Adding Arterial-Phase CT to SPECT/CT Improves Parathyroid Adenoma Preoperative Localisation

Adding arterial-phase contrast-enhanced computed tomography to 99mTc-sestamibi single photon emission computed tomography-computed tomography protocols improves pre-surgical localisation of parathyroid adenomas, according to a retrospective study published in EJNMMI Research. Arterial-phase CT and the combination of arterial-phase CT with 99mTc-sestamibi SPECT/CT each correctly identified 84.9 percent of parathyroid adenomas, whereas 99mTc-sestamibi SPECT/CT alone detected 75.6 percent.

The study reviewed 73 patients with primary hyperparathyroidism who underwent arterial-phase CT and 99mTc-sestamibi SPECT/CT before receiving surgery between March 2023 and May 2025. Preoperative imaging findings were correlated with intraoperative and postoperative biochemical markers to evaluate diagnostic accuracy across the modalities.

Arterial-phase contrast-enhanced CT detected eight adenomas that had been missed by 99mTc-sestamibi SPECT/CT. In contrast, 99mTc-sestamibi SPECT/CT did not detect any adenomas that were missed by arterial-phase CT, and all adenomas correctly identified with 99mTc-sestamibi SPECT/CT were also identified on the arterial-phase scans.

Preoperative localisation of parathyroid adenomas is essential for effective surgical planning in primary hyperparathyroidism to reduce operating time and complications. Conventional 99mTc-sestamibi SPECT/CT is performed with unenhanced CT, while up to 90 percent of adenomas are detected on the arterial phase of 4D-CT. In a secondary evaluation of 20 diagnostically challenging cases requiring 18F-choline PET/CT, the imaging achieved 80.6 percent sensitivity by localising 25 of 31 adenomas, alongside identifying five false-positive glands.

Subject of Research: Preoperative localisation of parathyroid adenomas using arterial-phase CT and SPECT/CT

Article Title: Addition of arterial-phase contrast-enhanced CT to 99mTc-sestamibi SPECT/CT improves pre-operative localisation of parathyroid adenomas

Article References: Keys, K., Bhatt, Y., Parthipun, A., Leung, C., Choy, P. M., & Wagner, T. (2026). Addition of arterial-phase contrast-enhanced CT to 99mTc-sestamibi SPECT/CT improves pre-operative localisation of parathyroid adenomas. EJNMMI Research. https://doi.org/10.1186/s13550-026-01540-7

Image Credits: AI Generated

DOI: 10.1186/s13550-026-01540-7

Keywords: parathyroid adenomas, primary hyperparathyroidism, SPECT/CT, arterial-phase CT, preoperative localisation, 18F-choline PET/CT, computed tomography, endocrine surgery, Addition, arterial-phase, contrast-enhanced, mTc-sestamibi