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PubMed1998

Parathyroid imaging using simultaneous double-window recording of technetium-99m-sestamibi and iodine-123.

UNLABELLED: Technetium-99m-sestamibi represents an important advance in the scintigraphic location of parathyroid neoplasms. However, the optimal procedure for 99mTc-sestamibi parathyroid scanning has not been defined. The first objective of this work was to optimize the technical aspects of subtraction scanning, using simultaneous double-window recording of 99mTc-sestamibi and 1231 instead of successive image recording. The second objective was to compare two protocols for detecting abnormal parathyroid glands: subtraction scanning and single-tracer double-phase scanning. METHODS: Thirty patients referred for first surgery of primary hyperparathyroidism had both subtraction scanning and double-phase scanning in the same imaging session. Images of 99mTc-sestamibi and 123I were recorded simultaneously in nonoverlapping windows and then subtracted. For double-phase scanning, images of 99mTc-sestamibi, acquired 15 min and 120 min after tracer injection, were visually compared. Surgery disclosed a solitary adenoma in 27 patients, bilateral adenomata in 2 patients and 3 hyperplastic glands in the last patient. No patient had persistent hypercalcemia. RESULTS: Preoperative 99mTc-sestamibi/123I subtraction scanning located 25 of 27 solitary adenomas, the bilateral adenomata and 3 of 3 hyperplastic glands. The overall sensitivity for enlarged parathyroids was 94%, and the false-positive image rate was 3%. The 99mTc-sestamibi single-tracer technique located 22 of 27 solitary adenomas, the bilateral adenomata and 1 of 3 hyperplastic glands. Overall sensitivity was 79% and the false-positive image rate was 10%. The gamma camera imaging time was 30 min for the subtraction technique and 50 min for the single-tracer double-phase study. An ectopic adenoma in the sheath of the right carotid artery was detected by both techniques. CONCLUSION: These results, together with other data in the literature, indicate that 99mTc-sestamibi/123I subtraction imaging is accurate in locating enlarged parathyroids. Classical difficulties of this technique (motion artifacts and prolonged immobilization) were avoided by using simultaneous recording of the two isotopes. In this series subtraction imaging was more rapid and more sensitive (p < 0.04) than the single-tracer technique.

Adenoma↗
PubMed1994

Preoperative localization of parathyroid tissue with technetium-99m sestamibi 123I subtraction scanning.

To evaluate the utility of technetium-99m (Tc-99m) sestamibi for visualization of functioning parathyroid tissue, 14 subjects underwent Tc-99m sestamibi 123I subtraction scanning as part of the preoperative evaluation for hyperparathyroidism. Informative scans were obtained in 13 subjects, including 7 patients with recurrent or persistent hyperparathyroidism, and correctly identified the location of the hyperfunctioning parathyroid tissue found at surgery. In all informative patients, hyperparathyroidism was due to adenomatous disease or hyperplasia secondary to renal failure. Successful scans were obtained with glands as small as 220 mg. In the lone patient in whom Tc-99m sestamibi scanning failed to localize hyperfunctioning parathyroid tissue, surgery revealed a 1700-mg hyperplastic parathyroid neoplasm in the neck. In no case did a Tc-99m sestamibi scan suggest parathyroid tissue where there was none. In 1 case, a patient presented with persistent hyperparathyroidism after 1 neck and a second combined neck and mediastinal exploration. Tc-99m sestamibi imaging revealed uptake in the periaortic region, and a 570-mg adenoma was found in the aortopulmonary window. Using only initial studies, prospective evaluation provided a sensitivity of 78.5% and a positive predictive value of 100%. After repeat studies in 5 patients, 2 of 3 patients with initially negative results and technically deficient scans became positive on restudy. Inclusion of these studies increased sensitivity to 93%. Tc-99m sestamibi 123I subtraction scanning appears to be a reliable noninvasive method for preoperative localization of hyperfunctioning parathyroid tissue.

Adult↗