HYPERPARATHYROIDISM IN HIGH-RISK SURGICAL PATIENTS - EVALUATION WITH DOUBLE-PHASE TC-99M SESTAMIBI IMAGING

PURPOSE: To evaluate the accuracy of technetium-99m sestamibi as a sin gle agent in the detection and localization of hyperfunctioning parath yroid tissue in patients who underwent prior neck exploration or who o therwise are high surgical risks. MATERIALS AND METHODS: Thirty-nine p atients with hyperparathyroidism underwent 40 double-phase Tc-99m sest amibi studies. Histopathologic correlation was obtained for all studie s. RESULTS: Thirty patients had solitary adenomas, and nine had hyperp lastic glands. One developed recurrent hypercalcemia after five-gland resection and underwent repeat imaging and operation. Double-phase ses tamibi imaging prospectively enabled localization of 46 (77%) of 60 ab normal glands. Twenty-eight (93%) of 30 adenomas were correctly locali zed, whereas 18 (60%) of 30 hyperplastic glands were localized. The ov erall specificity of the study was 98% with one false-positive study. Gland weight and vascularity were statistically significant predictors of uptake of sestamibi. CONCLUSION: Double-phase Tc-99m sestamibi ima ging is a promising technique for localization of parathyroid adenomas in high-risk surgical patients. Localization of multiple hyperplastic glands remains a challenge.