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Arch Surg. 2005 Apr;140(4):383-6.

Sestamibi scans are not all created equally.

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  • 1Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.

Abstract

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 hyperthyroidism 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 MEASURES:

concordance among the scan and operative localization, lateralization, and cure rate.

RESULTS:

Initial protocol: 97 patients underwent surgery for primary hyperthyroidism 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 (52%) 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.

PMID:
15841562
[PubMed - indexed for MEDLINE]
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