral exploration.
• ¹⁸F-fluorocholine PET/CT serves as a valuable second-line option for complex cases.