THE ROLE OF SPECT/CT SCINTIGRAPHY IN LOCALIZATION OF PARATHYROID ADENOMASSebastijan Rep
, 2016, master's thesis
Abstract: Parathyroid scintigraphy is based on the different accumulation and distribution of radiopharmaceutical 99mTc-MIBI (MIBI) in parathyroid and adjacent tissues. Different scintigraphic techniques can be used: subtraction scintigraphy is a combination of MIBI and 99mTc-pertehnetate (pertehnetate) scintigraphy; SPECT can be performed after intravenous injection of MIBI or in the combination with low-dose computerized tomography (SPECT/CT) which allows precise anatomical localization of enlarged parathyroid glands (EPG).
The objectives of our study were: to assess diagnostic performance of preoperative localization of EPG (adenomas and hyperplasia) of the early, delayed and combined SPECT/CT and of subtraction scintigraphy in patients with biochemically proven primary hyperparathyroidism (PHP); to determine whether size of EPG, serum parathyroid hormone (PTH), calcium (Ca) and phosphate (P) correlate with successful localization; to assess radiation exposure of patients with early and late SPECT/CT and subtraction scintigraphy
The study included 41 patients in whom early, delay SPECT/CT and subtraction scintigraphy were performed. For all scintigraphic methods sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Receiver Operating Characteristic analysis was used to express relationship between scintigraphy results and size of the EPG and serum Ca, P and PTH levels. ImPACT CT Patient Dosimetry Calculator and weighting factors for radiopharmaceuticals (MIBI and pertechnetate) were used for calculating patient expose dose.
Sensitivity and specificity were 51.1% and 98.3 for subtraction scintigraphy, 65.1% and 97.5% for early SPECT/CT and 65.1% and 95.5% for delay SPECT/CT. In combined early and delay SPECT/CT sensitivity and specificity were 74.4% and 95.1%.Only size of the EPG correlated with successful localization in our study (AUC of 0.791-0.810). The highest average ED per patient had subtraction scintigraphy (7.37±0.40 mSv), which was statistically significant higher in comparison to combined early and delayed SPECT/CT (6.81±0.44 mSv).
The most sensitive and most accurate method of preoperative localization of EPG in patients with PHP is combined early and delayed SPECT/CT. Only size of the EPG correlates with successful localization. The highest radiation exposure is after subtraction scintigraphy.
Keywords: Enlarged parathyroid glands, early SPECT/CT, delayed SPECT/CT, combined SPECT/CT, subtraction scintigraphy, 99mTc-MIBI, 99mTc-pertechnetate, effective dose, serum parathyroid hormone, calcium, phosphate
Published in RUNG: 03.10.2016; Views: 5946; Downloads: 249
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