Institut Perubatan & Pergigian Termaju - Tesis

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Browsing Institut Perubatan & Pergigian Termaju - Tesis by Subject "99mTc-Sestamibi SPECT/CT"

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    Added Value Of 99mtc-sestamibi Spect/CT Over Dual Phase Planar Scintigraphy In Patients With Hyperparathyroidism In Hospital Pulau Pinang
    (2023-05)
    Adnan, Akmal Asyiqien
    Purpose: This study aims to investigate the added value of 99mTc-Sestamibi SPECT and SPECT/CT for pre-operative localisation of hyperfunctioning parathyroid glands. Methods: Retrospective data analysis was performed on 22 eligible patients with biochemical evidence of hyperparathyroidism who underwent 99mTc-Sestamibi SPECT/CT from 1st September 2019 to 31st March 2021 in Hospital Pulau Pinang and had a histopathological diagnosis of surgically excised lesions. The imaging findings were compared to histopathological examination as reference standard. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated according to standard formulas. Agreement of diagnostic performance between planar, SPECT and SPECT/CT was analysed by Fleiss kappa test. Results: Sensitivity, PPV, and NPV were the highest in SPECT/CT; 100%, 90.4% and 100% respectively, followed by SPECT (sensitivity 89.5%, PPV 89.5% and NPV 33.3%) and the lowest in planar (sensitivity 84.2%, PPV 88.8% and NPV 25.0%). All imaging techniques showed the same specificity (33.3%). Fleiss’ kappa analysis showed that there was a moderate overall agreement of diagnostic performance between planar, planar with SPECT and planar with SPECT/CT, κ=0.573 (95% CI, 0.332 to 0.815), p < 0.001. Conclusion: SPECT and SPECT/CT have significant incremental diagnostic value over planar scintigraphy in the pre-operative localisation of hyperfunctioning parathyroid glands, particularly in posteriorly located glands. SPECT/CT has also shown additional benefit in cases with slow thyroidal washout and especially crucial for surgical planning.