The efficacy of technetium-99m-MIBI scan and intraoperative methylene bluestaining for the localization of abnormal parathyroid glands

The efficacy of the technetium-99m-2-methoxy-isobutylisonitrile (Tc-MIBI) s can and intraoperative methylene blue staining was analyzed in a consecutiv e series of 15 patients with primary hyperparathyroidism who underwent neck surgical exploration. A total of 17 abnormal parathyroid glands mere remov ed, 7 of which were confirmed histologically as adenomas and 10 as hyperpla sias. The Tc-MIBI scan and the thallium-201-technetium-99m subtraction (TI/ Tc) scan preoperatively localized 11 (69%) of 16, and 6 (40%) of 15 abnorma l parathyroid glands, respectively. The Tc-MIBI scan correctly localized tw o ectopic abnormal parathyroid glands which mere not localized by the Ty/Tc scan or ultrasonography (US), However, it also demonstrated false-positive accumulations caused by thyroid diseases in two patients, There were it ab normal parathyroid glands not detected by the preoperative imaging techniqu es, whereas all 17 abnormal parathyroid glands mere stained with methylene blue, the infusion of which caused no adverse effects or toxicity. In concl usion, Tc-MIBI scanning and intraoperative methylene blue staining are effe ctive techniques for the localization of abnormal parathyroid glands in pat ients with primary hyperparathyroidism.