Value of dual-phase (99m)Tc-sestamibi scintigraphy with neck and thoracic SPECT/CT in secondary hyperparathyroidism.

OBJECTIVE: Surgical intervention in the form of parathyroidectomy is generally considered only for severe secondary hyperparathyroidism (sHPT). However, correct location of the parathyroid glands before parathyroidectomy is a challenge. The purpose of this study was to compare the diagnostic value of early and delayed phase (99m)Tc-sestamibi SPECT/CT in the detection of parathyroid tissue to guide operative treatment of patients with sHPT. SUBJECTS AND METHODS: Eighty patients with sHPT who were undergoing hemodialysis were evaluated preoperatively with dual-phase (99m)Tc-sestamibi SPECT/CT parathyroid scintigraphy to locate parathyroid tissue before parathyroidectomy. The scintigraphic results were classified as positive or negative. The accuracy of (99m)Tc sestamibi early and delayed phase SPECT/CT scintigraphy was determined. RESULTS: Early phase (99m)Tc-sestamibi SPECT/CT depicted 3.57 parathyroid glands (PTGs) and delayed phase (99m)Tc-sestamibi SPECT/CT depicted 3.55 PTGs per study. The specificity of both early and delayed phase (99m)Tc-sestamibi SPECT/CT in detecting PTGs was 100%. The (99m)Tc-sestamibi SPECT/CT images of 7 of 80 patients showed positive findings in the delayed phase and negative findings in the early phase. The (99m)Tc-sestamibi SPECT/CT images of 6 of 80 patients showed positive findings in the early phase and negative findings in the delayed phase. CONCLUSION: The results of our study indicate that both early and delayed phase (99m)Tc-sestamibi SPECT/CT should be performed in the preoperative evaluation of hemodialysis patients with sHPT due to chronic kidney disease. Performance of both early and delayed phase (99m)Tc-sestamibi SPECT/CT did not increase the radiation dose compared with the use of only the early or the delayed phase.

Bone marrow metastases from alveolar rhabdomyosarcoma with impressive FDG PET/CT finding but less-revealing bone scintigraphy.

An 18F-FDG PET/CT scan was performed in a 26-year-old man with a known alveolar rhabdomyosarcoma for staging. The PET/CT scan showed abnormally increased FDG activity involving almost all bones in the imaged regions. In contrast, 99mTc-MDP whole-body bone scan demonstrated only very limited bone metastases.

The application of SPECT/CT for preoperative planning in patients with secondary hyperparathyroidism.

BACKGROUND AND PURPOSE: Secondary hyperparathyroidism (SHPT) is a frequent and challenging issue in patients undergoing dialysis for chronic kidney disease. Surgical intervention in the form of parathyroidectomy is generally considered only in cases of severe SHPT. However, identification of the exact location of the parathyroid glands (PTGs) before parathyroidectomy is a challenge. The aim of this study was to evaluate the role of 99mTc sestamibi single-photon emission computed tomography (SPECT)/computed tomography (CT) in the detection of parathyroids to guide operative therapy in patients with SHPT. PATIENTS AND METHODS: Ninety patients with SHPT who were on hemodialysis were evaluated preoperatively with double-phase 99mTc sestamibi static planar and SPECT/CT parathyroid scintigraphy to evaluate for parathyroids before parathyroidectomy. The sensitivity, specificity, and accuracy of 99mTc sestamibi static planar and SPECT/CT scintigraphy were determined. RESULTS: Compared with static planar scintigraphy, 99mTc sestamibi SPECT/CT was able to detect a larger number of PTGs per study, as well as PTGs of smaller diameter and PTGs of smaller size. The sensitivity, specificity, and accuracy of 99mTc sestamibi SPECT/CT in detecting PTGs were 78.9, 100, and 78.9%, respectively, compared with 55.6, 100, and 55.6% for static planar 99mTc sestamibi. CONCLUSION: Our study indicates that 99mTc sestamibi SPECT/CT has a higher sensitivity compared with static planar scintigraphy in the preoperative evaluation of hemodialysis patients with SHPT because of chronic kidney disease. SPECT/CT can not only detect a larger number of PTGs but can also depict the precise location of PTGs more accurately when compared with static planar scintigraphy.