Preliminary Experience With Double-phase SPECT Using Tc-99m Sestamibi in Patients With Hyperparathyroidism

• Published in: Clinical nuclear medicine 1997-04, Vol.22 (4), p.217-221
• Main Authors: NEUMANN, DONALD R, ESSELSTYN, CALDWELL B, KIM, EUNICE Y, GO, RAYMUNDO T, OBUCHOWSKI, NANCY A, RICE, THOMAS W
• Format: Article
• Language: English
• Subjects: Adenoma - diagnostic imaging; Adenoma - surgery; Biological and medical sciences; Endocrine glands. Genital system. Mammary gland; Female; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroidectomy; Preoperative Care; Radionuclide investigations; Radiopharmaceuticals; Recurrence; Reoperation; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon - methods
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/00003072-199704000-00001

BACKGROUNDThere is a continual search for a better imaging modality for parathyroid pathology. In recent years, Tc-99m sestamibi has been proposed as an alternative to Tl-201 for parathyroid scintigraphy. The purpose of this study is to assess the usefulness of a double-phase Tc-99m sestamibi SPECT technique for parathyroid imaging. METHODSSixty-one consecutive patients with hyperparathyroidism were studied. Sixteen had previously undergone unsuccessful surgery for hyperparathyroidism. SPECT imaging of the neck and chest was performed at 15 minutes and again at 2 hours after 20-25 mCi of Tc-99m sestamibi was given intravenously. A positive scan was defined as a region of increased focal uptake that persisted on the delayed images. RESULTSWhen compared with surgical findings, double-phase sestamibi SPECT correctly identified 55% (26/47) of the parathyroid adenomas in the previously unoperated group, and 91% (10/11) of the parathyroid adenomas in the reoperative group. Double-phase sestamibi SPECT was negative in 92% (109/118) of the normal parathyroid glands in the previously unoperated group, and in 88% (15/17) in the reoperative group. CONCLUSIONSThese preliminary data suggest that double-phase Tc-99m sestamibi SPECT is a promising procedure for the preoperative detection and localization of hyperfunctioning parathyroid tissue, especially in patients with recurrent or persistent postoperative hyperparathyroidism.