Mohammad Bahador MD, Presenter: Nothing to Disclose

Hamid Reza Latifi MD, Abstract Co-Author: Nothing to Disclose

Stanley J. Grossman MD, Abstract Co-Author: Nothing to Disclose

Umesh Dhruv Oza MD, Abstract Co-Author: Nothing to Disclose

Ali Ozhand MD, Abstract Co-Author: Nothing to Disclose

Landis K. Griffeth MD, PhD, Abstract Co-Author: Nothing to Disclose

This study was undertaken to establish the optimal scintigraphic imaging protocol for preoperative localization of parathyroid adenoma, in order to guide minimally invasive unilateral neck exploration.

The study group consisted of 290 patients with primary hyperparathyroidism and surgically proven single-gland parathyroid adenoma who underwent preoperative parathyroid scintigraphy between June 2002 and September 2008. The patients were divided into two groups. The imaging examinations for each group were independently reviewed by 2 experienced nuclear medicine physicians who did not have knowledge of the final diagnosis or other imaging and laboratory test results. All patients underwent parathyroid scintigraphy utilizing the same I-123/Tc-99m sestamibi protocol. The planar images were performed with pinhole collimation in anterior and bilateral anterior oblique projections. A retrospective evaluation was performed of the individual components of the examination, resulting in seven imaging strategies: Early sestamibi (ES), delayed sestamibi (DS), early and delayed sestamibi (EDS), I-123/early sestamibi subtraction (SUBT), all planar images (AP), SPECT, and all images (ALL). Abnormalities were graded on a 5-point scale (0=definitely normal to 4=definitely abnormal). Based on routine surgical practice at our institution, it was decided to denote 0 and 1 as negative, and 2, 3, and 4 as positive, for purpose of statistical analysis. Imaging results were correlated with operative and surgical pathology findings.

The overall average accuracy for exact localization of single-gland adenoma among all readers for ES, DS, EDS, SUBT, ALP, SPECT, and ALL was 90%, 87%, 91%, 94%, 94%, 83%, and 94%, respectively. For every reader, ALL, SUBT and ALP were the most accurate strategies, and significantly more accurate than SPECT (P=<0.05).

Preoperative localization of single-gland parathyroid adenoma is most accurate when interpreting ALP, SUBT, or ALL imaging.

An optimal nuclear imaging strategy for patients with primary hyperparathyroidism can accurately guide minimally invasive parathyroidectomy, and prevent unnecessary whole-neck exploration.

Bahador, M, Latifi, H, Grossman, S, Oza, U, Ozhand, A, Griffeth, L, Optimal Interpretative Strategy for Preoperative Parathyroid Scintigraphy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8011921.html