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Incremental Value of 99mTc-Sestamibi SPECT/CT Over Dual-Phase Planar Scintigraphy in Patients With Primary Hyperparathyroidism and Inconclusive Ultrasound

Published on Jul 16, 2019in Frontiers of Medicine in China
· DOI :10.3389/fmed.2019.00164
Roberta Assante8
Estimated H-index: 8
(University of Naples Federico II),
Emilia Zampella10
Estimated H-index: 10
(University of Naples Federico II)
+ 8 AuthorsAlberto Cuocolo40
Estimated H-index: 40
(University of Naples Federico II)
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Abstract
Background: We evaluated the incremental value of 99mTc-sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism. Methods: Forty-six patients with biochemical evidence of hyperparathyroidism and inconclusive ultrasound underwent 99mTc-sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Recursive partitioning and regression trees (RPART) analysis was used to assess the value of SPECT/CT over planar scintigraphy for classifying patients with or without adenoma. The added value of SPECT/CT was also evaluated by decision curve analysis. Results: Planar scintigraphy was positive for presence of hyperfunctioning parathyroid in 52% of patients, with sensitivity of 63% and specificity of 100%. SPECT/CT was positive in 80% of patients with sensitivity of 97% and specificity of 100%. At RPART analysis, after an initial split on planar imaging results, no further split was performed in patients with positive results, while those with negative results were further stratified by SPECT/CT. At decision curve analysis, the model including SPECT/CT was associated with the highest net benefit compared to the model including only planar technique and to a strategy considering that all patients should be treated. Conclusion: 99mTc-sestamibi SPECT/CT provides incremental value over dual-phase scintigraphy in preoperative localization of hyperfunctioning parathyroid tissue in subjects with inconclusive ultrasound. Hybrid technique allows a better identification of pathological lesion to perform minimally invasive surgery and showed the highest net benefit, improving selection of surgical approach
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References31
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Published on Oct 1, 2016in JAMA Surgery10.67
Scott M. Wilhelm9
Estimated H-index: 9
(Case Western Reserve University),
Tracy S. Wang26
Estimated H-index: 26
(MCW: Medical College of Wisconsin)
+ 13 AuthorsNancy Dugal Perrier41
Estimated H-index: 41
(University of Texas MD Anderson Cancer Center)
Importance Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. Objective To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. Evidence Review A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015. Levels of evidence were determined using t...
Giorgio Treglia31
Estimated H-index: 31
,
Ramin Sadeghi24
Estimated H-index: 24
(MUMS: Mashhad University of Medical Sciences)
+ 4 AuthorsDavid W. Eisele49
Estimated H-index: 49
Background Parathyroid scintigraphy using 99mTc-MIBI single photon emission computed tomography (SPECT)/CT has been proposed as one of the most accurate localization techniques in patients with primary hyperparathyroidism (PHPT). The purpose of this review was to meta-analyze published data on the detection rate of 99mTc-MIBI SPECT/CT in the preoperative planning of patients with PHPT. Methods A comprehensive literature search of studies published through June 2014 was performed. The pooled dete...
Published on Mar 1, 2013in The Journal of Clinical Endocrinology and Metabolism5.61
John W. Kunstman15
Estimated H-index: 15
,
Jonathan Kirsch14
Estimated H-index: 14
(Yale University)
+ 1 AuthorsRobert Udelsman60
Estimated H-index: 60
(Yale University)
Clinical Context: The prevalence of hyperparathyroidism, especially primary hyperparathyroidism, has increased in recent decades due to improvements in diagnostic techniques with a corresponding surge in parathyroid surgery, leading to the development of focused, minimally invasive surgical approaches. Focused parathyroidectomy is predicated on preoperative localization of suspected parathyroid pathology. As a result, there has been a proliferation of parathyroid imaging modalities and protocols...
Published on Dec 1, 2012in Annals of Nuclear Medicine1.65
Yong-il Kim1
Estimated H-index: 1
(Seoul National University Bundang Hospital),
Young Ho Jung2
Estimated H-index: 2
(Seoul National University Hospital)
+ 1 AuthorsHo-Young Lee46
Estimated H-index: 46
(SNU: Seoul National University)
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).
Published on Jun 1, 2012in Journal of Nuclear Medicine Technology
Bennett S. Greenspan8
Estimated H-index: 8
,
Gary L. Dillehay10
Estimated H-index: 10
(NU: Northwestern University)
+ 7 AuthorsMark Tulchinsky18
Estimated H-index: 18
(PSU: Pennsylvania State University)
1St. Louis, Missouri; 2Northwestern University, Chicago, Illinois; 3Thomas Jefferson University, Philadelphia, Pennsylvania; 4Southern Molecular Imaging, Savannah, Georgia; 5St. Thomas’ Hospital, London, United Kingdom; 6North Shore–Long Island Jewish Health System, New Hyde Park, New York; 7Barnes–Jewish Hospital, St. Louis, Missouri; 8Vanderbilt University, Nashville, Tennessee; and 9Milton S. Hershey Medical Center, Hershey, Pennsylvania
Published on Jan 1, 2010in Diagnostic and interventional radiology
Mehmet Oeksuez10
Estimated H-index: 10
,
Helmut Dittmann17
Estimated H-index: 17
+ 4 AuthorsSusanne Martina Eschmann24
Estimated H-index: 24
297 S poradic primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient population, with a prevalence of one per 500 women and one per 2000 men over 40 years of age. Both increased cell proliferative activity and a decreased sensitivity of cells to secretory inhibition by calcium occur in hyperparathyroidism (1). The diagnosis of hyperparathyroidism is usually made by the demonstration of an inappropriately elevated parathyroid hormone level compared to the simultan...
Published on Sep 1, 2009in Journal of The American College of Surgeons4.45
Andrew B. Greene3
Estimated H-index: 3
(Cleveland Clinic),
Robert S. Butler20
Estimated H-index: 20
(Cleveland Clinic)
+ 5 AuthorsMira Milas27
Estimated H-index: 27
(Cleveland Clinic)
Background The introduction of limited explorations (LE) for parathyroidectomy broadened the management possibilities for hyperparathyroidism. We sought to document this evolution of change in parathyroid surgery. Study Design Members of the American Association of Endocrine Surgeons and the American College of Surgeons were sent a 49-question survey, and 256 surgeons, accounting for 46% of parathyroid operations nationwide, responded. Associations derived from questionnaire data were tested for...
Elif Hindié30
Estimated H-index: 30
,
Omer Ugur16
Estimated H-index: 16
(Hacettepe University)
+ 7 AuthorsDomenico Rubello53
Estimated H-index: 53
The present guidelines were issued by the Parathyroid Task Group of the European Association of Nuclear Medicine. The main focus was imaging of primary hyperparathyroidism. Dual-tracer and single-tracer parathyroid scintigraphy protocols were discussed as well as the various modalities of image acquisition. Primary hyperparathyroidism is an endocrine disorder with high prevalence, typically caused by a solitary parathyroid adenoma, less frequently (about 15%) by multiple parathyroid gland diseas...
Published on Feb 1, 2009in The Journal of Clinical Endocrinology and Metabolism5.61
John P. Bilezikian17
Estimated H-index: 17
(Columbia University),
Aliya Khan30
Estimated H-index: 30
(McMaster University),
John T. Potts81
Estimated H-index: 81
(Harvard University)
Objective: Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to guide the use of diagnostics and management for this condition in clinical practice. Participants: Interested professional societies selected representatives for the consensus committee and provided funding for a one-day meeting. A subgroup of this committee set the program and developed key questions for review. Consensus was established at a closed meeting that followed and...
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