PRIMARY HYPERPARATHYROIDISM - HIGHER SUCCESS RATE OF FIRST SURGERY AFTER PREOPERATIVE TC-99M-SESTAMIBI-I-123 SUBTRACTION SCANNING

PURPOSE: To evaluate the usefulness and cost-effectiveness of routine preoperative technetium-99m sestamibi-iodine-123 subtraction scanning in patients with parathyroid gland disease. MATERIALS AND METHODS: Tc- 99m sestamibi-I-123 subtraction scanning was performed in 65 patients with primary hyperparathyroidism who were referred for evaluation befo re first surgery. RESULTS: Focal tracer uptake was detected in the med iastinum in two patients who then underwent primary sternotomy; a para thyroid adenoma, anterior to the ascending aorta, was resected in each case. In a third patient, imaging showed tracer uptake above the thyr oid gland; this patient underwent resection of an undescended parathyr oid adenoma located in the sheath of the right carotid artery. Initial surgery was curative in all patients. Preoperative subtraction scans depicted 56 of 59 (95%) solitary adenomas. Four patients had hyperplas ia; two had double adenoma. Imaging findings indicated multiple parath yroid involvement in five of these patients and facilitated location o f 12 of 15 (80%) enlarged glands. Four adenomas and two hyperplastic g lands that weighed less than 100 mg were detected. The positive predic tive value for any suspected location was 96%. Average surgery time wa s reduced from 120 to 90 minutes. CONCLUSION: Preoperative subtraction scanning is useful in planning parathyroid surgery and appears to be cost-effective.