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Comparison of Parathyroid Imaging with Technetium-99m-Pertechnetate/Sestamibi Subtraction, Double-Phase Technetium-99m-Sestamibi and Technetium-99m-Sestamibi SPECT

Departments of Radiology and Surgery, University of Maryland Medical System, Baltimore, Maryland

Correspondence: For correspondence or reprints contact: Charles C. Chen, MD, Department of Radiology, Saint Francis Medical Center, 530 NE Glen Oak Ave., Peoria, IL 61637.

ABSTRACT

The ability of ^99mTc-pertechnetate/sestamibi subtraction, double-phase ^99mTc-sestamibi and ^99mTc-sestamibi SPECT imaging to localize abnormal parathyroid tissue was compared. Methods: Fifty-five consecutive patients had parathyroid imaging before surgery for hyperparathyroidism. Imaging consisted of ^99mTc-pertechnetate pinhole images of the neck followed by ^99mTc-sestamibi pinhole images of the neck and parallel-hole images of the neck and chest (early images). Within 2.5–4.0 hr later pinhole images of the neck, parallel-hole and SPECT images of the neck and chest were obtained (late images). Nodular foci of increased sestamibi activity were considered abnormal. Results: The sensitivity for abnormal parathyroid glands by visual comparison of early images and pertechnetate images was 72%–75%, late images and pertechnetate images was 73%–78% and double-phase (early and late) sestamibi images was 62%–65%; computer subtraction of pertechnetate from early images was 71%–74%; and SPECT imaging was 79%. The sensitivity for parathyroid adenomas was 89%–98%, while the sensitivity for hyperplastic parathyroid glands was only 47%–58%. Conclusion: Late imaging, computer subtraction and SPECT may not be necessary since they provided only marginal improvements on visual comparison of early sestamibi with pertechnetate images. Double-phase sestamibi imaging was less sensitive, so baseline thyroid imaging with pertechnetate is recommended.

Key Words: parathyroid • hyperparathyroidism • technetium-99m-sestamibi • technetium-99m-MIBI

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