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General Clinical Specialties: EndocrinologyAdvances in Management of Benign Endocrine Disorders |
1 London Health Sciences Centre, London, Ontario, Canada
355
Objectives: To assess the added-value of integrated SPECT-CT in patients (pts) explored for hyperparathyroidism (HPT) by double-phase 99mTc-sestaMIBI (DPM).
Methods: 42 consecutive pts (30F/12M) with HPT (mean iPTH=28 pmol/l) underwent a DPM planar session (10min+120min) immediately followed by a low-dose SPECT-CT session (Infinia-Hawkeye-4, GE Healthcare) in their pre-surgical work-up. A 5-point scale was used for qualitative interpretation of planar/SPECT-CT data. Imaging results were correlated to the surgical and pathological findings.
Results: Overall, 37 pts had a histologically proven parathyroid adenoma (PA; n=33) or hyperplasia (HP; n=4). Among them, SPECT-CT was probably/definitely positive in 32 pts vs. 21 pts for planar DPM. Additionally, the rate of definite scores (definitely positive/negative) increased from 17 to 27 after SPECT-CT, while the rate of unsure scores (equivocal + probably negative/positive) decreased from 25 to 15 after SPECT-CT. Among the 5 pts with a false negative planar/SPECT-CT study, 4 pts had a small PA (V<1.5cm3) and 1 pt had a multiple HP with extensive clear cell change. In 4 pts with a positive planar/SPECT-CT study but a negative pathology, the iPTH/Ca levels continued to rise after surgery, thereby, suggesting that PA/HP were left behind in ectopic locations. CT-based attenuation correction significantly increased the 99mTc-sestaMIBI signal in positive cases with proven PA/HP. SPECT-CT-guided surgery was found useful for 3D-anatomical localization of PA/HP and reduction in operating time.
Conclusions: In parathyroid 99mTc-sestaMIBI imaging, double-phase planar plus low-dose SPECT-CT improves the interpretation confidence, which led to significantly increase the sensitivity (meanSV= 88.23% vs. 63.17%, p<.01) and the diagnostic accuracy (meanDAc= 85.54% vs. 64.67%, p<.05) for appropriate surgical planning.
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