Tc-99m-MIBI scintigraphy for recurrent hyperparathyroidism after total parathyroidectomy with autograft.
The aim of this study is to assess the sensitivity of Tc-99m-MIBI for the pre-operative localization of hyperfunctioning parathyroid glands in patients with persistent or recurrent hyperparathyroidism (HPT) after total parathyroidectomy (PTX) with autograft.


METHODS
Tc-99m-MIBI scintigraphy was performed on 7 patients (3 men and 4 women; aged 32 to 62) on hemodialysis with persistent or recurrent HPT after PTX due to secondary hyperparathyroidism. Tc-99m-MIBI of 370 MBq was injected intravenously. Double-phase planar images were acquired at 15 min and 120 min-postinjection. SPECT images of the chest in an early phase were also obtained.


RESULTS
All patients underwent surgery after scintigraphy. The enlarged parathyroid grafts were removed in 4 patients. An unusual location of parathyroid hyperplasia was found in 2 patients. In one patient, the abnormal graft coexisted with an ectopic parathyroid in the mediastinal region. Tc-99m-MIBI was able to identify all hyperfunctioning parathyroids correctly (100% sensitivity). In one case, a focus of the increased uptake in SPECT was considered as a false positive. The remnant of ectopic parathyroid in the mediastinum was only detected by SPECT images.


CONCLUSIONS
Tc-99m-MIBI parathyroid scintigraphy is useful for the pre-operative localization of persistent or recurrent HPT following total PTX with autograft.
Itoh
Kazuo
K
Department of Radiology, JR Sapporo General Hospital, Japan. itohka51@ra2.so-net.ne.jp
Ishizuka
Reiki
R
D000328:Adult; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000637:transplantation; D016105:Parathyroidectomy; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014182:Transplantation, Autologous
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi