Head-to-Head Comparison of Tc-99m-sestamibi SPECT/CT and C-11-L-Methionin PET/CT in Parathyroid Scanning Before Operation for Primary Hyperparathyroidism

Sys Vestergaard, Oke Gerke, Mette Bay, Anders Rørbæk Madsen, Lis Stilgren, Charlotte Ejersted, Kate Isabella Rewers, Nick Jakobsen, Jon Thor Asmussen, Poul-Erik Braad, Henrik Petersen, Anders Thomassen, Søren Schifter

Research output: Contribution to journalJournal articleResearchpeer-review


PURPOSE: The preferred nuclear medicine method for identification of hyperfunctioning parathyroid glands in hyperparathyroidism (HPT) develops continuously in relation to the technological progress. Diagnostic methods based on PET/CT have during recent years evolved with new tracer possibilities competing with traditional scintigraphic methods. This investigation is a head-to-head comparison of Tc-99m-sestamibi SPECT/CT gamma camera scintigraphy (sestamibi SPECT/CT) and C-11-L-methionin PET/CT imaging (methionine PET/CT) for preoperative identification of hyperfunctioning parathyroid glands.

PROCEDURES: The study is a prospective cohort study including 27 patients diagnosed with primary hyperparathyroidism (PHPT). Two nuclear medicine physicians assessed all examinations independently and blinded. All scanning assessments were matched to the final surgical diagnosis as confirmed by histopathology. Biochemical monitoring of the therapeutical effects was performed preoperatively by PTH-measurements and followed postoperatively for up to 12 months. Comparisons were made for differences in sensitivity and positive predictive value (PPV).

RESULTS: Twenty-seven patients (18 females, 9 males; mean age (range): 58.9 years (34.1-79)) were enrolled into the study. The 27 patients had a total of 33 identified sites of lesions of which 28 (85%) turned out to be histopathological verified hyperfunctioning parathyroid glands. The sensitivity and PPV for sestamibi SPECT/CT were 0.71 and 0.95; that of methionine PET/CT was 0.82 and 1, respectively. Both sensitivity and PPV were slightly lower for sestamibi SPECT/CT than for methionine PET PET/CT (-0.11, 95% confidence interval (95% CI): -0.29 to 0.08; -0.05, 95% CI: -0.14 to 0.04, respectively), but not to a statistically significant extent (p=0.38 and p=0.31). The sensitivity and PPV for diagnostic CT were 0.64 (95% CI: 0.44 to 0.81) and 1 (95% CI: 0.81 to 1).

CONCLUSIONS: Methionine PET/CT performed comparable to sestamibi SPECT/CT with respect to identification and localization of hyperfunctioning parathyroid glands prior to surgery.

Original languageEnglish
JournalMolecular Imaging and Biology
Issue number4
Pages (from-to)720-726
Publication statusPublished - Aug 2023


  • C-11-L-methionine PET/CT
  • Hyperfunctioning parathyroid glands
  • Hyperparathyroidism
  • Primary hyperparathyroidism
  • Sestamibi SPECT/CT
  • Hyperparathyroidism, Primary/diagnostic imaging
  • Organotechnetium Compounds
  • Prospective Studies
  • Humans
  • Methionine
  • Tomography, Emission-Computed, Single-Photon
  • Male
  • Tomography, X-Ray Computed
  • Positron Emission Tomography Computed Tomography
  • Radionuclide Imaging
  • Female
  • Nitriles
  • Racemethionine
  • Technetium Tc 99m Sestamibi
  • Radiopharmaceuticals
  • Carbon Radioisotopes


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