Donald Richard Neumann MD, PhD, Presenter: Nothing to Disclose

Guiyun Wu MD, Abstract Co-Author: Nothing to Disclose

To determine the diagnostic accuracy of 123I/99mTc-sestamibi subtraction SPECT/CT for the localization of parathyroid lesions in patients with primary hyperparathyroidism who have undergone previous parathyroid surgery.

A total of 23 consecutive surgical patients with primary hyperparathyroidism were studied, all of whom had undergone parathyroid surgery previously. Each patient underwent 123I/99mTc-sestamibi SPECT/CT prior to reoperation using a hybrid SPECT/CT instrument that combined a dual-detector SPECT camera with a 6-slice multidetector spiral CT scanner. Four hours after being given 123I sodium iodide orally, each patient received 99mTc-sestamibi intravenously, followed immediately by a simultaneous, dual-isotope SPECT scan of the neck and upper chest. Then, without moving the patient, a non-contrast CT scan of the same body region was performed. Normalization and subtraction of the 123I SPECT images from the 99mTc SPECT images were performed. The subtraction SPECT images were coregistered with the CT images for interpretation. Surgical and histopathologic findings from reoperation were used as the standard of comparison. 

Surgery was successful in all 23 patients, with the removal of 27 parathyroid lesions (a solitary parathyroid adenoma in 20 patients, double parathyroid adenomas in 1 patient, 4 hyperplastic parathyroid glands in 1 patient, and 1 parathyroid carcinoma in 1 patient). 29.6% (8/27) of the resected parathyroid lesions were in ectopic or heteroptopic locations. Subtraction SPECT/CT correctly localized all 22 parathyroid adenomas (100% sensitivity), 2 of the 4 hyperplastic parathyroid glands (50% sensitivity), and the parathyroid carcinoma. Subtraction SPECT/CT was positive in one case of a benign reactive lymph node; there were no other false-positive subtraction SPECT/CT findings in this series.

123I/99mTc-sestamibi subtraction SPECT/CT is highly sensitive for the detection and localization of parathyroid lesions in patients with recurent or residual postoperative primary hyperparathyroidism.

123I/99mTc-sestamibi subtraction SPECT/CT is a useful localization technique and is recommended for the evaluation of patients with recurrent or residual postoperative primary hyperparathyroidism.

Neumann, D, Wu, G, I-123/Tc-99m Sestamibi Subtraction SPECT/CT in Recurrent/Persistent Postoperative Hyperparathyroidism.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8008916.html