The usefulness of Tc-99m tetrofosmin scintigraphy in the diagnosis and localization of hyperfunctioning parathyroid glands.
OBJECTIVE
The aim of the work was to study the diagnostic value of Tc-99m tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroid disease.


METHODS
We studied 31 patients, 19 with primary and 12 with secondary hyperparathyroid disease. Five of these patients were renal graft recipients. All patients underwent surgery. Each patient was injected with 555 to 740 MBq (15 to 20 mCi) Tc-99m tetrofosmin. Subsequently, radionuclide images were acquired 15 and 120 minutes after injection using a low-energy, all-purpose, parallel-hole collimator. Pertechnetate thyroid scintigraphy was obtained in nine cases (24 to 48 h later) when the thyroid activity made it difficult to identify the parathyroid glands.


RESULTS
All cases showed tracer uptake as early as 15 minutes after injection. In the group of patients with primary hyperparathyroid disease, 15 showed focal uptake in a parathyroid gland, and surgery revealed an adenoma in the same location. In one patient with hyperplasia, scintigraphy identified only two of four diseased glands. In the three remaining cases, scintigraphy showed focal uptake in the lower parathyroid gland, whereas at surgery the abnormal gland was located in the upper pole. In the secondary hyperparathyroidism group, seven patients showed diffuse tracer uptake in two or more glands, and histologic analysis confirmed hyperplasia in all of them. Five cases showed focal uptake, with three evaluated after surgery (uptake in the only remaining gland); one of them was a renal graft recipient, and the remaining patient had chronic renal failure and was receiving hemodialysis.


CONCLUSIONS
Our results suggest that Tc-99m tetrofosmin may be a suitable tracer for preoperative detection and screening of anomalous parathyroid glands. The earlier images at 15 minutes were better than those at 120 minutes. Tc-99m tetrofosmin is cleared more slowly from the normal thyroid than is Tc-99m sestamibi, and both of these tracers may give better results than the old pertechnetate TI-201 subtraction technique.
Vallejos
V
V
Department of Nuclear Medicine, CSUB Hospital Príncipes de España, Barcelona, Spain.
Martin-Comin
J
J
Gonzalez
M T
MT
Rafecas
R
R
Muñoz
A
A
Fernãndez
A
A
Mora
J
J
Ramos
M
M
D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging*; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging; D006965:Hyperplasia; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D006435:Renal Dialysis; D013670:Sodium Pertechnetate Tc 99m; D013382:Subtraction Technique; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D013997:Time Factors
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi; D013670:Sodium Pertechnetate Tc 99m