Parathyroid Scintigraphy: Optimization of 99mTc-sestamibi/123I subtraction SPECT/CT
Tunninen, Virpi (2017)
Tampere University of Technology
2017
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https://urn.fi/URN:ISBN:978-952-15-4021-9
https://urn.fi/URN:ISBN:978-952-15-4021-9
Tiivistelmä
Hyperparathyroidism is a common endocrine disorder caused by one or more hyperfunctioning parathyroid glands secreting excess amounts of parathyroid hormone. This leads to hypercalcemia that may lead to numerous clinical manifestations, such as osteoporotic fractures. Surgery is the only curative treatment, with current trends towards minimally invasive operations. A prerequisite for targeted operation is a sensitive and specific preoperative localization that is, also capable of identifying ectopic glands and multiple gland disease.
Preoperative localization is performed using nuclear medicine, i.e., scintigraphic techniques, with 99mTc-sestamibi being the imaging agent of choice. Unfortunately, 99mTcsestamibi is not a specific agent for parathyroid tissue, and several protocols are in use with variable sensitivity and specificity figures.
The aim of this thesis was to find the optimal protocol for parathyroid scintigraphy with the highest sensitivity and specificity. Subsequently, the national status of protocols was investigated. These protocols were tested in the clinical environment and finally the protocol of choice was optimized with the use of phantoms.
Our results indicate that the dual-isotope method with 99mTc-sestamibi and 123I is superior when compared with the use of 99mTc-sestamibi alone.99mTc-sestamibi/123I subtraction SPECT/CT is a highly sensitive and specific protocol for parathyroid scintigraphy and should be preferred over planar acquisition techniques due to important anatomical 3D information. However, acquisition and processing parameters have a profound effect on the outcome of 99mTc-sestamibi/123I subtraction SPECT/CT. The protocol should therefore be tested with known anthropomorphic phantoms. With careful optimization, 99mTc-sestamibi/123I subtraction SPECT/CT is an adequate technique for parathyroid scintigraphy without additional acquisitions. The results of this thesis will provide guidelines for proposing recommendations for parathyroid scintigraphy.
Preoperative localization is performed using nuclear medicine, i.e., scintigraphic techniques, with 99mTc-sestamibi being the imaging agent of choice. Unfortunately, 99mTcsestamibi is not a specific agent for parathyroid tissue, and several protocols are in use with variable sensitivity and specificity figures.
The aim of this thesis was to find the optimal protocol for parathyroid scintigraphy with the highest sensitivity and specificity. Subsequently, the national status of protocols was investigated. These protocols were tested in the clinical environment and finally the protocol of choice was optimized with the use of phantoms.
Our results indicate that the dual-isotope method with 99mTc-sestamibi and 123I is superior when compared with the use of 99mTc-sestamibi alone.99mTc-sestamibi/123I subtraction SPECT/CT is a highly sensitive and specific protocol for parathyroid scintigraphy and should be preferred over planar acquisition techniques due to important anatomical 3D information. However, acquisition and processing parameters have a profound effect on the outcome of 99mTc-sestamibi/123I subtraction SPECT/CT. The protocol should therefore be tested with known anthropomorphic phantoms. With careful optimization, 99mTc-sestamibi/123I subtraction SPECT/CT is an adequate technique for parathyroid scintigraphy without additional acquisitions. The results of this thesis will provide guidelines for proposing recommendations for parathyroid scintigraphy.
Kokoelmat
- Väitöskirjat [4905]