Comparison of Five Parathyroid Scintigraphic Protocols

Objectives. We compared five parathyroid scintigraphy protocols in patients with primary (pHPT) and secondary hyperparathyroidism (sHPT) and studied the interobserver agreement. The dual-tracer method ((99m)Tc-sestamibi/(123)I) was used with three acquisition techniques (parallel-hole planar, pinhole planar, and SPECT/CT). The single-tracer method ((99m)Tc-sestamibi) was used with two acquisition techniques (double-phase parallel-hole planar, and SPECT/CT). Thus five protocols were used, resulting in five sets of images. Materials and Methods. Image sets of 51 patients were retrospectively graded by four experienced nuclear medicine physicians. The final study group consisted of 24 patients (21 pHPT, 3 sHPT) who had been operated upon. Surgical and histopathologic findings were used as the standard of comparison. Results. Thirty abnormal parathyroid glands were found in 24 patients. The sensitivities of the dual-tracer method (76.7-80.0%) were similar (P = 1.0). The sensitivities of the single-tracer method (13.3-31.6%) were similar (P = 0.625). All differences in sensitivity between these two methods were statistically significant (P < 0.012). The interobserver agreement was good. Conclusion. This study indicates that any dual-tracer protocol with (99m)Tc-sestamibi and (123)I is superior for enlarged parathyroid gland localization when compared with single-tracer protocols using (99m)Tc-sestamibi alone. The parathyroid scintigraphy was found to be independent of the reporter.