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Diagnostic Value of Ultrasound, Technetium-99m Sestamibi and 4D-CT in Parathyroid Adenoma Localisation
EP34258
Poster Title: Diagnostic Value of Ultrasound, Technetium-99m Sestamibi and 4D-CT in Parathyroid Adenoma Localisation
Submitted on 27 Oct 2020
Author(s): Jul Yang, Isobel Chen, Mohamed Shawgi
Affiliations: Departments of Radiology and Nuclear Medicine, James Cook University Hospital
Poster Views: 492
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Poster Information
Abstract: Background: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Four-dimensional (4D) CT has emerged as an additional modality for parathyroid imaging along with ultrasound (US) and Technetium-99m (Tc-99m) Sestamibi single-photon emission computed tomography (SPECT). We aimed to evaluate the diagnostic performance of all three modalities in patients with suspected parathyroid adenoma.

Method: Retrospective study performed in a tertiary centre between March 2018 and December 2019. All patients with suspected parathyroid adenoma had ultrasound of the neck, TC-99m Sestamibi SPECT and 4D-CT prior to surgery. All imaging findings were collated on RIS/PACS and correlated with surgical pathology reports on clinical system webICE.

Results: 16 patients underwent surgical excision (10 women, 6 men; mean age 65 years). 13 patients (81%) had histologically confirmed parathyroid adenoma. Comparing the three modalities, 4D-CT had the highest sensitivity and accuracy (85%, 81%, respectively), followed by Tc-99m Sestamibi SPECT (77%, 69%), with US being less sensitive than the other two modalities (69%, 63%). Combination of Tc-99m Sestamibi SPECT and US increased the sensitivity to 92% and accuracy to 81%. Combination of 4D-CT with either US or Tc-99m Sestamibi SPECT increased sensitivity to 100% and accuracy to 88%.

Conclusion: Although addition of 4D-CT provided higher sensitivity than Tc-99m Sestamibi SPECT and US alone, the combination of all modalities provided the best diagnostic accuracy. Weighing the risk of higher radiation dose associated with multi-phase CT imaging, 4D-CT should ideally be reserved for difficult cases and problem solving.
Summary: Diagnostic Value of Ultrasound, Technetium-99m Sestamibi and 4D-CT in Parathyroid Adenoma LocalisationReferences: Hoang JK, Reiman RE, Nguyen GB, Januzis N, Chin BB, Lowry C, Yoshizumi TT. Lifetime Attributable Risk of Cancer from Radiation Exposure During Parathyroid Imaging: Comparison of 4DCT and Parathyroid Scintigraphy. AJR 2015Report abuse »
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