(99m)Tc-Sestamibi/(123)I Subtraction SPECT/CT in Parathyroid Scintigraphy: Is Additional Pinhole Imaging Useful?

OBJECTIVES: This retrospective study evaluated whether the use of additional anterior (99m)Tc-sestamibi/(123)I pinhole imaging improves the outcome of (99m)Tc-sestamibi/(123)I subtraction SPECT/CT in parathyroid scintigraphy (PS). MATERIALS AND METHODS: PS using simultaneous dual-isotope subtraction methods and an acquisition protocol combining SPECT/CT and planar pinhole imaging was performed for 175 patients with primary or secondary hyperparathyroidism. All patients who proceeded to surgery with complete postsurgery laboratory findings were included in this study (n = 94). SPECT/CT images alone and combined with pinhole images were evaluated. RESULTS: There were 111 enlarged parathyroid glands of which 104 and 108 glands were correctly visualized by SPECT/CT (seven false positives) or SPECT/CT with pinhole (three false positives), respectively. Both sensitivity and specificity were higher with combined SPECT/CT with pinhole than with SPECT/CT alone (97% versus 94% and 99% versus 98%, resp., not significant). The false-positive rate was 6% with SPECT/CT and decreased to 3% using combined SPECT/CT with pinhole. CONCLUSION: (99m)Tc-sestamibi/(123)I subtraction SPECT/CT is a highly sensitive and specific protocol for PS. The use of additional anterior pinhole imaging increases both sensitivity and specificity of PS, although this increase is not statistically significant.