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Comparison of Planar Scintiscanning and Pinhole Subtraction Spect in Preoperative Imaging of Primary Hyperparathyroidism in an Endemic Goiter Area

Profanter, Christoph MD*; Prommegger, Rupert MD*; Gabriel, Michael MD†; Lucciarini, Paolo MD*; Moncayo, Roy MD†; Wetscher, Gerold J. MD*

CME Review Articles: Bone & Mineral

A unilateral surgical approach in patients with primary hyperparathyroidism (HPTH) requires a reliable preoperative parathyroid localization procedure. The aim of this study was to compare the approved planar scintiscanning by means of 99mTcO4−201Tl subtraction or 99mTc-sestamibi with 99mTcO4−201Tl pinhole subtraction SPECT.

Fifty patients with primary HPTH and preoperative localization diagnosis were retrospectively analyzed. Thirty-three of them underwent preoperative planar scintiscanning with 99mTcO4−201Tl subtraction or 99mTc-sestamibi, 17 had 99mTcO4−201Tl pinhole subtraction SPECT.

Planar scintiscanning had an overall accuracy of 81.8%, 99mTcO4−201Tl pinhole subtraction SPECT of 81.3%. In patients with solitary parathyroid adenomas the planar scintiscanning provided correct results in 86.7%, whereas 99mTcO4−201Tl pinhole subtraction SPECT had an accuracy of 93.3% in these patients. Concomitant thyroid nodules diminished the accuracy of planar scanning to 78.6%. The accuracy of 99mTcO4−201Tl pinhole subtraction SPECT was not diminished by multinodular goiter, all patients with solitary parathyroid adenomas and multinodular thyroid disease were accurately localized.

The sensitivity of 99mTcO4−201Tl pinhole subtraction SPECT is statistically not significantly different compared with planar 99mTcO4−201Tl subtraction or 99mTc-sestamibi scintiscanning in patients with HPTH and solitary adenomas. Therefore, it is concluded that both imaging procedures are comparable in their diagnostic value for preoperative localization for successful unilateral parathyroidectomy. Although the results are not significantly different because of the number of patients, it is concluded 99mTcO4−201Tl pinhole subtraction SPECT to be superior to planar scintiscanning in patients with underlying multinodular thyroid pathology.

Learning Objectives:

* Recognize the goals and limitations of parathyroid gland imaging in patients with primary hyperparathyroidism (HPTH).

* Compare the accuracy and sensitivity of planar scintiscanning and pinhole subtraction SPECT (single photon emission CT) under varying clinical conditions.

* Describe ways in which the availability of these imaging techniques can influence the management of patients with primary PTH.

*General Surgeon and Consultant, Department of General Surgery, and †Physician and Nuclear Medicine Specialist, Department of Nuclear Medicine, University of Innsbruck, Austria.

Chief Editor’s Note: This article is the 8th of 36 that will be published in 2003 for which a total of up to 36 Category 1 CME credits can be earned. Instructions for how credits can be earned appear following the Table of Contents.

Address correspondence and reprint requests to: Christoph Profanter, M.D., University of Innsbruck, Department of General Surgery, Anichstrasse 35, A-6020 Innsbruck, Austria. E-mail:

The authors have disclosed that they have no significant relationship with or financial interest in any commercial company pertaining to this educational activity.

© 2003 Lippincott Williams & Wilkins, Inc.