Head-to-Head Comparison of Tc-99m-sestamibi SPECT/CT and C-11-L-Methionin PET/CT in Parathyroid Scanning Before Operation for Primary Hyperparathyroidism

Purpose The preferred nuclear medicine method for identification of hyperfunctioning parathyroid glands in hyperparathyroidism (HPT) develops continuously in relation to the technological progress. Diagnostic methods based on PET/CT have during recent years evolved with new tracer possibilities comp...

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Published in:Molecular imaging and biology 2023-08, Vol.25 (4), p.720-726
Main Authors: Vestergaard, Sys, Gerke, Oke, Bay, Mette, Madsen, Anders Rørbæk, Stilgren, Lis, Ejersted, Charlotte, Rewers, Kate Isabella, Jakobsen, Nick, Asmussen, Jon Thor, Braad, Poul-Erik, Petersen, Henrik, Thomassen, Anders, Schifter, Søren
Format: Article
Language:English
Subjects:
Computed tomography
Confidence intervals
Diagnostic systems
Histopathology
Hyperparathyroidism
Imaging
Localization
Medical imaging
Medicine
Medicine & Public Health
Methionine
Nuclear medicine
Parathyroid hormone
Positron emission
Radiology
Research Article
Scanning
Scintigraphy
Sensitivity
Single photon emission computed tomography
Statistical analysis
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Summary:Purpose The preferred nuclear medicine method for identification of hyperfunctioning parathyroid glands in hyperparathyroidism (HPT) develops continuously in relation to the technological progress. Diagnostic methods based on PET/CT have during recent years evolved with new tracer possibilities competing with traditional scintigraphic methods. This investigation is a head-to-head comparison of Tc-99m-sestamibi SPECT/CT gamma camera scintigraphy (sestamibi SPECT/CT) and C-11-L-methionin PET/CT imaging (methionine PET/CT) for preoperative identification of hyperfunctioning parathyroid glands. Procedures The study is a prospective cohort study including 27 patients diagnosed with primary hyperparathyroidism (PHPT). Two nuclear medicine physicians assessed all examinations independently and blinded. All scanning assessments were matched to the final surgical diagnosis as confirmed by histopathology. Biochemical monitoring of the therapeutical effects was performed preoperatively by PTH-measurements and followed postoperatively for up to 12 months. Comparisons were made for differences in sensitivity and positive predictive value (PPV). Results Twenty-seven patients (18 females, 9 males; mean age (range): 58.9 years (34.1–79)) were enrolled into the study. The 27 patients had a total of 33 identified sites of lesions of which 28 (85%) turned out to be histopathological verified hyperfunctioning parathyroid glands. The sensitivity and PPV for sestamibi SPECT/CT were 0.71 and 0.95; that of methionine PET/CT was 0.82 and 1, respectively. Both sensitivity and PPV were slightly lower for sestamibi SPECT/CT than for methionine PET PET/CT (−0.11, 95% confidence interval (95% CI): −0.29 to 0.08; −0.05, 95% CI: −0.14 to 0.04, respectively), but not to a statistically significant extent ( p =0.38 and p =0.31). The sensitivity and PPV for diagnostic CT were 0.64 (95% CI: 0.44 to 0.81) and 1 (95% CI: 0.81 to 1). Conclusions Methionine PET/CT performed comparable to sestamibi SPECT/CT with respect to identification and localization of hyperfunctioning parathyroid glands prior to surgery.
ISSN:1536-1632
1860-2002
DOI:10.1007/s11307-023-01808-7