Purpose: We evaluated the efficacy of 99mTc-sestamibi SPECT/CT for planning minimally invasive parathyroidectomy (MIP), comparing with dual phase 99mTc-sestamibi scintigraphy, 99mTc-sestamibi SPECT and conventional imaging (US and CT). Methods: Thirty-one patients (M:F = 10:21, range 35-78 years old) who showed high serum parathyroid hormone (intact PTH) level were included. 99mTc-sestamibi scintigraphy was performed 15 and 150 min after injection of 99mTc-sestamibi (555 MBq), and 99mTc-sestamibi SPECT/CT was obtained just after the delayed scan. Comparison study between imaging modalities was done by patient-based and lesion location-based analysis. The location of the lesion was confirmed by the operative finding. An operation was performed in 24 patients. Seven patients had normal 99mTc-sestamibi SPECT/CT, and followed for more than 6 months after SPECT/CT. Results: Among 24 patients, parathyroid adenoma was detected in 19 patients and the other 5 had parathyroid hyperplasia (total 35 lesions). 99mTc-sestamibi scintigraphy detected abnormal uptake in 15 patients with 24 lesions. Conventional imaging identified abnormal findings in 17 patients with 27 lesions. SPECT detected abnormal findings in 18 patients with 27 lesions. SPECT/CT identified abnormal findings in 24 patients with 35 lesions. SPECT/CT demonstrated 100 % sensitivity in a patient-based analysis. SPECT/CT exhibited significantly better sensitivity than 99mTc- sestamibi scintigraphy, SPECT and conventional imaging (p < 0.05). All lesion location was correctly identified to perform MIP. The final clinical diagnosis of 7 normal SPECT/CT patients was secondary hyperparathyroidism on 6 months follow-up. Conclusions: We correctly identified the precise location of parathyroid adenomas or hyperplasia by 99mTc-sestamibi SPECT/CT which was helpful to perform MIP.
- Minimally invasive parathyroidectomy
- Parathyroid adenoma
- Parathyroid hyperplasia
- Tc-sestamibi SPECT/CT
- Tc-sestamibi scintigraphy