PARATHYROID ADENOMAS - ACCURATE DETECTION AND LOCALIZATION WITH TC-99M SESTAMIBI SPECT

PURPOSE: To evaluate the ability to detect and localize parathyroid ad enomas with technetium-99m sestamibi single photon emission computed t omography (SPECT). MATERIALS AND METHODS: Forty-seven adult patients u nderwent Tc-99m sestamibi SFECT. Early (15-30 minutes after injection) and delayed (2-4 hours after injection) images were acquired. Thirty- three patients were examined for initial parathyroid surgery; the rema ining 14, for repeat surgery because of persistent or recurrent hyperp arathyroidism. SPECT reprojection images viewed in a rotating cine-dis play mode were read independently by two nuclear medicine physicians w ho were blinded to the results of other localization studies. Thirty-s even patients underwent subsequent neck exploration. SPECT findings we re compared with surgical and histopathologic findings. RESULTS: In th e 37 patients who underwent surgery, parathyroid adenomas were confirm ed in 34 (92%) and hyperplasia in three (8%). In 31 patients, adenomas were correctly detected and localized with early SPECT images (sensit ivity, 91%). In contrast, the sensitivity of delayed SPECT images was 74% (25 of 34 patients) for detection and 32% (11 of 34 patients) for localization. Early SPECT images were significantly better for localiz ation (P <.001) and detection (P =.03). CONCLUSION: For Tc-99m sestami bi parathyroid imaging, early SPECT images were the most accurate in t he detection and localization of parathyroid adenomas.