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Limits to Parathyroid Imaging with Thallium-201 Confirmed by Tissue Uptake and Phantom Studies

Departments of Nuclear Medicine, Chemical Pathology and Surgery, Royal Liverpool Hospital, Liverpool, England

Correspondence: For reprints contact: T.M.D. Gimlette, MD, FRCP, Dept. of Nuclear Medicine, Royal Liverpool Hospital, Prescot St., Liverpool, L7 8XP, England.

ABSTRACT

Correct location by ²⁰¹Tl imaging of 48 parathyroids in 35 patients was related to size; 25 out of 26 parathyroids of mass >1.0 g were correctly located, none of ten parathyroids <0.3 g was correctly located. In seven patients previously imaged, 108 µCi (4.0 MBq) of ²⁰¹Tl was injected when the thyroid was first exposed surgically. Subsequently weighed and histologically confirmed samples of parathyroid, thyroid, and skeletal muscle were counted against a standard in a well counter. Thallium-201 uptake, as %/g, did not differ between hyperplastic and adenomatous parathyroids. Mean parathyroid uptake was 0.018 %/g, thyroid 0.01 %/g, muscle 0.0026 %/g of administered dose. Lower limits for correct location lay between 0.006–0.0149% of administered dose and between 0.25–0.8 g. Studies using a ²⁰¹Tl phantom containing small aliquots of ²⁰¹Tl at higher concentrations suggested 0.0075% of the usual patient imaging dose as a lower limit for correct location.

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