consensus that the addition of single-photon emission CT (SPECT) without or with a coregistered CT (SPECT/CT) improves localization of parathyroid adenomas over a planar dual-phase sestamibi method [59,61,62]. The sensitivity of sestamibi imaging is decreased in the setting of MGD [55,58], concomitant nodular thyroid disease [56,66], small adenomas [53], and mild hypercalcemia [58]. Literature regarding the pediatric population is limited. A retrospective review of 29 patients reported that sestamibi was useful only in older children with a single adenoma in the setting of sporadic PHPT, and added minimal additional information compared with US, with otherwise no utility for sestamibi in neonates or familial PHPT [67]. Sestamibi Dual-Phase Scan with SPECT or SPECT/CT Neck The addition of SPECT or SPECT/CT to a dual-phase sestamibi scan is more commonly utilized than planar imaging alone. Although there are a number of variations in the timing of the SPECT or SPECT/CT acquisition (ie, early, delayed, or both), it is generally accepted that the improved contrast resolution of SPECT or SPECT/CT over planar imaging provides more precise anatomic localization of parathyroid adenomas [68,69]. The sensitivity of dual-phase sestamibi with SPECT or SPECT/CT is decreased by MGD, uptake masked by retained radionuclide in adjacent thyroid or submandibular gland tissue, and smaller size of the adenoma (within these subsets, sensitivity ranges from 24% to 66%) [71-73]. Sestamibi Scan and I-123 Thyroid Scan Subtraction scintigraphy of parathyroid glands using a combination of sestamibi and I-123 sodium iodide is a commonly utilized alternative or adjunct to the dual-phase sestamibi technique. The 2009 European Association of Nuclear Medicine parathyroid guidelines expressed a preference for the dual-tracer sestamibi and I-123 technique, citing improved sensitivity for MGD and improved likelihood of distinguishing sestamibi-avid thyroid nodules from parathyroid lesions [15].
Parathyroid Adenoma. consensus that the addition of single-photon emission CT (SPECT) without or with a coregistered CT (SPECT/CT) improves localization of parathyroid adenomas over a planar dual-phase sestamibi method [59,61,62]. The sensitivity of sestamibi imaging is decreased in the setting of MGD [55,58], concomitant nodular thyroid disease [56,66], small adenomas [53], and mild hypercalcemia [58]. Literature regarding the pediatric population is limited. A retrospective review of 29 patients reported that sestamibi was useful only in older children with a single adenoma in the setting of sporadic PHPT, and added minimal additional information compared with US, with otherwise no utility for sestamibi in neonates or familial PHPT [67]. Sestamibi Dual-Phase Scan with SPECT or SPECT/CT Neck The addition of SPECT or SPECT/CT to a dual-phase sestamibi scan is more commonly utilized than planar imaging alone. Although there are a number of variations in the timing of the SPECT or SPECT/CT acquisition (ie, early, delayed, or both), it is generally accepted that the improved contrast resolution of SPECT or SPECT/CT over planar imaging provides more precise anatomic localization of parathyroid adenomas [68,69]. The sensitivity of dual-phase sestamibi with SPECT or SPECT/CT is decreased by MGD, uptake masked by retained radionuclide in adjacent thyroid or submandibular gland tissue, and smaller size of the adenoma (within these subsets, sensitivity ranges from 24% to 66%) [71-73]. Sestamibi Scan and I-123 Thyroid Scan Subtraction scintigraphy of parathyroid glands using a combination of sestamibi and I-123 sodium iodide is a commonly utilized alternative or adjunct to the dual-phase sestamibi technique. The 2009 European Association of Nuclear Medicine parathyroid guidelines expressed a preference for the dual-tracer sestamibi and I-123 technique, citing improved sensitivity for MGD and improved likelihood of distinguishing sestamibi-avid thyroid nodules from parathyroid lesions [15].