Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis.

OBJECTIVE: Successful performance of minimally invasive parathyroidectomy (MIP) is based on the accuracy of preoperative parathyroid localization studies. Despite the various methodologies available, no consensus has been reached so far on the optimal imaging technique. The aim of our meta-analysis was to determine the accuracy of technetium-99m-hexakis methoxyisobutylisonitrile single photon emission tomography/computed tomography ((99m)Tc-MIBI SPET/CT), SPET and MIBI scintigraphy for the preoperative localization of primary hyperparathyroidism (PHPT) lesions, thus facilitating better management of these patients. METHODS: Publications were screened by a comprehensive computer search of PubMed and EMBASE for 25 years. Data were extracted from included articles and forest plots of sensitivity and positive predictive value were calculated to investigate the diagnostic accuracy of SPET/CT, SPET and MIBI scintigraphy. RESULTS: Eighteen articles were included in our study. The sensitivities of SPET/CT, SPET and planar scintigraphy were 84% (95% CI: 78%-90%), 66% (95% CI: 57%-74%) and 63% (95% CI: 51%-74%), respectively. The PPV of the above three imaging modalities were: 95% (95% CI: 92%-98%), 82% (95% CI: 73%-89%) and 90% (95% CI: 96%-99%), respectively. CONCLUSION: Our present meta-analysis showed that using (99m)Tc-MIBI, combining anatomical information of CT and functional abnormalities on SPET, as presented on SPET/CT was by far more sensitive and accurate than SPET or planar scintigraphy in localizing PHPT lesions. We firmly believe that this technique will be the main diagnostic means, to detect PHPT lesions and support minimally invasive parathyroidectomy.