Improving the yield of preoperative parathyroid localization: technetium Tc 99m-sestamibi imaging after thyroid suppression.
BACKGROUND
Preoperative localization is essential for successful directed, minimally invasive or reoperative parathyroidectomy. Standard technetium Tc 99m-sestamibi imaging is the most sensitive modality for localization. We reviewed our experience with (99m)Tc-sestamibi imaging and specifically investigated the effect of thyroid suppression on repeat imaging of patients who had initially nonlocalizing scans.


METHODS
. The records of patients who underwent (99m)Tc-sestamibi imaging during evaluation for primary hyperparathyroidism were reviewed. A subset of patients with initially nonlocalizing scans underwent thyroid suppression with either thyroxin or liothyronine and then had their scans repeated.


RESULTS
Ninety-nine patients with primary hyperparathyroidism underwent (99m)Tc-sestamibi imaging followed by parathyroidectomy (initial operation, 78; reoperation, 21). Successful parathyroid localization was obtained on standard imaging in 67 patients. Fourteen of 32 patients who had nonlocalizing (99m)Tc-sestamibi imaging studies underwent an additional scan after thyroid suppression. In 10 of 14 patients (71%), repeat (99m)Tc-sestamibi imaging after thyroid suppression successfully localized abnormal parathyroid tissue.


CONCLUSIONS
Thyroid suppression may improve the yield of (99m)Tc-sestamibi imaging in patients with hyperparathyroidism who have an initially nonlocalizing study. This diagnostic strategy may be helpful in patients motivated to undergo a directed, minimally invasive operation, as well as in the evaluation of patients for reoperative parathyroidectomy.
Royal
Richard E
RE
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Delpassand
Ebrahim S
ES
Shapiro
Suzanne E
SE
Fritsche
Herbert A
HA
Vassilopoulou-Sellin
Rena
R
Sherman
Steven I
SI
Gagel
Robert F
RF
Evans
Douglas B
DB
Lee
Jeffrey E
JE
D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D009532:Nickel; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013974:Thyroxine / Q000008:administration & dosage; D014025:Titanium; D015899:Tomography, Emission-Computed, Single-Photon; D014284:Triiodothyronine / Q000008:administration & dosage
D019275:Radiopharmaceuticals; D014284:Triiodothyronine; C040654:titanium nickelide; D009532:Nickel; D017256:Technetium Tc 99m Sestamibi; D014025:Titanium; D013974:Thyroxine