Scientific paper
Prospective comparison of technetium-99m-sestamibi/iodine-123 radionuclide scan versus high-resolution ultrasonography for the preoperative localization of abnormal parathyroid glands in patients with previously unoperated primary hyperparathyroidism

https://doi.org/10.1016/S0002-9610(05)80335-6Get rights and content

Surgery for primary hyperparathyroidism is successful in 95% of patients, but ectopic glands and anatomic variations in location are causes of surgical failure. The radionuclide imaging agent, technetium (Tc)-99m-sestamibi, in conjunction with subtraction iodine-123 scanning, is a new method of preoperative localization of abnormal parathyroid glands.

In a study approved by the Institutional Review Board, 22 patients with primary hyperparathyroidism underwent preoperative evaluation with high-resolution ultrasonography and Tc-99m-sestamibi/I-123 radionuclide scanning for attempted localization of abnormal parathyroid glands. Results of Tc-99m-sestamibi scanning and ultrasound were correlated with surgical and pathologic findings.

Of 22 patients, 16 had a solitary parathyroid adenoma, 1 had a double adenoma, and 5 had diffuse parathyroid hyperplasia. The Tc-99m-sestamibi/I-123 radionuclide scan preoperatively identified a solitary adenoma in 14 of 16 patients (sensitivity: 88%). However, when the data were analyzed retrospectively along with surgical and pathologic findings, the Tc-99m-sestamibi scan correctly localized all parathyroid adenomas for a sensitivity of 100%. The one patient with a double adenoma had a localization image consistent with two enlarged glands. All patients with diffuse parathyroid hyperplasia had Tc-99m-sestamibi imaging consistent with diffuse hyperplasia, although delineation of individual enlarged glands was not possible. High-resolution ultrasound identified 11 of 16 parathyroid adenomas (sensitivity: 69%). The patient with a double adenoma had a negative ultrasound. Ultrasound was less accurate in five patients with diffuse hyperplasia: one scan was completely negative, two scans revealed only one enlarged gland, and two scans revealed two enlarged glands.

The Tc-99m-sestamibi/I-123 subtraction radionuclide scan is more sensitive than high-resolution ultrasonography for the preoperative localization of abnormal parathyroid glands. Tc-99m-sestamibi/I-123 radionuclide scanning may be more useful than ultrasonography to the surgeon in the preoperative localization of abnormal parathyroid glands.

References (13)

There are more references available in the full text version of this article.

Cited by (114)

  • Shear wave elastography and parathyroid adenoma: A new tool for diagnosing parathyroid adenomas

    2016, European Journal of Radiology
    Citation Excerpt :

    The diagnostic accuracy of MIBI scan is limited [8]. Several publications reported a sensitivity of 50% to 85% for MIBI scan for primary hyperparathyroidism [9–13]. Adding B-mode US and fine needle aspiration biopsy (FNAB) with parathyroid hormone (PTH) washout to MIBI scan has improved localization of parathyroid adenoma [14].

  • Predictors of accuracy in preoperative parathyroid adenoma localization using ultrasound and Tc-99 m-Sestamibi: A 4-quadrant analysis

    2013, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
    Citation Excerpt :

    Of the 190 patients with pHPT who had preoperative ultrasound in our study, ultrasound was correct in identifying the location of an adenoma confirmed at operation by quadrant in 130 patients (66%) and in 152 (77%) patients by laterality. Our results are consistent with those of other institutions, despite conducting a more detailed 4-quadrant analysis [11–23]. Correct localization by quadrant for sestamibi scan was achieved in 75 of 177 patients (42%), with accurate localization by laterality in 92 of 177 (52%) patients.

View all citing articles on Scopus

Presented at the 39th Annual Meeting of the Society of Head and Neck Surgeons, Los Angeles, California, March 18–21, 1993.

1

From the Departments of Surgery (ATC, ARM, JPW) and Radiology (GJB,S), Sections of Endocrine Surgery and Nuclear Medicine, Medical College of Georgia, Augusta, Georgia.

View full text