title: Differential findings of tc-99m sestamibi dual-phase parathyroid scintigraphy between benign and malignant parathyroid lesions in patients with primary hyperparathyroidism.
abstract: OBJECTIVE
  This study aimed to investigate the differential findings in clinical and biochemical features, and Tc-99m sestamibi (MIBI) dual-phase parathyroid scintigraphy for malignant and benign parathyroid lesions in patients with primary hyperparathyroidism.
  
  
  METHODS
  Subjects were 102 parathyroid lesions from 91 patients with primary hyperparathyroidism. Scintigraphic findings included radioactivity grade, uptake pattern, uptake contour, lesion size on early and delayed images, and degree of washout. Clinical and biochemical features were also evaluated. Histopathology confirmed the final diagnosis for all the patients.
  
  
  RESULTS
  Final diagnoses were 94 benign parathyroid lesions and 8 parathyroid carcinomas. The patients with parathyroid carcinoma were significantly older (p = 0.002) and had significantly higher serum parathyroid hormone concentrations than those with benign parathyroid lesions (p < 0.001). All malignant parathyroid lesions showed intense radioactivity similar to or greater than the submandibular gland activity on delayed images (p = 0.007), and little radioactivity difference between early and delayed images (p = 0.012). The cancer incidence for parathyroid lesions with both intense radioactivity and no washout was 17.0% (8/47). When parathyroid lesions with all of the above-mentioned findings were regarded as malignant, the cancer incidence significantly increased from 17.0% to 33.3% (8/24, p < 0.001).
  
  
  CONCLUSIONS
  For Tc-99m MIBI dual-phase parathyroid scintigraphy, uptake grade on delayed images and washout were significantly useful diagnostic criteria for differentiating benign from malignant parathyroid lesions, along with age and parathyroid hormone serum concentration.
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Miju
authors.initials: M
authors.lastname: Cheon
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 Korea.
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Sook Kyung
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Jang
authors.initials: J
authors.lastname: Yoo
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Soo Bin
authors.initials: SB
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Kyung-Han
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
authors.forename: Byung-Tae
authors.initials: BT
authors.lastname: Kim
keywords: Parathyroid adenoma; Parathyroid carcinoma; Parathyroid hyperplasia; Parathyroid scintigraphy; Primary hyperparathyroidism; Tc-99m Sestamibi