Efficacy of ⁹⁹mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy: comparative study with ⁹⁹mTc-sestamibi scintigraphy, SPECT, US and CT.

PURPOSE: We evaluated the efficacy of (99m)Tc-sestamibi SPECT/CT for planning minimally invasive parathyroidectomy (MIP), comparing with dual phase (99m)Tc-sestamibi scintigraphy, (99m)Tc-sestamibi SPECT and conventional imaging (US and CT).

METHODS

Thirty-one patients (M:F = 10:21, range 35-78 years old) who showed high serum parathyroid hormone (intact PTH) level were included. (99m)Tc-sestamibi scintigraphy was performed 15 and 150 min after injection of (99m)Tc-sestamibi (555 MBq), and (99m)Tc-sestamibi SPECT/CT was obtained just after the delayed scan. Comparison study between imaging modalities was done by patient-based and lesion location-based analysis. The location of the lesion was confirmed by the operative finding. An operation was performed in 24 patients. Seven patients had normal (99m)Tc-sestamibi SPECT/CT, and followed for more than 6 months after SPECT/CT.

RESULTS

Among 24 patients, parathyroid adenoma was detected in 19 patients and the other 5 had parathyroid hyperplasia (total 35 lesions). (99m)Tc-sestamibi scintigraphy detected abnormal uptake in 15 patients with 24 lesions. Conventional imaging identified abnormal findings in 17 patients with 27 lesions. SPECT detected abnormal findings in 18 patients with 27 lesions. SPECT/CT identified abnormal findings in 24 patients with 35 lesions. SPECT/CT demonstrated 100 % sensitivity in a patient-based analysis. SPECT/CT exhibited significantly better sensitivity than (99m)Tc-sestamibi scintigraphy, SPECT and conventional imaging (p < 0.05). All lesion location was correctly identified to perform MIP. The final clinical diagnosis of 7 normal SPECT/CT patients was secondary hyperparathyroidism on 6 months follow-up.

CONCLUSIONS

We correctly identified the precise location of parathyroid adenomas or hyperplasia by (99m)Tc-sestamibi SPECT/CT which was helpful to perform MIP.