Sestamibi scans are not all created equally.

HYPOTHESIS: The sensitivity of sestamibi scanning techniques used for preoperative localization in primary hyperparathyroidism is a function of the parameters of image acquisition and processing.

DESIGN

Criterion standard vs optimized technique.

SETTING

Tertiary referral center.

PATIENTS: One hundred forty-eight consecutive patients with primary hyperthyroidism were analyzed. Under the initial protocol, 97 patients underwent a preexisting standard sestamibi--single-photon emission computed tomographic scan and surgical exploration. The scanning technique was modified and in the revised protocol, 51 patients underwent imaging and surgical exploration.

INTERVENTION: Image acquisition and processing revisions as follows: patient positioning standardized, collimator resolution adjusted, radioactive tracer delay extended, visualization field broadened, data extraction refined, and image processing filter modified.

MAIN OUTCOME MEASURES: concordance among the scan and operative localization, lateralization, and cure rate.

RESULTS

Initial protocol: 97 patients underwent surgery for primary hyperthyroidism with the initial sestamibi design. Eighty-one patients (83%) had a positive result, that is, at least 1 gland was identified; 77 patients (79%) had correct lateralization; and 49 patients (52%) had precise localization. Revised protocol: 51 patients underwent imaging under the optimized protocol. Forty-nine patients (96) had a positive result; 47 patients (92%) had correct lateralization; and 36 patients (70%) had precise localization. These improvements were significant, with P<.05 for localization and P<.01 for lateralization. Cure rates were 96% in both groups, confirmed by laboratory and pathologic findings.

CONCLUSIONS

Sestamibi optimization in primary hyperparathyroidism can improve scan sensitivity. This may permit a focused minimally invasive operation.