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The Journal of Nuclear Medicine Vol. 36 No. 3 467-469
© 1995 by Society of Nuclear Medicine
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Scintigraphic Pitfalls in Giant Parathyroid Glands

Anton Staudenherz, Dikran Telfeyan, Erich Steiner, Bruno Niederle, Thomas Leitha and Kurt Kletter

Clinics of Nuclear Medicine, General Surgery and Radiology, University of Vienna, Vienna, Austria

Correspondence: For correspondence or reprints contact: K. Kletter, MD, PhD, University of Vienna, Univ. Clinic of Nuclear Medicien, Währinger-Gürtel 18-20, A-1090 Wien, Austria.

ABSTRACT

We report a case of hyperparathyroidism with surgically confirmed bilaterally enlarged parathyroid glands mimicking a normal thyroid gland. Technetium-99m-pertechnetate-201TI chloride subtraction scintigraphy was inconclusive because of suppressed thyroidal [99mTc]pertechnetate uptake after coronary angiography. Technetium-99m-sestamibi double-phase scintigraphy showed homogeneous 99mTc-sestamibi uptake that mimicked a normal thyroid gland and no differential washout, thus leading to an erroneous visual interpretation of a normal scan. Semiquantitative assessment of tracer washout, however, can differentiate between normal thyroid tissue and symmetrical parathyroid uptake mimicking normal thyroid tissue. We conclude that semiquantitative assessment of tracer washout increases the diagnostic sensitivity of 99mTc-sestamibi double-phase scintigraphy if: (a) the interpreter is unaware of the anatomical situation, (b) the scintigraphic delineation of the thyroid is hampered by a blocked tracer uptake or (c) the visual interpretation reveals no differential washout in the neck region.

Key Words: parathyroid glands • technetium-thallium subtraction scintigraphy • technetium-99m-pertechnetate • technetium-99m-sestamibi • hyperparathyroidism






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Copyright © 1995 by the Society of Nuclear Medicine.