title: Early parathyroid MIBI SPECT imaging in the diagnosis of persistent hyperparathyroidism.
abstract: We present a case that demonstrates the utility of early SPECT images associated with fusion images with MRI for presurgical localization in a case of persistent hyperparathyroidism after a first surgery. Three years after that surgery, severe hypercalcemia (14.7 mg/dL) and elevated parathormone (PTH) (944 pg/mL) were detected. MRI and SPECT parathyroid scintigraphy showed an abnormal parathyroid lesion localized behind the inferior pole of the thyroid right lobe. At surgical reexploration a right inferior parathyroid adenoma was removed (258 mg). However, intraoperative PTH remained high and a total thyroidectomy was performed looking for an intrathyroid lesion. After that, the elevated PTH persisted and an ectopic parathyroid gland was identified in the tracheoesophageal groove (958 mg), corresponding with the lesion seen on the fusion image of MRI and SPECT. After removal of this lesion, the PTH dropped to 85%.
authors.affiliation: Department of Endocrinology, Nuclear Medicine Section, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta, Santiago de Chile.
authors.forename: V Gilberto
authors.initials: VG
authors.lastname: González
authors.forename: B Pilar
authors.initials: BP
authors.lastname: Orellana
authors.forename: M José
authors.initials: MJ
authors.lastname: Manuel López
authors.forename: M Marcela
authors.initials: MM
authors.lastname: Jiménez
authors.forename: Y Juan Carlos
authors.initials: YJ
authors.lastname: Quintana
mesh_terms: D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D010281:Parathyroid Hormone / Q000096:biosynthesis; D010282:Parathyroid Neoplasms / Q000150:complications / Q000601:surgery; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi