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Pinhole Versus Parallel-Hole Collimators for Parathyroid Imaging: An Intraindividual Comparison

Division of Nuclear Medicine and Molecular Imaging, North Shore–Long Island Jewish Health System, Manhasset and New Hyde Park, New York

Correspondence: For correspondence or reprints contact: Kenneth J. Nichols, Division of Nuclear Medicine and Molecular Imaging, North Shore–Long Island Jewish Health System, 270-05 76th Ave., New Hyde Park, NY 11040. E-mail: knichols{at}lij.edu

This study was undertaken to determine the effects of collimators on the accuracy of preoperative sestamibi parathyroid imaging of the neck. Methods: Forty-nine patients with primary hyperparathyroidism underwent preoperative ^99mTc-sestamibi parathyroid imaging. The protocol included early and late pinhole and parallel-hole imaging. One experienced nuclear physician, without knowledge of other test results or final diagnoses, interpreted studies. For both pinhole and parallel-hole images, focally increased sestamibi accumulation outside the normal tracer biodistribution that persisted or increased in intensity from early to late images was interpreted as positive for a parathyroid lesion. Final diagnoses were operatively confirmed in all patients. Results: Fifty-four parathyroid lesions were resected from the 49 patients. Forty-five patients had single-gland disease. Four patients had multigland disease: 3 had 2 lesions and 1 had 3 lesions. Median lesion weight was 840 mg. Pinhole imaging was significantly more sensitive than parallel-hole imaging (89% vs. 56%; P = 0.0003) for all 54 lesions. Specificity did not significantly differ between pinhole and parallel-hole imaging (93% vs. 96%, P = 0.29). Pinhole imaging was significantly more sensitive than parallel-hole imaging for lesions above (100% vs. 68%, P = 0.003) and below (77% vs. 42%, P = 0.03) the median weight and for single-gland disease (96% vs. 67%, P = 0.001). Pinhole imaging also was more sensitive for multigland disease, although the difference was only marginally significant (55% vs. 0%, P = 0.037). Conclusion: Because sensitivity is significantly higher, sestamibi parathyroid imaging of the neck should be performed with a pinhole collimator.

Key Words: primary hyperparathyroidism; scintigraphy; collimators; image processing; lesion detection