TY - JOUR
T1 - A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism
AU - Krakauer, Martin
AU - Wieslander, Bente
AU - Myschetzky, Peter Sand
AU - Lundstrøm, Anke
AU - Bacher, Theis
AU - Sørensen, Christian Hjort
AU - Trolle, Waldemar
AU - Nygaard, Birte
AU - Bennedbæk, Finn N
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Purpose Preoperative localization of the diseased parathyroid gland(s) in primary hyperparathyroidism allows for minimally invasive surgery. This study was designed to establish the optimal first-line preoperative imaging modality. Patients and Methods Ninety-one patients were studied consecutively in a prospective head-to-head comparison of dual isotope (99mTc-MIBI vs 123I) inftraction parathyroid scintigraphy (PS), dual-phase PS, 4-dimensional (4D) CT, and ultrasonography (US). Surgery, histological confirmation, and postoperative normalization of Ca++ and parathyroid hormone were the reference standard. Results Ninety-seven hyperfunctioning parathyroid glands (HPGs) were identified by the reference standard. Sensitivity and specificity for inftraction PS, dual-phase PS, 4D-CT, and US were 93%, 65%, 58%, and 57% as well as 99%, 99.6%, 86%, and 95%, respectively. Interrater agreement was excellent for inftraction PS (κ = 0.96) while only fair for 4D-CT (κ = 0.34). Pinhole imaging and inftraction of delayed images (the latter especially in case of a nodular thyroid gland) increased the sensitivity of inftraction PS. SPECT/low-dose CT did not increase sensitivity but aided in the exact localization of the HPGs. Of 7 negative inftraction PS studies, 4D-CT and US were able to locate 3 and 1 additional HPGs, respectively. Conclusions Dual isotope pinhole inftraction PS has higher diagnostic accuracy compared with dual-phase PS, 4D-CT, and US as a first-line imaging study in primary hyperparathyroidism. In case of a negative scintigraphy or suspicion of multiglandular disease, 4D-CT and/or US is recommended as a second-line modality. However, diagnostic algorithms should be adapted in accordance with local availability and expertise.
AB - Purpose Preoperative localization of the diseased parathyroid gland(s) in primary hyperparathyroidism allows for minimally invasive surgery. This study was designed to establish the optimal first-line preoperative imaging modality. Patients and Methods Ninety-one patients were studied consecutively in a prospective head-to-head comparison of dual isotope (99mTc-MIBI vs 123I) inftraction parathyroid scintigraphy (PS), dual-phase PS, 4-dimensional (4D) CT, and ultrasonography (US). Surgery, histological confirmation, and postoperative normalization of Ca++ and parathyroid hormone were the reference standard. Results Ninety-seven hyperfunctioning parathyroid glands (HPGs) were identified by the reference standard. Sensitivity and specificity for inftraction PS, dual-phase PS, 4D-CT, and US were 93%, 65%, 58%, and 57% as well as 99%, 99.6%, 86%, and 95%, respectively. Interrater agreement was excellent for inftraction PS (κ = 0.96) while only fair for 4D-CT (κ = 0.34). Pinhole imaging and inftraction of delayed images (the latter especially in case of a nodular thyroid gland) increased the sensitivity of inftraction PS. SPECT/low-dose CT did not increase sensitivity but aided in the exact localization of the HPGs. Of 7 negative inftraction PS studies, 4D-CT and US were able to locate 3 and 1 additional HPGs, respectively. Conclusions Dual isotope pinhole inftraction PS has higher diagnostic accuracy compared with dual-phase PS, 4D-CT, and US as a first-line imaging study in primary hyperparathyroidism. In case of a negative scintigraphy or suspicion of multiglandular disease, 4D-CT and/or US is recommended as a second-line modality. However, diagnostic algorithms should be adapted in accordance with local availability and expertise.
U2 - 10.1097/RLU.0000000000000988
DO - 10.1097/RLU.0000000000000988
M3 - Journal article
C2 - 26447369
SN - 0363-9762
VL - 41
SP - 93
EP - 100
JO - Clinical Nuclear Medicine
JF - Clinical Nuclear Medicine
IS - 2
ER -