PT - JOURNAL ARTICLE AU - Camilla Schalin-Jäntti AU - Eeva Ryhänen AU - Ilkka Heiskanen AU - Marko Seppänen AU - Johanna Arola AU - Jukka Schildt AU - Mika Väisänen AU - Lassi Nelimarkka AU - Irina Lisinen AU - Ville Aalto AU - Pirjo Nuutila AU - Matti J. Välimäki TI - Planar Scintigraphy with <sup>123</sup>I/<sup>99m</sup>Tc-Sestamibi, <sup>99m</sup>Tc-Sestamibi SPECT/CT, <sup>11</sup>C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism? AID - 10.2967/jnumed.112.109561 DP - 2013 May 01 TA - Journal of Nuclear Medicine PG - 739--747 VI - 54 IP - 5 4099 - http://jnm.snmjournals.org/content/54/5/739.short 4100 - http://jnm.snmjournals.org/content/54/5/739.full SO - J Nucl Med2013 May 01; 54 AB - All patients with primary hyperparathyroidism should undergo localization studies before reoperation, but it is not known which method is most accurate. The purpose of this prospective study was to compare the performance of planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT (SPECT/CT), 11C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism. Methods: Twenty-one patients referred for reoperation of persistent hyperparathyroidism were included and investigated with 123I/99mTc-sestamibi, SPECT/CT (n = 19), 11C-methionine PET/CT, and SVS (n = 18) before reoperation. All patients had been operated on 1–2 times previously because of hyperparathyroidism. The results of the localization studies were compared with operative findings, histology, and biochemical cure. Results: Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%–79%) for 123I/99mTc-sestamibi, 19% (95% CI, 5%–42%) for SPECT/CT, 65% (95% CI, 43%–84%) for 11C-methionine PET/CT, and 40% (95% CI, 19%–65%) for SVS (P &lt; 0.01 for 123I/99mTc-sestamibi vs. SPECT/CT). The corresponding accuracy for the correct quadrant or more specific site was 48% (95% CI, 27%–69%) for 123I/99mTc-sestamibi, 14% (95% CI, 3%–36%) for SPECT/CT, 61% (95% CI, 39%–80%) for 11C-methionine PET/CT, and 25% (95% CI, 9%–49%) for SVS (P &lt; 0.02 for 123I/99mTc-sestamibi vs. SPECT/CT). In the 3 patients not cured, preoperative 123I/99mTc-sestamibi and SPECT/CT remained negative, SVS was false predictive in all, and 11C-methionine PET/CT in 1. 11C-methionine PET/CT accurately revealed the pathologic gland in 4 of 8 (50%) patients with a negative 123I/99mTc-sestamibi scan result, all of whom were biochemically cured after reoperation. Conclusion: Planar scintigraphy with 123I/99mTc-sestamibi performs well in complicated primary hyperparathyroidism and is recommended as first-line imaging before reoperation. 11C-methionine PET/CT provides valuable additional information if 123I/99mTc-sestamibi scan results remain negative. 99mTc-sestamibi SPECT/CT and SVS provide no additional information, compared with the combined results of 123I/99mTc-sestamibi and 11C-methionine PET/CT imaging.