title: Sestamibi versus thallium subtraction scintigraphy in parathyroid localization: a prospective comparative study in patients with predominantly mild primary hyperparathyroidism.
abstract: BACKGROUND
  Technetium 99m sestamibi was recently introduced for the preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism with promising results. However, the sensitivity of sestamibi and thallium to detect abnormal parathyroid glands is partly dependent on the gland size. In this study we compared the sensitivity of sestamibi subtraction scintigraphy with thallium subtraction scintigraphy in patients with predominantly mild increase in serum calcium level.
  
  
  METHODS
  Thirty-nine patients with primary hyperparathyroidism were included. The mean (+/-SD) serum level of calcium was 2.75 +/- 0.17 mmol/L. In 28 (72%) of the patients the serum level of calcium was less than 2.85 mmol/L. These patients were classified as having mild abnormalities in serum calcium. All patients were investigated before operation with both sestamibi and thallium subtraction scintigraphy.
  
  
  RESULTS
  In two patients autonomous thyroid adenomas precluded subtraction scintigraphy. Sestamibi subtraction scintigraphy correctly localized 31 (86%) of 36 parathyroid adenomas compared with only 17 (47%) of 36 by thallium subtraction scintigraphy (p < 0.001). There was one false-positive result in the sestamibi group because of a thyroid adenoma, and two of the scans were negative. Both the sestamibi and the thallium subtraction scintigraphy localized one single enlarged gland in all three patients with multiple gland involvement. In no case was multiglandular disease predicted.
  
  
  CONCLUSIONS
  Sestamibi subtraction scintigraphy is superior to thallium subtraction scintigraphy and has a high sensitivity to localize a solitary parathyroid adenoma in patients with mild increase in serum calcium level. The sensitivity decreases in patients with multiglandular parathyroid disease and concomitant thyroid nodular abnormalities.
authors.affiliation: Department of Surgery, Lund University Hospital, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Bergenfelz
authors.forename: J
authors.initials: J
authors.lastname: Tennvall
authors.forename: S
authors.initials: S
authors.lastname: Valdermarsson
authors.forename: P
authors.initials: P
authors.lastname: Lindblom
authors.forename: S
authors.initials: S
authors.lastname: Tibblin
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging*; D008297:Male; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013382:Subtraction Technique; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes
chemical_list: D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi