Role of Single-Photon Emission Computerised Tomography Versus Ultrasonography or 4D-Computed Tomography in the Management of Primary Hyperparathyroidism

Introduction The aim of the current study was to determine the diagnostic accuracy of three commonly used localization modalities for parathyroid adenomas, i.e., single-photon emission computerised tomography/computed tomography (SPECT/CT), ultrasound (USG) and 4D-computed tomography (4D-CT), especially when used in combination. Methods Medical records of patients diagnosed with primary hyperparathyroidism were reviewed from January 2015 to December 2020. Intra-operative findings were compared with preoperative localization studies (USG, SPECT/CT and 4D-CT) in order to determine sensitivity, specificity and accuracy of these studies. Results One hundred eighty-nine medical records were reviewed. SPECT/CT has a sensitivity of 60.51% and a diagnostic accuracy of 60.21%. USG had the lowest sensitivity of 49.36% with a diagnostic accuracy of 51.6%. 4D-CT had the highest sensitivity of 82.72%, a specificity of 56% and a diagnostic accuracy of 76.42%. When SPECT/CT was used in combination with USG the sensitivity was significantly higher (p=0.0001) at 69.54% and when SPECT/CT was used in combination with 4D-CT the sensitivity was significantly higher at 91.4% (p=0.0001). Conclusions SPECT/CT was more sensitive and accurate as compared to USG but when they were used together the sensitivity was significantly higher. Superior preoperative localization was provided by 4D-CT as compared to SPECT/CT.