title: Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism.
abstract: BACKGROUND
  Until now, preoperative parathyroid imaging has been considered unnecessary because currently available techniques do not provide any better results than an expert surgeon. We conducted a multicenter prospective study evaluating the capability of technetium 99m sestamibi scintigraphy in the preoperative identification of pathologic glands.
  
  
  METHODS
  Ninety-three patients with hyperparathyroidism, seven of them reoperative cases, were studied. In addition, 20 age-matched normocalcemic control subjects were also studied.
  
  
  RESULTS
  Surgical confirmation of scintigraphic images was obtained in 91 of 93 cases (sensitivity, 97.8%). In all reoperative cases (n = 7), in all cases of ectopic glands (whether operated or not; n = 6), and in all patients with a single-gland disease (n = 70), topographic identification of the pathologic gland was correct in 100%. In multiple-gland disease (n = 23), involvement of more than one gland was visualized in only 61% of the patients; however, in 91% of patients, at least one gland was localized. Surgical success-defined as postoperative normocalcemia-with this approach was 100%. All scans of normocalcemic control subjects were negative. Of 31 patients in whom a multinodular goiter coexisted, seven presented a significant radionuclide background at 120 minutes' scan. False-positive images were found together with those corresponding to the pathologic glands in only three cases.
  
  
  CONCLUSIONS
  99mTc-sestamibi is a highly reliable, sensitive, and specific technique for imaging of pathologic glands in hyperparathyroidism, especially in single-gland disease. It may be considered as a first line single-procedure when a preoperative topographic diagnosis is required.
authors.affiliation: Hospital de Sant Pau, Autonomous University of Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Caixàs
authors.forename: L
authors.initials: L
authors.lastname: Bernà
authors.forename: A
authors.initials: A
authors.lastname: Hernández
authors.forename: F J
authors.initials: FJ
authors.lastname: Tébar
authors.forename: P
authors.initials: P
authors.lastname: Madariaga
authors.forename: O
authors.initials: O
authors.lastname: Vegazo
authors.forename: A L
authors.initials: AL
authors.lastname: Bittini
authors.forename: B
authors.initials: B
authors.lastname: Moreno
authors.forename: E
authors.initials: E
authors.lastname: Faure
authors.forename: D
authors.initials: D
authors.lastname: Abós
authors.forename: J
authors.initials: J
authors.lastname: Piera
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: J
authors.initials: J
authors.lastname: Farrerons
authors.forename: M
authors.initials: M
authors.lastname: Puig-Domingo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi