Tc-99m sestamibi before and during treatment in a patient with sarcoidosisand persistent hyperparathyroidism

Purpose: Tc-99m sestamibi (MIBI) uptake in pulmonary sarcoidosis has been r eported, but it has never been studied before and during treatment with glu cocorticoids. Methods: The authors performed MIBI scintigraphy and somatostatin receptor scintigraphy in a patient with sarcoidosis of the mediastinum, lungs, and l iver and who had persistent hyperparathyroidism after unsuccessful neck exp loration. Results: Somatostatin receptor scintigraphy showed high mediastinal and pul monary uptake in a pattern characteristic of sarcoidosis, Sustained MIBI up take occurred in the same, although smaller, region. After the diagnosis wa s confirmed by liver biopsy, the patient was treated with glucocorticoids. Repeated MIBI scintigraphy showed that the uptake in the mediastinum had cl early decreased. Conclusions: This decrease of MIBI uptake in the mediastinal lymph nodes wi th therapy may imply that MIBI can be used to assess the response to treatm ent in sarcoidosis. Perhaps a relation exists between MIBI uptake at the mo ment of diagnosis and prognosis. Further studies in more patients are neede d to evaluate the role of MIBI in the management of sarcoidosis.