SPECT/CT fusion image of a parathyroid adenoma (green) and blood vessels. Image source: SNM

SNM has selected an image presented by Kunihiro Nakada, MD from Hokko Memorial Hospital in Sapporo, Japan, and colleagues, illustrating the potential of hybrid molecular imaging to provide precise data regarding anatomical localization, angiography and metabolism of enlarged parathyroid gland, as the 2010 Image of the Year from more than 1,500 studies presented last week during its annual meeting in Salt Lake City.

Michael M. Graham, PhD, MD, immediate past-president of SNM said, “This year’s image of the year provides an example of a novel imaging presentation, using a combination of SPECT with high resolution CT angiography, which pinpoints the abnormally functioning parathyroid adenoma and the arteries feeding it. With this information, physicians may be able determine the exact location and size of the abnormal gland and plan minimally invasive surgery that reduces operative time, thus improving patient care.”

In the study, Nakada and colleagues scanned 31 patients with symptoms of primary hyperparathyroidism using technetium 99m-methoxyisobutylisonitrile (MIBI), combined with SPECT and multidetector CT (MDCT).

The researchers obtained thin-slice multiplanar reconstruction images of the neck using a 64-row MDCT with contrast enhancement. When the enlarged gland was successfully identified, volume-rendered images of the thyroid and parathyroid with feeding arteries were generated. Then, 2D- and 3D fusion images were also obtained using dedicated workstations. The diagnostic value of 3D SPECT/CT fusion images was compared with those by MIBI SPECT alone and by ultrasound.

A total of 34 glands were identified by surgery. SPECT/CT fusion image, MIBI SPECT and ultrasound identified 94 percent, 79 percent and 79 percent adenomas, respectively. The fusion imaging technique identified five glands that were missed by ultrasound and MIBI SPECT.

The fusion images successfully showed feeding arteries in 29 adenomas, according Nakada and colleagues.

With the use of fusion images for navigation, preliminary results in eight patients showed that operation time is decreased by approximately 82 percent compared to studies performed without fusion images, added Nakada and colleagues.