Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

Bas Twigt, Anne Vollebregt, Piet de Hooge, Alex Muller, Thijs van Dalen

Department of Internal Medicine, Diakonessen Hospital Utrecht, Utrecht, The Netherlands.
Department of Nuclear Medicine, Diakonessen Hospital Utrecht, Utrecht, The Netherlands.
Department of Surgery, Diakonessen Hospital Utrecht, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

DOI: 10.4236/ijohns.2012.13019                

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.

Keywords

Imaging-Primary Hyperparathyroidism-Sestamibi Scan-Ultrasound-CT

Conflicts of Interest

The authors declare no conflicts of interest.

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