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General Clinical Specialties: EndocrinologyAdvances in Management of Benign Endocrine Disorders |
1 Radiology, University of Michigan Health Sciences, Ann Arbor, Michigan
356
Objectives: Dual time point imaging with [Tc-99m]sestamibi is employed routinely in localization of parathyroid adenomas. Early and delayed imaging with planar and/or SPECT is highly sensitive. Recently there has been interest in use of SPECT/CT hybrid imaging for evaluation of complex cases. We performed a retrospective comparison of SPECT/CT sestamibi imaging to conventional planar and SPECT imaging.
Methods: Planar and SPECT images of the neck and upper thorax were obtained both immediately and 2 hr following administration of [Tc-99m]sestamibi. SPECT/CT images were obtained at the second imaging point. Fifty-one patients diagnosed with primary hyperparathyroidism were evaluated. Twenty-eight patients underwent surgical resection and were examined histopathologically.
Results: Combined planar and SPECT imaging identified 93% of biopsy-proven parathyroid adenomas. Use of delayed SPECT/CT imaging in isolation identified only 82% of parathyroid adenomas. The addition of immediate planar and SPECT images to delayed SPECT/CT imaging increased the identification rate to 96%, and changed the diagnosis from positive to negative in two patients (4%). In four patients (8%), SPECT/CT identified additional findings, including a pulmonary nodule, loculated pleural effusion, carotid space mass, and benign sinus disease.
Conclusions: The use of the delayed SPECT/CT imaging without early imaging limits sensitivity. However, the sensitivity of delayed SPECT/CT imaging (83%) improves significantly when combined with immediate planar and SPECT imaging (96%). This suggests SPECT/CT may be optimized when performed early, and combined with immediate planar imaging.
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