Performance of Tc99m MIBI SPECT/CT with or without the Use of High Resolution Ultrasound in Preoperative Localization of Parathyroid Adenoma

Primary hyperparathyroidism (PHPT) is a common endocrine disease cause by overproduction of parathyroid hormone (PTH).  As surgery remains the only curative treatment, accurate preoperative localization is important to ensure focused minimally invasive surgery with a high cure rate.  Among many modalities, technetium-99m sestamibi (Tc99m MIBI) scintigraphy and high-resolution ultrasound (HRUS) are the most commonly used modalities for preoperative localization of parathyroid adenomas.  Tc99m MIBI and ultrasound performance has been widely studied and have a wide range of sensitivities, creating discrepancies in the literature as to the single most appropriate modality.  Most studies were performed retrospectively and, therefore, are more susceptible to bias.  In this study we intend to investigate the relative diagnostic performance of Tc99m MIBI scintigraphy and ultrasound.  We will also evaluate accuracy of each modality with regard to anatomic localization, extent of surgery and relative cost of each localization modality. 

We will undertake a study with 100 patients who have biochemical and clinical evidence of PHPT and who are scheduled for routine surgery and preoperative imaging. 50/100 patients will undergo dual phase Tc99m MIBI planar and SPECT/CT scanning, followed by HRUS.  50/100 patients will undergo HRUS followed by dual phase Tc99m MIBI SPECT/CT scanning.  We will investigate the performance of Tc99m MIBI vs. HRUS in the preoperative localization of PHPT adenoma. Truth will be measured against surgery and histology analysis.  Results of this study may be used to design larger and more comprehensive studies.

Funding:  Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences
Grant Type: Internal
PI: Bital Savir-Baruch, MD

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