Malavika Nathan MBBS, Presenter: Nothing to Disclose

Richard Millard, Abstract Co-Author: Nothing to Disclose

Charles Giddings, Abstract Co-Author: Nothing to Disclose

Michael Stearns, Abstract Co-Author: Nothing to Disclose

Anne-Marie Quigley, Abstract Co-Author: Nothing to Disclose

Recent advances in minimally invasive, focused parathyroid surgery require accurate pre-operative localisation of the parathyroid abnormality in order to facilitate a successful surgico-clinical outcome. Single photon emission computed tomography (SPECT) with CT fusion directly correlates anatomical and functional information, enabling precise anatomical localisation in three dimensions. We aim to determine the accuracy of 99mTc-sestamibi SPECT/CT in the detection of hyper-functioning parathyroid glands by correlation with surgical and histological findings.  

Between May 2007 and March 2009, patients with primary and secondary hyperparathyroidism, who were imaged with 99m Tc-sestamibi SPECT/CT and subsequently underwent surgery, were included in the study. We retrospectively reviewed the scintigraphic images, noting the location of the abnormality based on a quadrant (right side: upper and lower; left side: upper and lower). In addition, an attempt was made to distinguish adenoma from gland hyperplasia on imaging characteristics. Imaging was then correlated with surgical and pathological results.

In total, 19 patients had abnormal parathyroid imaging with subsequent surgical and histological examination. 99m Tc-Sestamibi SPECT/CT correctly identified the location and type of parathyroid abnormality in 16 patients (84%). In 1 patient, the type of parathyroid lesion did not correlate with surgico-pathologic findings. No detectable parathyroid histological abnormality was found in one patient. No parathyroid tissue was sampled at surgery in the remaining patient.

Our study demonstrates that 99mTc-sestamibi SPECT/CT is an accurate and useful tool in the pre-operative localisation of parathyroid abnormalities, allowing for focused, minimally invasive parathyroidectomy.

Accurate localisation of parathyroid abnormalities with 99mTc-sestamibi SPECT/CT is a vital pre-operative step in the surgical management of hyperparathyroidism.

Nathan, M, Millard, R, Giddings, C, Stearns, M, Quigley, A, Accuracy and Usefulness of 99mTc-Sestamibi SPECT/CT in the Localisation of Parathyroid Abnormalities: Surgical and Histological Correlation.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8006020.html