Volume 62, Issue 5 pp. 642-648
Medical Imaging—Original Article

Highly specific preoperative selection of solitary parathyroid adenoma cases in primary hyperparathyroidism by quantitative image analysis of the early-phase Technetium-99m sestamibi scan

DaeHee Kim

Corresponding Author

DaeHee Kim

Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

Correspondence

Dr DaeHee Kim, Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.

Email: [email protected]

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Jeffrey A Rhodes

Jeffrey A Rhodes

Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

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Jeffrey A Hashim

Jeffrey A Hashim

Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

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Lawrence Rickabaugh

Lawrence Rickabaugh

Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

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David M Brams

David M Brams

Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

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Edward Pinkus

Edward Pinkus

Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

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Yamin Dou

Yamin Dou

Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

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First published: 07 June 2018
Citations: 4
D Kim MD; JA Rhodes MD; JA Hashim MD; L Rickabaugh BS, CNMT; DM Brams MD; E Pinkus MD; Y Dou MD.
Conflict of interest: No disclaimer or disclosure. No financial support or grant was used for the study.

Abstract

Introduction

Highly specific preoperative localizing test is required to select patients for minimally invasive parathyroidectomy (MIP) in lieu of traditional four-gland exploration. We hypothesized that Tc-99m sestamibi scan interpretation incorporating numerical measurements on the degree of asymmetrical activity from bilateral thyroid beds can be useful in localizing single adenoma for MIP.

Methods

We devised a quantitative interpretation method for Tc-99m sestamibi scan based on the numerically graded asymmetrical activity on early phase. The numerical ratio value of each scan was obtained by dividing the number of counts from symmetrically drawn regions of interest (ROI) over bilateral thyroid beds. The final pathology and clinical outcome of 109 patients were used to perform receiver operating curve (ROC) analysis.

Results

Receiver operating curve analysis revealed the area under the curve (AUC) was calculated to be 0.71 (P = 0.0032), validating this method as a diagnostic tool. The optimal cut-off point for the ratio value with maximal combined sensitivity and specificity was found with corresponding sensitivity of 67.9% (56.5–77.2%, 95% CI) and specificity of 75.0% (52.8–91.8%, 95% CI). An additional higher cut-off with higher specificity with minimal possible sacrifice on sensitivity was also selected, yielding sensitivity of 28.6% (18.8–38.6%, 95% CI) and specificity of 90.0% (69.6–98.8%, 95% CI).

Conclusions

Our results demonstrated that the more asymmetrical activity on the initial phase, the more successful it is to localize a single parathyroid adenoma on sestamibi scans. Using early-phase Tc-99m sestamibi scan only, we were able to select patients for minimally invasive parathyroidectomy with 90% specificity.

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