Comparison of SPECT/CT, SPECT, and Planar Imaging with Single- and Dual-Phase 99mTc-Sestamibi Parathyroid Scintigraphy

Journal of Nuclear Medicine

Jeffrey P. Leal¹  Martha A. Zeiger¹  Alan P. Dackiw¹  Harvey A. Ziessman¹  Sibyll Goetze¹  Kent P. Friedman¹  William C. Lavely¹  Ralph P. Tufano¹  Zhe Zhang¹  Elizabeth Garret-Mayer¹ 

关键词: hyperparathyroidism;    parathyroid adenoma;    parathyroid scintigraphy;    SPECT/CT;    minimally invasive parathyroidectomy;   

DOI  :  10.2967/jnumed.107.040428

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

Various methodologies for 99mTc-sestamibi parathyroid scintigraphy are in clinical use. There are few direct comparisons between the different methods and even less evidence supporting the superiority of one over another. Some reports suggest that SPECT is superior to planar imaging. The addition of CT to SPECT may further improve parathyroid adenoma localization. The purpose of our investigation was to compare hybrid SPECT/CT, SPECT, and planar imaging and to determine whether dual-phase imaging is advantageous for the 3 methodologies. Methods: Scintigraphy was performed on 110 patients with primary hyperparathyroidism and no prior neck surgery. Of these, 98 had single adenomas and are the subject of this review. Planar imaging and SPECT/CT were performed at 15 min and 2 h after injection. Six image sets (early and delayed planar imaging, SPECT, and SPECT/CT) and combinations of the 2 image sets were reviewed for adenoma localization at 13 possible sites. Each review was scored for location and certainty of focus by 2 reviewer groups. Surgical location served as the standard. Sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, and κ-values were determined for each method. Results: The overall κ-coefficient (certainty of adenoma focus) between reading groups was 0.68 (95% confidence interval, 0.66–0.70). The highest values were for dual-phase studies that included SPECT/CT. Dual-phase planar imaging, SPECT, and SPECT/CT were statistically significantly superior to single-phase early or delayed imaging in sensitivity, area under the curve, and positive predictive value. Neither single-phase nor dual-phase SPECT was statistically superior to dual-phase planar imaging. Early-phase SPECT/CT in combination with any delayed imaging method was superior to dual-phase planar imaging or SPECT for sensitivity, area under the curve, and positive predictive value. Conclusion: Early SPECT/CT in combination with any delayed imaging method was statistically significantly superior to any single- or dual-phase planar or SPECT study for parathyroid adenoma localization. Localization with dual-phase acquisition was more accurate than with single-phase 99mTc-sestamibi scintigraphy for planar imaging, SPECT, and SPECT/CT.

【 授权许可】

Unknown