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99mTc-MIBI pinhole SPECT in primary hyperparathyroidism: comparison with conventional SPECT, planar scintigraphy and ultrasonography

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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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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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Correspondence to Catherine Ansquer.

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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

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