Parathyroid glands: combination of (99m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules.
OBJECTIVE
To determine the appropriate choice of imaging techniques for localization of nodular lesions of parathyroid glands.


METHODS
First, computed tomographic (CT), magnetic resonance (MR), ultrasonographic (US), and technetium 99m methoxyisobutyl-isonitrile (MIBI) scintigraphic images in 49 patients with primary hyperparathyroidism were retrospectively evaluated. A single-blind, prospective study that included 16 patients with primary hyperparathyroidism was then conducted. MR, US, scintigraphic, and color Doppler US images of the neck were obtained and analyzed.


RESULTS
In the retrospective study, CT, MR imaging, and US had low sensitivity (13%, 17%, and 27%, respectively) and specificity (39%, 65%, and 65%, respectively). Scintigraphy had 57% sensitivity and 85% specificity. In the prospective study, the use of latest-generation MR and US equipment and the participation of experienced operators led to improved sensitivity and specificity for these techniques. The combination of US and scintigraphy resulted in improved sensitivity (96%), specificity (83%), and positive and negative predictive values (88% and 94%, respectively), relative to the results obtained with either method alone. Doppler US was of little help in the setting of small glands.


CONCLUSIONS
The combination of (99m)Tc MIBI scintigraphy and US performed by well-trained operators with up-to-date instruments appeared to be the best diagnostic tool for the preoperative diagnosis of parathyroid disease.
De Feo
M L
ML
Endocrine Unit of the Department of Clinical Physiopathology, University of Florence, Italy.
Colagrande
S
S
Biagini
C
C
Tonarelli
A
A
Bisi
G
G
Vaggelli
L
L
Borrelli
D
D
Cicchi
P
P
Tonelli
F
F
Amorosi
A
A
Serio
M
M
Brandi
M L
ML
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging*; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000000981:diagnostic imaging*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi