TITLE:
Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism
AUTHORS:
Bas Twigt, Anne Vollebregt, Piet de Hooge, Alex Muller, Thijs van Dalen
KEYWORDS:
Imaging-Primary Hyperparathyroidism-Sestamibi Scan-Ultrasound-CT
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.1 No.3,
November
29,
2012
ABSTRACT: Background: The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in “MIBI-negative”-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in “MIBI-negative”-patients. The positive predictive value of a “positive” MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.