SECONDARY HYPERPARATHYROIDISM - DETECTION WITH I-123 TC-99M-SESTAMIBISUBTRACTION SCINTIGRAPHY VERSUS US

PURPOSE: To compare iodine-123-technetium-99m-sestamibi subtraction sc intigraphy with ultrasonography (US) for detection of parathyroid abno rmalities in uremic patients with secondary hyperparathyroidism. MATER IALS:AND METHODS: Fourteen adult uremic patients with severe second ar y hyperparathyroidism underwent subtraction scintigraphy before total or subtotal parathyroidectomy. Subtraction scintigrams were acquired w ith a double-energy-window technique. US was performed with high-frequ ency transducers and standard methods. RESULTS: I-123-Tc-99m-sestamibi subtraction scintigraphy correctly demonstrated 41 of 50 surgically c onfirmed enlarged parathyroids; US demonstrated 27. Sensitivity for de tection of hyperplastic glands was 82% for scintigraphy and 54% for US . Scintigrams were correct in seven patients, and US scans were correc t in five. Scintigraphy demonstrated all four enlarged parathyroids in six of 12 patients who were to undergo first surgery, whereas US demo nstrated all four enlarged glands in three of the 12 patients. Gland w eight was correlated with likelihood of detection with either method. Glands undetected at scintigraphy were significantly (P < .01) smaller (mean weight, 257 mg) than those undetected at US (mean weight, 467 m g). CONCLUSION: I-123-Tc-99m-sestamibi subtraction scintigraphy is eff icient for detection of enlarged parathyroid glands in uremic patients with secondary hyperparathyroidism and is more sensitive than US.