TC-99M SESTAMIBI SCINTIGRAPHY, MAGNETIC-RESONANCE-IMAGING AND VENOUS-BLOOD SAMPLING IN PERSISTENT AND RECURRENT HYPERPARATHYROIDISM

Surgical treatment for primary hyperparathyroidism (HPT) is effective in 90% of cases. Recurrent or persistent HPT occurs in 10% of cases. P arathyroid imaging is indicated to confirm and locate an abnormal glan d before reoperation. The aim of this study was to evaluate whether th e combination of Tc-99(m) sestamibi scintigraphy, MRI and venous blood sampling (VBS) improved the overall sensitivity for abnormal parathyr oid gland detection. 18 patients with recurrent or persistent HPT unde rwent sestamibi scintigraphy (n=18), MRI (T-1 weighted and STIR sequen ces) (n=18) and venous blood sampling (n=12) at different sites (inter nal jugular veins, innominate veins, and superior vena cava). All pati ents underwent surgical exploration. MRI yielded positive results in 1 5 cases (sensitivity 88%), sestamibi scintigraphy in 14 cases (83%) an d VBS in 10 cases out of 12 (83%). Combined results of MRI, sestamibi and VBS yielded positive results in 16 cases (94%). The combination of MRI, sestamibi scintigraphy and VBS improved accuracy in detecting ab normal parathyroid glands before reoperation.