VALUE OF TECHNETIUM 99M SESTAMIBI I-123 IMAGING IN REOPERATIVE PARATHYROID SURGERY

Background. The purpose of this study was to assess the contribution o f technetium 99m sestamibi iodine 123 (T/S) imaging to preoperative an d intraoperative management of patients with persistent hyperparathyro idism. Methods. During a period of 10 months, all patients being prepa red for reoperative parathyroid surgery (n = 10), two patients deemed significant operative risks (one patient with severe chronic obstructi ve pulmonary disease and one patient with severe cervical spine ankylo sing spondylitis), and two patients who had undergone prior thyroid op eration were studied with T/S imaging. Six patients undergoing reopera tive surgery had undergone one, three had undergone two, and one had u ndergone three prior procedures. Results. T/S imaging correctly locali zed 14 of 16 parathyroid tumors. By comparison, only 1 of 6 thallium t echnetium and 3 of 12 computed tomography (CT) scans (in seven patient s) were positive. T/S imaging guided the reoperative surgical approach accurately in 12 of 14 patients, including one case of an undescended left lower gland at the level of the mandible and identification of a third gland on the left in another case. Sternal split was required t o remove three lesions localized by TIS imaging, two beneath the aorti c arch and one nestled in the aortopulmonary window in a patient who h ad undergone two prior procedures including a sternal split. In these three cases T/S imaging was particularly useful, because CT scans, tha llium technetium scans, magnetic resonance imaging, and arteriography were not diagnostic. The outcome after operation was favorable in all 14 cases, with correction of hypercalcemia and no permanent laryngeal nerve injuries or hypocalcemia. Conclusion. We concluded that T/S imag ing is more accurate than thallium technetium and CT scans in evaluati on of patients with persistent hyperparathyroidism.