Preliminary experience with double-phase SPECT using Tc-99m sestamibi in patients with hyperparathyroidism.
BACKGROUND
There 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 T1-201 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.


METHODS
Sixty-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.


RESULTS
When 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.


CONCLUSIONS
These 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.
Neumann
D R
DR
Department of Nuclear Medicine, Cleveland Clinic Foundation, Ohio 44195-5074, USA.
Esselstyn
C B
CB
Kim
E Y
EY
Go
R T
RT
Obuchowski
N A
NA
Rice
T W
TW
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D012008:Recurrence; D012086:Reoperation; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi