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Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism
D R Neumann1, C B Esselstyn, R T Go
1Department of Nuclear Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Objective:
Our purpose was to compare double-phase 99mTc-sestamibi single-photon emission computed tomography (SPECT) and simultaneous 123I-99mTc-sestamibi subtraction SPECT for preoperative localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism.
Subjects And Methods:
Fifteen patients with primary hyperparathyroidism underwent preoperative double-phase 99mTc-sestamibi SPECT and simultaneous 123I-99mTc-sestamibi subtraction SPECT imaging. At surgery, the location, weight, and histopathologic evaluation of all identified parathyroid glands were recorded.
Results:
At surgery, 17 parathyroid adenomas and 37 normal parathyroid glands were identified. The sensitivity, specificity, and diagnostic accuracy for the detection of parathyroid adenomas were 88%, 97%, and 94%, respectively, for simultaneous 123I-99mTc-sestamibi subtraction SPECT and 53%, 86%, and 76%, respectively, for double-phase 99mTc-sestamibi SPECT. The differences in sensitivity and diagnostic accuracy were statistically significant (p = .031 and p = .016, respectively).
Conclusion:
Compared with double-phase 99mTc-sestamibi SPECT, simultaneous 123I-99mTc-sestamibi subtraction SPECT is a superior imaging study for the preoperative localization of hyperfunctioning parathyroid tissue.
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