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Technetium-99m-Sestamibi Imaging before Reoperation for Primary Hyperparathyroidism

Department of Nuclear Medicine, Warren G. Magnuson Clinical Center
Metabolic Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases
Surgery Branch, National Cancer Institute
National Institutes of Health, Bethesda, Maryland

Correspondence: For correspondence or reprints contact: Clara C. Chen, MD, Department of Nuclear Medicine, Clinical Center, NIH, Bldg. 10, Rm 1c/401, 9000 Rockville Pike, Bethesda, MD 20892-1180.

ABSTRACT

Recent studies have reported high sensitivities for parathyroid localization with ^99mTc-sestamibi and have been performed using either ¹²³I/^99mTc-sestamibi or a double-phase sestamibi scanning technique. These studies have focused primarily on patients undergoing initial surgery. We studied 35 patients prior to reoperative surgery to investigate the relative sensitivities of these two techniques in this patient population. Methods: Double-phase sestamibi scanning (early and delayed imaging) was performed in all patients. Evaluable ¹²³/^99mTc-sestamibi subtraction studies were also obtained in 25 patients. Results were correlated with surgical findings in 32 patients and with clinical outcome in 3 patients in whom mediastinal lesions were radiographically ablated. Results: Overall, double-phase sestamibi imaging detected 23 of 39 abnormal parathyroid glands (59%), whereas ¹²³/^99mTc-sestamibi detected 19 of 27 (70%). Oblique imaging, delayed imaging and ¹²³I subtraction all contributed to sensitivity, and ¹²³I subtraction also proved useful in patients with partial thyroid suppression. Two patients had lesions visible on the early sestamibi images that were not seen at all on the delayed scans. There were four false-positive findings. Conclusion: No significant differences between double-phase sestamibi and ¹²³/^99mTc-sestamibi subtraction scanning were found, although the latter tended to be more sensitive.

Key Words: iodine-123/technetium-99m-sestamibi • subtraction • hyperparathyroidism

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