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J Nucl Med. 2008; 49 (Supplement 1):243P
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General Clinical Specialties: Endocrinology

Endocrinology Posters

The incremental value of pinhole thyroid gland (TH) imaging to dual phase sestamibi pinhole & SPECT/CT imaging in evaluating primary hyperparathyroidism patients (PHP)

Sherif Heiba1, Hongju Son1, Lale Kostakoglu1 and Josef Machac1

1 Nuclear Medicine Division, Mount Sinai School of Medicine, New York, New York

1041

Objectives: Dual phase sestamibi imaging with early SPECT/CT (DP) was recently found a better technique for parathyroid adenoma (PA) localization than planar or SPECT alone. However, PA produces variable DP patterns, & confirmation of both PA diagnosis (Dx) & localization could be further complicated by TH abnormality. This study evaluates if TH pinhole imaging provides incremental information to DP in PHP work-up.

Methods: Scans of 81 PHP were evaluated by 2 observers. Pinhole neck DP images with early neck/chest SPECT/CT correlation were reviewed for PA Dx & localization. A separate review was performed with pinhole dual isotope comparison (I-123/Tc-99m sestamibi) in addition to DP (DI/DP). Confidence in PA presence, location, & overall Dx was scored as certain, probable or uncertain. Furthermore, PA was classified as clearly or unclearly distinguishable from TH. Final Dx was confirmed surgically/pathologically as PA, parathyroid hyperplasia, other, or no pathology.

Results: There were 77 PA identified (6 PHP with 2 PA, 3 PHP with mediastinal PA). Both DP & DI/DP detected 72 PA. Greater Dx certainty of PA was attained with DI/DP than DP (52 Vs 34, P < 0.01). DI/DP accurately localized 8 more PA than DP. Of the 60 PA accurately localized by both, confidence in PA presence & localization was higher (p < 0.05) in DI/DP (46, 43) than DP (34, 31). PA was more definitely discriminated from TH using DI/DP (38) than DP (17, p < 0.001).

Conclusions: In our group, confidence in PA presence & localization was significantly higher with DI/DP than DP alone, reflected in overall higher DI/DP Dx certainty. The easier distinction of PA from underlying TH appears to be an important factor for the superior performance of DI/DP in PHP evaluation.





This Article
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Right arrow Email this article to a friend
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Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Heiba, S.
Right arrow Articles by Machac, J.
PubMed
Right arrow Articles by Heiba, S.
Right arrow Articles by Machac, J.