Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online before print May 15, 2008, 10.1148/radiol.2481071066
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
2481071066v1
248/1/221    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nichols, K. J.
Right arrow Articles by Palestro, C. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nichols, K. J.
Right arrow Articles by Palestro, C. J.
(Radiology 2008;248:221-232.)
© RSNA, 2008

Nuclear Medicine

Preoperative Parathyroid Scintigraphic Lesion Localization: Accuracy of Various Types of Readings1

Kenneth J. Nichols, PhD, Maria B. Tomas, MD, Gene G. Tronco, MD, Josephine N. Rini, MD, Biju D. Kunjummen, MD, Keith S. Heller, MD, Laura A. Sznyter, MD, and Christopher J. Palestro, MD

1 From the Division of Nuclear Medicine and Molecular Imaging (K.J.N., M.B.T., G.G.T., J.N.R., B.D.K., C.J.P.) and Department of Surgery (L.A.S.), North Shore Long Island Jewish Health System, 270-05 76th Ave, New Hyde Park, NY 11040; and Division of Endocrine Surgery, New York University School of Medicine, New York, NY (K.S.H.). From the 2006 RSNA Annual Meeting. Received June 18, 2007; revision requested August 23; revision received October 12; accepted January 4, 2008; final version accepted January 31. Address correspondence to K.J.N. (e-mail: knichols@lij.edu).

Purpose: To retrospectively compare the accuracy of various parathyroid scintigraphy readings for single-gland disease (SGD) and multigland disease (MGD) in patients with primary hyperparathyroidism, with histologic analysis as the reference standard.

Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant study. Records of 462 patients with primary hyperparathyroidism who underwent preoperative imaging with a technetium 99m (99mTc) sestamibi and 99mTcO4– protocol that consisted of early and late pinhole 99mTc sestamibi, pinhole thyroid imaging, image subtraction, and single photon emission computed tomography (SPECT) were retrospectively reviewed. An experienced nuclear medicine physician without knowledge of other test results or of the final diagnoses graded images on a scale from 0 (definitely normal) to 4 (definitely abnormal). Early pinhole 99mTc sestamibi images, late pinhole 99mTc sestamibi images, subtraction images, SPECT images, early and late pinhole 99mTc sestamibi images, all planar images, and all images—including SPECT images—were read in seven sessions. Receiver operating characteristic curves were generated for each session and were used to calculate sensitivity, specificity, and accuracy.

Results: A total of 534 parathyroid lesions were excised. Of the 462 patients, 409 had one lesion, whereas 53 had multiple lesions. Reading all images together was more accurate (89%, P = .001) than was reading early (79%), late (85%), subtraction (86%), and SPECT (83%) images seperately; however, it was not significantly more accurate than reading planar images (88%) or early and late images together (87%). Reading all images was significantly less sensitive in the detection of lesions with a median weight of 600 mg or less than in the detection of lesions with a median weight of more than 600 mg (86% vs 94%, P = .004). Per-lesion sensitivity for reading all images was significantly higher for SGD than for MGD (90% vs 66%, P < .001). Sensitivity of reading all images together in the identification of patients with MGD was 62%.

Conclusion: Reviewing early, late, and subtraction pinhole images together with SPECT images maximizes parathyroid lesion detection accuracy. Test sensitivity is adversely affected by decreasing lesion weight and MGD.

© RSNA, 2008




This article has been cited by other articles:


Home page
 J. Nucl. Med. Technol.Home page
M. B. Tomas, P. V. Pugliese, G. G. Tronco, C. Love, C. J. Palestro, and K. J. Nichols
Pinhole Versus Parallel-Hole Collimators for Parathyroid Imaging: An Intraindividual Comparison
J. Nucl. Med. Technol., December 1, 2008; 36(4): 189 - 194.
[Abstract] [Full Text] [PDF]