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Parathyroid Imaging Using Simultaneous Double-Window Recording of Technetium-99m-Sestamibi and Iodine-123

Departments of Nuclear Medicine, Vascular and Endocrine Surgery, and Endocrinology, Henri Mondor University Hospital, Créteil, France

Correspondence: For correspondence or reprints contact: Dr. Elif Hindi#x00E9;, Service de Biophysique et Médecine Nucléaire, Hôpital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny 94010, Créteil, France.

ABSTRACT

Technetium-99m-sestamibi represents an important advance in the scintigraphic location of parathyroid neoplasms. However, the optimal procedurefor ^99mTc-sestamibi parathyroid scanning has not been defined. The first objective of this work was to optimize the technical aspects of subtraction scanning, using simultaneous double-window recording of ^99mTc-sestamibi and 1@linstead of suc cessive image recording. The second objective was to compare two protocols for detecting abnormal parathyroid glands: subtraction scanning and single-tracer double-phase scanning. Methods: Thirty patients referred for first surgery of primary hyper parathyroidism had both subtraction scanning and double-phase scanning in the same imaging session. Images of ^99mTc-sestamibi arid ¹²³I were recorded simultaneously in nonoverlapping windows and then subtracted. For double-phase scanning, images of ^99mTc-sestamibi, acquired 15 min and 120 min after tracer injection, were visually compared. Surgery disclosed a solitary adenoma in 27 patients, bilateral adenomata in 2 patients and 3 hyperplastic glands in the last patient. No patient had persistent hypercalcemia. Results: Preoperative ^99mTc-sestamibV'23I subtraction scanning located 25 of 27 solitary adenomas, the bilateral adenomata and 3 of 3 hyperplastic glands. The overall sensitivity for enlarged parathyroids was 94%, and the false-positive image rate was 3%. The ^99mTc-sestamibi single-tracer technique located 22 of 27 solitary adeno mas, the bilateral adenomata and 1 of 3 hyperplastic glands. Overall sensitivity was 79% and the false-positive image rate was 10%. The gamma camera imaging time was 30 min for the subtraction technique and 50 min for the single-tracer double-phase study. An ectopic adenoma in the sheath of the right carotid artery was detected by both techniques. Conclusion: These results, together with other data in the literature, indicate that ^99mTc-sestamibif ¹²³I subtraction imaging is accurate in locating enlarged parathyroids. Classical difficulties of this technique (motion artifacts and prolonged immobilization) were avoided by using simultaneous recording of the two isotopes. In this series subtraction imaging was more rapid and more sensitive (p < 0.04) than the single-tracer technique.

Key Words: primary hyperparathyroidism • parathyroid • adenoma • hyperplasia • radionuclide study • parathyroid imaging • technetium-99m-sestamibi • MIBI • Iodine-123 subtraction • single-tracer technique • double-phase technique • subtraction scanning • dual-isotope imaging

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