Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism

Area of Science:

• Nuclear Medicine
• Radiopharmacology
• Endocrine Surgery

Background:

• Primary hyperparathyroidism is often caused by hyperfunctioning parathyroid tissue.
• Accurate preoperative localization of this tissue is crucial for successful surgical intervention.
• Current imaging techniques have varying degrees of efficacy.

Purpose of the Study:

• To compare the efficacy of double-phase 99mTc-sestamibi SPECT and simultaneous 123I-99mTc-sestamibi subtraction SPECT.
• To determine the optimal imaging modality for preoperative localization of hyperfunctioning parathyroid tissue.

Main Methods:

• A study involving fifteen patients with primary hyperparathyroidism.
• Preoperative imaging using both double-phase 99mTc-sestamibi SPECT and simultaneous 123I-99mTc-sestamibi subtraction SPECT.
• Surgical correlation including gland location, weight, and histopathologic evaluation.

Main Results:

• Simultaneous 123I-99mTc-sestamibi subtraction SPECT demonstrated higher sensitivity (88%), specificity (97%), and diagnostic accuracy (94%) compared to double-phase 99mTc-sestamibi SPECT (53%, 86%, 76%).
• The differences in sensitivity and diagnostic accuracy were statistically significant (p = .031 and p = .016, respectively).
• Seventeen parathyroid adenomas and 37 normal parathyroid glands were identified at surgery.

Conclusions:

• Simultaneous 123I-99mTc-sestamibi subtraction SPECT is a superior imaging modality for preoperative localization.
• This technique improves the surgical planning and outcomes for patients with primary hyperparathyroidism.