Accuracy of early-phase versus dual-phase single-photon emission computed tomography/computed tomography in the localization of Parathyroid disease

Rajarsi Mandal, Ashok Muthukrishnan, Robert L. Ferris, John R. De Almeida, Umamaheswar Duvvuri

Research output: Contribution to journalArticle

Abstract

Objectives/Hypothesis Preoperative localization for parathyroid disease has improved in recent years with the advent of dual-phase 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. However, dual-phase imaging is associated with increased cost, time, and radiation dose. The aim of this study was to investigate the need for late-phase imaging when using SPECT/CT for the preoperative localization of parathyroid disease. Study Design Retrospective chart analysis. Methods A retrospective review of 75 patients who underwent preoperative imaging localization and subsequent surgical resection for parathyroid disease at a tertiary referral center was performed. Of these, 50 patients met study criteria including preoperative SPECT/CT imaging and specific reporting of early- and late-phase focal radiotracer uptake. Localization accuracy was verified with definitive surgical findings confirmed by histological analysis and evidence of biochemical cure. Results Accurate localization of adenoma(s) was seen in 78.0% of patients using dual-phase SPECT/CT. Early-phase imaging alone localized 76.0%, whereas late-phase imaging alone localized 74.0%. Sensitivity and specificity for dual-phase imaging was 84.8% and 89.6%, respectively. In comparison, early-phase localization alone was found to have a sensitivity/specificity of 84.4%/89.4%; sensitivity/specificity of late-phase scanning alone was found to be 80.4%/89.1%. Dual-phase SPECT/CT scanning did not provide a statistically significant improvement in adenoma localization when compared to early-phase scanning alone. Conclusions Although further investigation is needed, the results of this study suggest that early-phase SPECT/CT scanning alone may obviate the need for dual-phase SPECT/CT scanning in the initial preoperative localization workup of parathyroid disease.

Original languageEnglish (US)
Pages (from-to)1496-1501
Number of pages6
JournalLaryngoscope
Volume125
Issue number6
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Parathyroid Diseases
Sensitivity and Specificity
Adenoma
Technetium Tc 99m Sestamibi
Single Photon Emission Computed Tomography Computed Tomography
Tertiary Care Centers
Retrospective Studies
Radiation
Costs and Cost Analysis

Keywords

  • minimally invasive parathyroidectomy
  • Parathyroid
  • parathyroid preoperative localization
  • parathyroid single-photon emission computed tomography/computed tomography

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Accuracy of early-phase versus dual-phase single-photon emission computed tomography/computed tomography in the localization of Parathyroid disease. / Mandal, Rajarsi; Muthukrishnan, Ashok; Ferris, Robert L.; De Almeida, John R.; Duvvuri, Umamaheswar.

In: Laryngoscope, Vol. 125, No. 6, 01.01.2015, p. 1496-1501.

Research output: Contribution to journalArticle

Mandal, Rajarsi ; Muthukrishnan, Ashok ; Ferris, Robert L. ; De Almeida, John R. ; Duvvuri, Umamaheswar. / Accuracy of early-phase versus dual-phase single-photon emission computed tomography/computed tomography in the localization of Parathyroid disease. In: Laryngoscope. 2015 ; Vol. 125, No. 6. pp. 1496-1501.
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title = "Accuracy of early-phase versus dual-phase single-photon emission computed tomography/computed tomography in the localization of Parathyroid disease",
abstract = "Objectives/Hypothesis Preoperative localization for parathyroid disease has improved in recent years with the advent of dual-phase 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. However, dual-phase imaging is associated with increased cost, time, and radiation dose. The aim of this study was to investigate the need for late-phase imaging when using SPECT/CT for the preoperative localization of parathyroid disease. Study Design Retrospective chart analysis. Methods A retrospective review of 75 patients who underwent preoperative imaging localization and subsequent surgical resection for parathyroid disease at a tertiary referral center was performed. Of these, 50 patients met study criteria including preoperative SPECT/CT imaging and specific reporting of early- and late-phase focal radiotracer uptake. Localization accuracy was verified with definitive surgical findings confirmed by histological analysis and evidence of biochemical cure. Results Accurate localization of adenoma(s) was seen in 78.0{\%} of patients using dual-phase SPECT/CT. Early-phase imaging alone localized 76.0{\%}, whereas late-phase imaging alone localized 74.0{\%}. Sensitivity and specificity for dual-phase imaging was 84.8{\%} and 89.6{\%}, respectively. In comparison, early-phase localization alone was found to have a sensitivity/specificity of 84.4{\%}/89.4{\%}; sensitivity/specificity of late-phase scanning alone was found to be 80.4{\%}/89.1{\%}. Dual-phase SPECT/CT scanning did not provide a statistically significant improvement in adenoma localization when compared to early-phase scanning alone. Conclusions Although further investigation is needed, the results of this study suggest that early-phase SPECT/CT scanning alone may obviate the need for dual-phase SPECT/CT scanning in the initial preoperative localization workup of parathyroid disease.",
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AU - De Almeida, John R.

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N2 - Objectives/Hypothesis Preoperative localization for parathyroid disease has improved in recent years with the advent of dual-phase 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. However, dual-phase imaging is associated with increased cost, time, and radiation dose. The aim of this study was to investigate the need for late-phase imaging when using SPECT/CT for the preoperative localization of parathyroid disease. Study Design Retrospective chart analysis. Methods A retrospective review of 75 patients who underwent preoperative imaging localization and subsequent surgical resection for parathyroid disease at a tertiary referral center was performed. Of these, 50 patients met study criteria including preoperative SPECT/CT imaging and specific reporting of early- and late-phase focal radiotracer uptake. Localization accuracy was verified with definitive surgical findings confirmed by histological analysis and evidence of biochemical cure. Results Accurate localization of adenoma(s) was seen in 78.0% of patients using dual-phase SPECT/CT. Early-phase imaging alone localized 76.0%, whereas late-phase imaging alone localized 74.0%. Sensitivity and specificity for dual-phase imaging was 84.8% and 89.6%, respectively. In comparison, early-phase localization alone was found to have a sensitivity/specificity of 84.4%/89.4%; sensitivity/specificity of late-phase scanning alone was found to be 80.4%/89.1%. Dual-phase SPECT/CT scanning did not provide a statistically significant improvement in adenoma localization when compared to early-phase scanning alone. Conclusions Although further investigation is needed, the results of this study suggest that early-phase SPECT/CT scanning alone may obviate the need for dual-phase SPECT/CT scanning in the initial preoperative localization workup of parathyroid disease.

AB - Objectives/Hypothesis Preoperative localization for parathyroid disease has improved in recent years with the advent of dual-phase 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. However, dual-phase imaging is associated with increased cost, time, and radiation dose. The aim of this study was to investigate the need for late-phase imaging when using SPECT/CT for the preoperative localization of parathyroid disease. Study Design Retrospective chart analysis. Methods A retrospective review of 75 patients who underwent preoperative imaging localization and subsequent surgical resection for parathyroid disease at a tertiary referral center was performed. Of these, 50 patients met study criteria including preoperative SPECT/CT imaging and specific reporting of early- and late-phase focal radiotracer uptake. Localization accuracy was verified with definitive surgical findings confirmed by histological analysis and evidence of biochemical cure. Results Accurate localization of adenoma(s) was seen in 78.0% of patients using dual-phase SPECT/CT. Early-phase imaging alone localized 76.0%, whereas late-phase imaging alone localized 74.0%. Sensitivity and specificity for dual-phase imaging was 84.8% and 89.6%, respectively. In comparison, early-phase localization alone was found to have a sensitivity/specificity of 84.4%/89.4%; sensitivity/specificity of late-phase scanning alone was found to be 80.4%/89.1%. Dual-phase SPECT/CT scanning did not provide a statistically significant improvement in adenoma localization when compared to early-phase scanning alone. Conclusions Although further investigation is needed, the results of this study suggest that early-phase SPECT/CT scanning alone may obviate the need for dual-phase SPECT/CT scanning in the initial preoperative localization workup of parathyroid disease.

KW - minimally invasive parathyroidectomy

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