Accuracy of technetium-99m SPECT-CT hybrid images in predicting the precise intraoperative anatomical location of parathyroid adenomas

Head Neck. 2008 Apr;30(4):509-17. doi: 10.1002/hed.20727.


Background: This study evaluated the accuracy of single photon emission computed tomography (SPECT)-CT imaging for the preoperative localization of parathyroid adenomas.

Methods: This study included both a quantitative and qualitative accuracy measure. The quantitative measure was the distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively. Qualitatively, surgeons were asked whether or not the adenoma was in the exact location predicted by the SPECT-CT scan. The time from initial incision to identification of the parathyroid was recorded. Patients referred to London Health Sciences Centre for a suspected parathyroid adenoma were eligible for this study.

Results: Twenty-three patients participated in this study. Eighteen (78.3%) had a single adenoma, 2 (8.7%) had double adenomas, and 3 (13.0%) had multiglandular hyperplasia. SPECT-CT correctly detected and localized 16 of 18 (88.9%) cases of single parathyroid adenomas. The mean distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively was 16.3 mm (95% < or = 19.0 mm). For single adenomas, the median time from skin incision to identification was 14 minutes (range, 8-40 minutes). The preoperative detection and localization of a single focus of sestamibi uptake yielded a parathyroid adenoma in the specified location in 80.0% of cases (95% CI, 97.4-66.5%).

Conclusions: SPECT-CT predicted the intraoperative location of a single parathyroid adenoma within 19.0 mm with 95% confidence. The correct detection and localization of multiglandular disease remains difficult.

MeSH terms

  • Adenoma / diagnostic imaging*
  • Adenoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Intraoperative Period
  • Male
  • Middle Aged
  • Parathyroid Neoplasms / diagnostic imaging*
  • Parathyroid Neoplasms / surgery*
  • Parathyroidectomy
  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi
  • Tomography, Emission-Computed, Single-Photon*


  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi