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Preoperative Localization of Parathyroid Lesions in Hyperparathyroidism: Relationship Between Technetium-99m-MIBI Uptake and Oxyphil Cell Content

Department of Medicine, Division of Endocrinology and Metabolism and Departments of Nuclear Medicine ami Pathology, Faculté de Médecine,Université de Sherbrooke, Québec, Canada

Correspondence: For correspondence or reprints contact: Pierre Maheux, MD, Division of Endocrinology and Metabolism, Centre Universitaire de Santé de I'Estrie (Fleurimont), 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.

ABSTRACT

The aim of this study was to assess the relationship between parathyroid oxyphil cell content and early or late phases of uptake of ^99mTc-MIBI, a radioisotope preferentially retained in mitochondria-rich cells. Methods: This study is a retrospective, single-blind analysis of all double-phase ^99mTc-MIBI parathyroid scintigraphy studies performed before surgery in our institution between 1990 and 1995. A total of 18 parathyroid lesions in 14 patients were reviewed. This sample included 11 cases of primary hyperparathyroidism (8 adenomas, 1 adenocarcinoma and 2 hyperplasias) and 3 cases of tertiary hyperparathyroidism secondary to chronic renal failure. Results: Uptake of ^99mTc-MIBI in the early phase of scintigraphy was associated with larger parathyroid lesions (1.61 ± 1.61 ml versus 0.33 ± 0.27 ml;p < 0.02) and higher serum calcium levels (3.00 ± 0.41 mM versus 2.67 ± 0.14 m/W;p < 0.02). More importantly, we found that a parathyroid oxyphil cell content greater than 25% was more often associated with a positive uptake of ^99mTc-MIBI in the late phase of the test (positive late uptake in 78% of lesions with a high oxyphil cell content versus 33% in lesions with an oxyphil cell content between 1%and 25% and 0% in lesions with no oxyphil cells; p < 0.04). Conclusion: These findings suggest that the late retention of ^99mTc-MIBI in double-phase scintigraphy is related to parathyroid oxyphil cell content.

Key Words: hyperparathyroidism • technetium-99m-MIBI • oxyphil cells • parathyroid adenoma

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