COMPARISON OF FDG-PET AND SESTAMIBI-SPECT IN PRIMARY HYPERPARATHYROIDISM

Preoperative localization of hyperfunctioning parathyroid tissue in pa tients with primary hyperparathyroidism has been a longstanding diagno stic challenge. This study directly compared FDG-PET and sestamibi-SPE CT for preoperative detection of abnormal parathyroid tissue. Methods: Twenty-one consecutive patients with primary hyperparathyroidism were studied prospectively before surgical neck exploration. SPECT of the neck and chest was performed at 15 min and 2 hr after intravenous Tc-9 9m-sestamibi. Regional body PET was performed 45 min after intravenous FDG. Results: Surgery revealed 19 solitary parathyroid adenomas, 2 pa rathyroid adenomas in one patient; and 3 hyperplastic parathyroid glan ds in one patient, and 51 normal parathyroid glands. The diagnostic se nsitivities for detection of parathyroid adenomas of 43% (9 of 21) for dual-phase sestamibi-SPECT and 86% (18 of 21) for FDG-PET were signif icantly different (p < 0.001). The difference in diagnostic specificit ies of 78% (40 of 51) for FDG-PET and 90% (46 of 51) for dual-phase se stamibi-SPECT approached statistical significance (p = 0.063). Conclus ion: This study demonstrates that FDG-PET is more sensitive than sesta mibi-SPECT in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism.