Preoperative imaging of abnormal parathyroid glands in patients with hyperparathyroid disease using combination Tc-99m-pertechnetate and Tc-99m-sestamibi radionuclide scans

• Published in: Annals of surgery 1994-05, Vol.219 (5), p.568-573
• Main Authors: Wei, J P, Burke, G J, Mansberger, Jr, A R
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adenoma - diagnostic imaging; Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - etiology; Hyperparathyroidism - surgery; Hyperplasia; Male; Middle Aged; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - pathology; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnostic imaging; Prospective Studies; Radionuclide Imaging; Renal Insufficiency - complications; Sodium Pertechnetate Tc 99m - administration & dosage; Technetium Tc 99m Sestamibi - administration & dosage
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199405000-00014

To evaluate the efficacy of combined Tc-99m-pertechnetate and Tc-99m-sestamibi radionuclide scanning for imaging abnormal parathyroid glands in hyperparathyroid disease in a prospective study. Established methods to localize abnormal parathyroid glands lack accuracy for routine use. Tc-99m-sestamibi used in conjunction with iodine-123 has excellent potential for preoperative imaging in patients with hyperparathyroid disease. An alternative method for parathyroid imaging was studied using Tc-99m-pertechnetate and Tc-99m-sestamibi. Thirty patients with hyperparathyroid disease had Tc-99m-pertechnetate and Tc-99m-sestamibi subtraction radionuclide scanning to visualize abnormal parathyroid glands before surgery. The patients had surgery and pathologic confirmation of all parathyroid glands. In 23 patients with primary hyperparathyroidism, 12 of 13 solitary adenomas were visualized. Six of nine patients with diffuse hyperplasia had bilateral uptake consistent with diffuse hyperplasia. Three of nine patients had negative scans. One patient previously operated on for diffuse hyperplasia had only one gland scanned. Seven patients with renal failure-associated hyperparathyroid disease were scanned: five had bilateral uptake of Tc-99m-sestamibi consistent with hyperplasia, and two who had been previously operated on had localization of remaining abnormal parathyroid glands. Tc-99m-pertechnetate combined with Tc-99m-sestamibi subtraction radionuclide scanning is less cumbersome to implement than iodine-123 combined with Tc-99m-sestamibi scanning. It has a high sensitivity for imaging solitary parathyroid adenomas or persistent solitary hyperplastic glands. However it does not have the resolution necessary to delineate all parathyroid glands in diffuse hyperplasia.