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Identifying Abnormal Parathyroid Glands in the Thyroid Uptake Area Using Technetium-99m-Sestamibi and Factor Analysis of Dynamic Structures

Service de Médecine Nucléaire et Service de Chirurgie, Hôpital Saint-Louis
Service de Médecine Nucléaire, Hôpital de la Pitié—Unité INSERM 66, Paris
Service de Médicine Nucléaire, Hôpital Avicenne, Bobigny, France

Correspondence: For correspondence and reprints contact: Dr. Claire Billotey, Service de Médecine Nucléaire, Hôpital Saint-Louis, 1 Av Claude Vellefaux, 75010 Paris, France.

ABSTRACT

A rapid (25 min) single tracer scintigraphic method to localize parathyroid gland abnormalities was evaluated in 24 patients with hyperparathyroidism. Methods: Scintigraphy was performed with ^99mTc-sestamibi prior to surgery. A 25-min dynamic series centered on the neck was acquired immediately after injection of ^99mTc-MIBI. Two planar static views were obtained after 1 and 2 hr. To identify abnormal parathyroid tissue in the thyroid uptake area, a factor analysis of dynamic structure (FADS) was applied to the dynamic acquisition. The results were compared to the analysis of the two planar static views. Results: FADS demonstrated abnormal uptake of the tracer in the thyroid area for 26 of the 31 parathyroid glands found to be abnormal at surgery (5/6 adenomas, 21/25 hyperplastic glands). In three cases, FADS demonstrated parathyroid uptake despite the absence of parathyroid tissue at surgery. FADS revealed as specific and more sensitive than the visual analysis of the two static views, since only 13/30 glands were still visible after 1 hr, and 5/26 after 2 hr. Furthermore, a study with two static views was found to be less sensitive for the detection of hyperplastic glands. Conclusion: FADS ^99mTc-MIBI is performed in less time than existing scintigraphic protocols. It is a promising method to detect abnormal parathyroid glands in the cervical area with a single tracer.

Key Words: parathyroid scintigraphy technetium-99m-sestamibi • factor analysis of dynamic series