THE IMPACT OF SPECT/CT HYBRID IMAGING ON ENHANCING DIAGNOSTIC ACCURACY OF PARATHYROID ADENOMA USING 99MTC-MIBI SCAN IN THE NUCLEAR MEDICINE DEPARTMENT OF KOSOVO
Ismet BAJRAMI, Armend JASHARI, Fakir SPAHIU, Sinisa STOJANOSKI, Elena Drakalska SERSEMOVA
Abstract
Aim: This study aimed to compare conventional planar 99mTc-MIBI scintigraphy with hybrid SPECT/CT imaging for the preoperative localization of parathyroid adenoma in patients with suspected primary hyperparathyroidism. The purpose of this study was to evaluate whether the addition of SPECT/CT improves diagnostic accuracy and anatomical localization, particularly in ectopic lesions and anatomically complex cases.
Methods: This retrospective observational study included 42 patients referred to the Nuclear Medicine Department of the University Clinical Center of Kosovo from March 2024 to January 2025, with suspected or biochemically confirmed primary hyperparathyroidism. All patients underwent dual-phase planar 99mTc-MIBI scintigraphy and hybrid SPECT/CT during the same diagnostic procedure. Planar images were acquired at 15, 60, 90, and 120 minutes after injection of the radiopharmaceutical 99mTc-MIBI, and SPECT/CT was obtained approximately 160 minutes after administration of the same radiopharmaceutical.
Results: All 42 patients underwent both imaging modalities. Planar scintigraphy showed 22 true-positive, 13 true-negative, 4 false-positive, and 3 false-negative findings, corresponding to a sensitivity of 88.0%, specificity of 76.5%, PPV (positive predictive value) of 84.6%, NPV (negative predictive value) of 81.3%, and accuracy of 83.3%. Hybrid SPECT/CT demonstrated 24 true-positive, 15 true-negative, 2 false-positive, and 1 false-negative finding, with higher sensitivity (96.0%), specificity (88.2%), PPV (92.3%), NPV (93.8%), and accuracy (92.9%).
Conclusion: There is improvement in the ability to localize as well as increase in diagnostic certainty by using hybrid SPECT/CT compared to plain planar scintigraphy. The most benefit from hybrid SPECT/CT has been seen in the detection of ectopic parathyroid adenoma, in cases adjacent to the thyroid gland, and in those cases that require pre-operative localization.
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