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Suguna Pappu, MD, PhD; Patricia Donovan, RN; David Cheng, MD, PhD; Robert Udelsman, MD, MBA

Arch Surg. 2005;140:383-386.

Hypothesis  The sensitivity of sestamibi scanning techniques used for preoperative localization in primary hyperparathyroidism is a function of the parameters of image acquisition and processing.

Design  Criterion standard vs optimized technique.

Setting  Tertiary referral center.

Patients  One hundred forty-eight consecutive patients with primary hyperparathyroidism were analyzed. Under the initial protocol, 97 patients underwent a preexisting standard sestamibi–single-photon emission computed tomographic scan and surgical exploration. The scanning technique was modified and in the revised protocol, 51 patients underwent imaging and surgical exploration.

Intervention  Image acquisition and processing revisions as follows: patient positioning standardized, collimator resolution adjusted, radioactive tracer delay extended, visualization field broadened, data extraction refined, and image processing filter modified.

Main Outcome Measure  Concordance among the scan and operative localization, lateralization, and cure rate.

Results  Initial protocol: 97 patients underwent surgery for primary hyperparathyroidism with the initial sestamibi design. Eighty-one patients (83%) had a positive result, that is, at least 1 gland was identified; 77 patients (79%) had correct lateralization; and 49 patients (51%) had precise localization. Revised protocol: 51 patients underwent imaging under the optimized protocol. Forty-nine patients (96%) had a positive result; 47 patients (92%) had correct lateralization; and 36 patients (70%) had precise localization. These improvements were significant, with P<.05 for localization and P<.01 for lateralization. Cure rates were 96% in both groups, confirmed by laboratory and pathologic findings.

Conclusions  Sestamibi optimization in primary hyperparathyroidism can improve scan sensitivity. This may permit a focused minimally invasive operation.

Author Affiliations: Department of Surgery (Drs Pappu, and Udelsman and Ms Donovan), and the Department of Diagnostic Radiology, Section of Nuclear Medicine (Dr Cheng), Yale University School of Medicine, New Haven, Conn.

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