Comparison of four-dimensional CT and Sestamibi SPECTCT in the localization management of primary hyperparathyroidism
Abstract Objective Accurate preoperative imaging localization is paramount to the success of targeted parathyroidectomy for primary hyperparathyroidism (PHPT). Four-dimensional (4D) CT is a promising method for preoperative localization of the parathyroid, but studies on the performance of 4D CT and...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
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| Series: | Cancer Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40644-025-00897-7 |
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| Summary: | Abstract Objective Accurate preoperative imaging localization is paramount to the success of targeted parathyroidectomy for primary hyperparathyroidism (PHPT). Four-dimensional (4D) CT is a promising method for preoperative localization of the parathyroid, but studies on the performance of 4D CT and technetium 99 m-sestamibi SPECT/CT for the diagnosis of diseases of the parathyroid are limited. Materials and methods To compare the diagnostic performance of sestamibi SPECT/CT and 4D-CT for preoperative localization in patients with PHPT in a single-institution from August 2017 to May 2024. Results Two hundred forty-two patients with PHPT (166 females; 52.5 years ± 13.4 [SD]) were evaluated. Among the 242 patients, 233 patients (96.3%) had single-gland disease, and 9 patients (3.7%) had multigland disease. Similar diagnostic performance was observed for sestamibi SPECT/CT and 4D-CT ([receiver operating characteristic ROC], 0.90 [95% CI: 0.87, 0.92] and 0.88 [95% CI: 0.85, 0.90], respectively; p = 0.11). Compared with 4D-CT, combined-modality sensitive reading and sestamibi SPECT/CT had the highest ROC, and, although there was no significant difference between the two (ROC, 0.91; 95% CI: 0.89, 0.93; p = 0.14), they significantly differed from 4D-CT (p = 0.0006). Sestamibi SPECT/CT showed an accuracy of 92% (95% CI: 90%, 94%), similar to 4D-CT (91%; 95% CI: 89%, 92%), combined-modality sensitive reading (91%; 95% CI: 89%, 93%) and combined-modality specificity reading (92%; 95% CI: 90%, 94%). Conclusion Sestamibi SPECT/CT has high accuracy in preoperative localization in patients with PHPT. Compared with sestamibi SPECT/CT alone, 4D-CT and combined-modality reading did not improve diagnostic performance. |
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| ISSN: | 1470-7330 |