1Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
2Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan
Objective(s): In this study, we aimed to analyze the relationship between the diagnostic ability of fused single photon emission computed tomography/computed tomography (SPECT/CT) images in localization of parathyroid lesions and the size of adenomas or hyperplastic glands. Methods: Five patients with primary hyperparathyroidism (PHPT) and 4 patients with secondary hyperparathyroidism (SHPT) were imaged 15 and 120 minutes after the intravenous injection of technetium99mmethoxyisobutylisonitrile (99mTc-MIBI). All patients underwent surgery and 5 parathyroid adenomas and 10 hyperplastic glands were detected. Pathologic findings were correlated with imaging results. Results: The SPECT/CT fusion images were able to detect all parathyroid adenomas even with the greatest axial diameter of 0.6 cm. Planar scintigraphy and SPECT imaging could not detect parathyroid adenomas with an axial diameter of 1.0 to 1.2 cm. Four out of 10 (40%) hyperplastic parathyroid glands were diagnosed, using planar and SPECT imaging and 5 out of 10 (50%) hyperplastic parathyroid glands were localized, using SPECT/CT fusion images. Conclusion: SPECT/CT fusion imaging is a more useful tool for localization of parathyroid lesions, particularly parathyroid adenomas, in comparison with planar and or SPECT imaging.
1. Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 2006; 238:264-71.
2. Even-SapirE, Flusser G, Lerman H, Lievshitz G, Metser U. SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy. J Nucl Med. 2007;48:319-24.
3. Shafiei B, Hoseinzadeh S, Fotouhi F, Malek H, Azizi F, Jahed A, et al. Preoperative 99mTcsestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: comparison of SPECT-CT, SPECT, and planar imaging. Nucl Med commun. 2012; 33:1070-6.
4. Ciappuccini R, Morera J, Pascal P, Rame JP, Heutte N, Aide N, et al. Dual-phase 99mTc-sestamibi scintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism: a single-institution experience. Clin Nucl Med.2012;37:223-8.
5. Papathanassiou D, Flament JB, Pochart JM, Patey M, Marty H, Liehn JC, et al. SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery. Clin Nucl Med. 2008; 33: 394-7.
6. Li L, Chen L, Yang Y, Han J, Wu s, Bao Y, et al. Giant anterior mediastinal parathyroid adenoma. Clin Nucl Med. 2012; 37: 889-91.
7. Torregrosa JV, Palomar MR, Pons F, Sabater L, Gilabert R, LIovera J, et al. Has double-phase MIBI scintigraphy usefulness in the diagnosis of hayperparathyroidism?. Nephrol Dial Transplant.1998; 13: 37-40.
8. Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med. 2012; 26: 794-803.
9. Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between Technetium-99m-MIBI uptake and oxyphil cell count. J Nucl Med. 1998; 39: 1441-4.
10. Erbil Y, Kapran Y, Işsever H, Barbaros U, Adalet I, Dizdaroğlu F, et al. The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism. Am J Surg. 2008; 195: 34-39.