Reduced-time-window sestamibi scanning for nonlocalized primary hyperparathyroidism

BACKGROUND: Technetium Tc 99m sestamibi scan is the standard of care for lo calizing parathyroid adenomas, METHODS AND MATERIAL: We performed a retrospective, single-institution stud y of 111 consecutive patients with primary hyperparathyroidism who underwen t standard sestamibi scan for localization of a parathyroid lesion. A revis ed protocol of reduced-time-window sestamibi scan was used in nonlocalized patients. The protocol was composed of single-view scans at 15, 30, 45, and 120 minutes and tomograms at 60 minutes. RESULTS: Thirty-five patients underwent surgery at our institution. Thirty- one had adenomas, and 4 had hyperplasia. Three of 31 patients did not show localization on the standard scan and underwent reduced-time-window scans, which localized 2 more adenomas. These were confirmed at the time of surger y. CONCLUSION: We suggest that all patients with a high degree of suspicion fo r a parathyroid adenoma, which is not visualized by a standard scan, underg o a reduced-time-window scan.