Comparison of four-dimensional CT and Sestamibi SPECTCT in the localization management of primary hyperparathyroidism

Accurate preoperative imaging localization is paramount to the success of targeted parathyroidectomy for primary hyperparathyroidism (PHPT). Four-dimensional (4D) CT is a promising method for preoperative localization of the parathyroid, but studies on the performance of 4D CT and technetium 99 m-sestamibi SPECT/CT for the diagnosis of diseases of the parathyroid are limited.

To compare the diagnostic performance of sestamibi SPECT/CT and 4D-CT for preoperative localization in patients with PHPT in a single-institution from August 2017 to May 2024.

Two hundred forty-two patients with PHPT (166 females; 52.5 years ± 13.4 [SD]) were evaluated. Among the 242 patients, 233 patients (96.3%) had single-gland disease, and 9 patients (3.7%) had multigland disease. Similar diagnostic performance was observed for sestamibi SPECT/CT and 4D-CT ([receiver operating characteristic ROC], 0.90 [95% CI: 0.87, 0.92] and 0.88 [95% CI: 0.85, 0.90], respectively; p = 0.11). Compared with 4D-CT, combined-modality sensitive reading and sestamibi SPECT/CT had the highest ROC, and, although there was no significant difference between the two (ROC, 0.91; 95% CI: 0.89, 0.93; p = 0.14), they significantly differed from 4D-CT (p = 0.0006). Sestamibi SPECT/CT showed an accuracy of 92% (95% CI: 90%, 94%), similar to 4D-CT (91%; 95% CI: 89%, 92%), combined-modality sensitive reading (91%; 95% CI: 89%, 93%) and combined-modality specificity reading (92%; 95% CI: 90%, 94%).

Sestamibi SPECT/CT has high accuracy in preoperative localization in patients with PHPT. Compared with sestamibi SPECT/CT alone, 4D-CT and combined-modality reading did not improve diagnostic performance.