The diagnostic utility of dual phase Tc-99m sestamibi parathyroid imaging.
OBJECTIVE
Primary hyperparathyroidism is a disease of uncertain etiology that results from hypersecretion of parathyroid hormone (PTH) by the parathyroid gland. In most institutions, the preferred imaging protocol utilizes a dual-phase technique with Tc-99m sestamibi which is reported to be more sensitive than earlier protocols involving TI-201 with Tc-99m pertechnetate subtraction. The purpose of this study is to evaluate the accuracy and clinical utility of Tc-99m sestamibi dual-phase scintigraphy for localizing hyperfunctioning parathyroid tissue.


METHODS
We retrospectively reviewed thirty-nine consecutive hyperparathyroid patients who received a dual-phase Tc-99m sestamibi parathyroid scan. Thirty-seven of the subjects subsequently underwent a bilateral neck exploration and parathyroidectomy. Each scan interpretation was then correlated with the histopathologic diagnosis and the patients' post-surgical clinical course.


RESULTS
The sestamibi dual-phase imaging protocol correctly localized 21 of 25 parathyroid adenomas and identified 8 out of 10 cases of hyperplasia. Our overall sensitivity and specificity were 83% and 75%, respectively. In addition, four of the adenomas were successfully localized intraoperatively using a gamma probe.


CONCLUSIONS
Parathyroid imaging with sestamibi appears to be superior to TI-201/Tc-99m pertechnetate subtraction based on the reported results of both techniques at various institutions. Dual-phase sestamibi imaging appears to be useful and cost-effective for presurgical localization of hyperfunctioning parathyroid tissue. In addition, sestamibi imaging in conjunction with an intraoperative probe is a very promising technique that has the potential to provide both localization information of a suspected parathyroid adenoma and to facilitate its surgical removal by reducing operation time.
Klieger
P
P
Division of Nuclear Medicine, University of Rochester Medical Center, New York 14642, USA.
O'Mara
R
R
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi; D013670:Sodium Pertechnetate Tc 99m