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Comparison of Technetium-99m-MIBI, Technetium-99m-Tetrofosmin, Ultrasound and MRI for Localization of Abnormal Parathyroid Glands

Divisions of Nuclear Medicine and Nephrology, Departments of Radiology, Endocrinology and Metabolism, and the Third Department of Internal Medicine, Kurume University School of Medicine, Kurume City, Japan

Correspondence: For correspondence or reprints contact: Masatoshi Ishibashi, MD, Division of Nuclear Medicine, Department of Radiology, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830, Japan.

ABSTRACT

Abnormal parathyroid tissue can be identified by radionuclide imaging with either ^99mTc-MIBI or ^99mTc-tetrofosmin.This study com pared the relative sensitivity of these two agents to localize parathy roid hyperplasia and adenoma. Methods: Twenty patients with primary (n = 9) or secondary (n = 11) hyperparathyroidism were studied with ^99mTc-MIBI and ^99mTc-tetrofosmin parathyroid imaging, ultrasonography and MRI. Radionuclide images of the neck were acquired 10 min and 2-3 hr after radiopharmaceutical injection. The images were visually evaluated for abnormal focal areas of increased tracer localization in the neck and mediastinum. A parathyroid gland/normal thyroid tissue activity ratio (referred to as the P/T uptake ratio) was calculated for each positive scan. Results: Of the 46 parathyroid glands surgically explored, the overall sensitivity and specificity of MIBI imaging were 83% and 83% (38/46); tetrofosmin imaging 87% and 83% (40/46); ultrasonography 78% and 40% (36/46); and MRI 80%and 60%(37/46), respectively. Both radiopharmaceuticals performed well in the nine patients found to have adenoma. The sensitivity and specificity of MIBI imaging were 100% and 100% (9/9); tetrofosmin imaging 100% and 100% (9/9); ultrasonography 78% and 67% (7/9); and MRI 100% and 100% (9/9), respectively. In the 37 glands with hyperplasia, MIBI imaging had a sensitivity of 78% and specificity of 75%; tetrofosmin imaging 84% and 75%; ultrasonography 78% and 43%; and MRI 73% and 60%, respectively. Conclusion: All imaging techniques localized abnormal parathyroid glands. The radiotracers have equal sensitivity for the localization of abnormal parathyroid glands. The sensitivity of these tracers was high as compared to ultrasonography or MRI.

Key Words: parathyroid glands • technetium-99m-MIBI • techne-tium-99m-tetrofosmin • ultrasound • magnetic resonance imaging

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