PREOPERATIVE IMAGING OF ABNORMAL PARATHYROID-GLANDS IN PATIENTS WITH HYPERPARATHYROID DISEASE USING COMBINATION TC-99M-PERTECHNETATE AND TC-99M-SESTAMIBI RADIONUCLIDE SCANS

Objective To evaluate the efficacy of combined Tc-99m-pertechnetate an d Tc-99m-sestamibi radionuclide scanning for imaging abnormal parathyr oid glands in hyperparathyroid disease in a prospective study. Summary Background Data Established methods to localize abnormal parathyroid glands lack accuracy for routine use. Tc-99m-sestamibi used in conjunc tion with iodine-123 has excellent potential for preoperative imaging in patients with hyperparathyroid disease. An alternative method far p arathyroid imaging was studied using Tc-99m-pertechnetate and Tc-99m-s estamibi. Methods Thirty patients with hyperparathyroid disease had Tc -99m-pertechnetate and Tc-99m-sestamibi subtraction radionuclide scann ing to visualize abnormal parathyroid glands before surgery. The patie nts had surgery and pathologic confirmation of all parathyroid glands. Results In 23 patients with primary hyperparathyroidism, 12 of 13 sol itary adenomas were visualized. Six of nine patients with diffuse hype rplasia had bilateral uptake consistent with diffuse hyperplasia. Thre e of nine patients had negative scans. One patient previously operated on for diffuse hyperplasia had only one gland scanned. Seven patients with renal failure-associated hyperparathyroid disease were scanned: five had bilateral uptake of Tc-99m-sestamibi consistent with hyperpla sia, and two who had been previously operated on had localization of r emaining abnormal parathyroid glands. Conclusions Tc-99m-pertechnetate combined with Tc-99m-sestamibi subtraction radionuclide scanning is l ess cumbersome to implement than iodine-123 combined with Tc-99m-sesta mibi scanning. It has a high sensitivity for imaging solitary parathyr oid adenomas or glands. However it does not have the resolution necess ary to delineate all parathyroid glands in diffuse hyperplasia.