LOCALIZATION OF A PARATHYROID ADENOMA BY THE ADDITION OF PINHOLE IMAGING TO TC-99M SESTAMIBI DUAL-PHASE SCINTIGRAPHY - REPORT OF A CASE ANDREVIEW OF EXPERIENCE

Scintigraphy using Tc-99m has been shown to be highly sensitive in loc alizing abnormal parathyroid glands in patients with hyperparathyroidi sm. False-negative studies most often are attributed to glandular size or location. The authors report a case of negative parathyroid imagin g using standard dual-phase technique, which was converted to a positi ve study by the addition of a pinhole view. During a 1-year period, th e authors systematically added an anterior-pinhole image of the neck t o all equivocal or negative Tc-99m studies. Five of 19 patient studies were pinhole-image positive and standard-image negative or equivocal. In selected patients undergoing Tc-99m scintigraphy for hyperparathyr oidism, the addition of a pinhole view may enhance study sensitivity a nd the confidence in interpretation.