Abstract
Purpose
A pinhole collimator is routinely used to increase the resolution of scintigraphy. This prospective study was conducted to determine the interest of 99mTc-MIBI pinhole single-photon emission computed tomography (SPECT) for the preoperative localisation of parathyroid lesions in primary hyperparathyroidism.
Methods
All patients underwent a neck ultrasonography (US), \( ^{{99{\text{m}}}} {\text{TcO}}^{{\text{ - }}}_{{\text{4}}} \) and 99mTc-MIBI planar images and two consecutive SPECT with a parallel (C-SPECT) and a pinhole collimator (P-SPECT). P-SPECT was performed with a tilted detector equipped with a pinhole collimator and reconstructed with a dedicated OSEM algorithm. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extra-thyroidal location of suspected lesions: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive. The results of these preoperative localisation studies were compared with surgical, pathological and 6-month biological findings.
Results
Fifty-one patients cured after surgery were included. Surgery revealed 55 lesions (median weight 0.5 g, 11 in ectopy). Sensitivities of US, planar imaging, C-SPECT and P-SPECT were, respectively, 51, 76, 82 and 87%. Nine glands were only detected by tomography and five glands only by P-SPECT. \( {^{{{\text{99m}}}} {\text{Tc - MIBI}}} \mathord{\left/ {\vphantom {{^{{{\text{99m}}}} {\text{Tc - MIBI}}} {^{{{\text{99m}}}} {\text{TcO}}^{ - }_{{\text{4}}} }}} \right. \kern-\nulldelimiterspace} {^{{{\text{99m}}}} {\text{TcO}}^{ - }_{{\text{4}}} } \) planar scans and P-SPECT were complementary and, when combined together, showed the highest sensitivity (93%). Compared with planar imaging and C-SPECT, P-SPECT increased CS for 42 and 53% of lesions, respectively, and contributed to markedly reduce the number of uncertain results.
Conclusions
A combination of planar \( {^{{{\text{99m}}}} {\text{Tc - MIBI}}} \mathord{\left/ {\vphantom {{^{{{\text{99m}}}} {\text{Tc - MIBI}}} {^{{{\text{99m}}}} {\text{TcO}}^{ - }_{{\text{4}}} }}} \right. \kern-\nulldelimiterspace} {^{{{\text{99m}}}} {\text{TcO}}^{ - }_{{\text{4}}} } \) scintigraphy and P-SPECT appears to be a highly accurate preoperative imaging procedure in primary hyperparathyroidism.
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References
Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 2003;44:1443–58.
Henry JF, Iacobone M, Mirallie E, Deveze A, Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery 2001;130:999–1004.
Arbab AS, Koizumi K, Toyama K, Arai T, Arak T. Ion transport systems in the uptake of 99Tcm-tetrofosmin, 99Tcm-MIBI and 201Tl in a tumour cell line. Nucl Med Commun 1997;18:235–40.
Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med 1998;39:1441–4.
Caillard C, Sebag F, Mathonnet M, Gibelin H, Brunaud L, Loudot C, et al. Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up). Surgery 2007;141:153–9.
Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128:29–35.
Biertho LD, Kim C, Wu HS, Unger P, Inabnet WB. Relationship between sestamibi uptake, parathyroid hormone assay, and nuclear morphology in primary hyperparathyroidism. J Am Coll Surg 2004;199:229–33.
Sharma J, Mazzaglia P, Milas M, Berber E, Schuster DM, Halkar R, et al. Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality? Surgery 2006;140:856–63.
Lorberboym M, Minski I, Macadziob S, Nikolov G, Schachter P. Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003;44:904–8.
Billotey C, Sarfati E, Aurengo A, Duet M, Mundler O, Toubert ME, et al. Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 1996;11:1773–8.
Ansquer C, Mirallie E, Sadot S, Couturier O, Valette F, Kraeber-Bodéré F. Comparison of 99mTc-MIBI / 99mTc dual planar scintigraphy, 99mTc-MIBI SPECT and ultrasound in preoperative localization of parathyroid lesions for primary hyperparathyroididsm [abstract]. Eur J Nucl Med Mol Imaging 2005;31(Suppl):S263.
Arveschoug AK, Bertelsen H, Vammen B. Presurgical localization of abnormal parathyroid glands using a single injection of Tc-99m sestamibi: comparison of high-resolution parallel-hole and pinhole collimators, and interobserver and intraobserver variation. Clin Nucl Med 2002;27:249–54.
Spanu A, Falchi A, Manca A, Marongiu P, Cossu A, Pisu N, et al. The usefulness of neck pinhole SPECT as a complementary tool to planar scintigraphy in primary and secondary hyperparathyroidism. J Nucl Med 2004;45:40–8.
Profanter C, Gabriel M, Wetscher GJ, Gadenstatter M, Mittermair R, Moncayo R, et al. Accuracy of preoperative pinhole subtraction single photon emission computed tomography for patients with primary and recurrent hyperparathyroidism in an endemic goiter area. Surg Today 2004;34:493–7.
Seret A, Defrise M, Blocklet D. 180 degree pinhole SPET with a tilted detector and OS-EM reconstruction: phantom studies and potential clinical applications. Eur J Nucl Mol Imaging 2001;28:1836–41.
Wanet PM, Sand A, Abramovici J. Physical and clinical evaluation of high-resolution thyroid pinhole tomography. J Nucl Med 1996;37:2017–20.
Vanhove C, Defrise M, Franken PR, Everaert H, Deconinck F, Bossuyt A. Interest of the ordered subsets expectation maximization (OS-EM) algorithm in pinhole single-photon emission tomography reconstruction: a phantom study. Eur J Nucl Med Mol Imaging 2000;27:140–6.
Carlier T, Bodet-Milin C, Oudoux A, Defrise M, Seret A, Couturier O, et al. Technical feasibility of pinhole SPECT acquisition in primary hyperparathyroidism: phantoms and patients studies [abstract]. J Nucl Med 2006;47(Suppl):378P.
Smith MF, Jaszczak RJ. Penetration and angle-dependent sensitivity for pinhole collimation. Med Phys 1997;24:1701–9.
Palmer J, Wollmer P. Pinhole emission computed tomography: method and experimental evaluation. Phys Med Biol 1990;35:339–50.
Chevallier JM, Martelli H, Wind P. Surgical discovery of parathyroid glands and the recurrent laryngeal nerve. Application of well known embryological concepts in the operating room. Ann Chir 1995;49:296–304.
Freudenberg LS, Frilling A, Sheu SY, Görges R. Optimizing preoperative imaging in primary hyperparathyroidism. Langenbecks Arch Surg 2006;391:551–6.
Rubello D, Gross MD, Mariani G, Al-Nahhas A. Scintigraphic techniques in primary hyperparathyroidism: from pre-operative localisation to intra-operative imaging. Eur J Nucl Med Mol Imaging 2007;926–33.
Vanhove C, Andreyev A, Defrise M, Nuyts J, Bossuyt A. Resolution recovery in pinhole SPECT based on multi-ray projections: a phantom study. Eur J Nucl Med Mol Imaging 2007;34:170–80.
Sohlberg A, Watabe H, Zeniya T, Iida H. Comparison of multi-ray and point-spread function based resolution recovery methods in pinhole SPECT reconstruction. Nucl Med Commun 2006;27:823–7.
Acknowledgements
The authors are very grateful to Pr. Michel Defrise from the Vrije Universiteit Brussel for providing the reconstruction algorithm dedicated to pinhole geometry. We would like to thank also Dr. Samantha Warren for her very useful suggestions.
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Carlier, T., Oudoux, A., Mirallié, E. et al. 99mTc-MIBI pinhole SPECT in primary hyperparathyroidism: comparison with conventional SPECT, planar scintigraphy and ultrasonography. Eur J Nucl Med Mol Imaging 35, 637–643 (2008). https://doi.org/10.1007/s00259-007-0625-9
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DOI: https://doi.org/10.1007/s00259-007-0625-9