99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance

Abstract

The aim of this study was to assess the correlation between technetium-99m methoxyisobutylisonitrile (MIBI) uptake by parathyroid adenomas, oxyphil cell content and volume of the lesions. Thirty-one patients with parathyroid adenomas were evaluated prospectively. Preoperative double-phase 99mTc-MIBI scintigraphy was performed in all patients and tracer uptake by parathyroid lesions was assessed semi-quantitatively employing region of interest ratios to normal adjacent neck areas. Surgical specimens underwent histological evaluation and oxyphil cell content was determined. The intensity of tracer uptake was compared with oxyphil cell content, volume of the lesions and serum levels of calcium and parathormone. 99mTc-MIBI tracer uptake was correlated with oxyphil cell content, volume of parathyroid lesions and the functional status of the parathyroid adenomas. Tracer accumulation in oxyphil cells might partially explain the preferential 99mTc-MIBI retention in parathyroid lesions.

A Rare Co-Occurrence of Parathyroid and Papillary Thyroid Carcinoma

“…Parathyroid tissue expressing P-glycoprotein or multi-drug resistance related protein (MRP) does not accumulate MIBI [20]. Mitochondria-rich oxyphil cells show greater uptake of MIBI; thus, parathyroid glands with fewer oxyphil cells may yield false negative results [21]. Thus, negative results on MIBI scans do not exclude parathyroid lesions if there is clinical suspicion.…”

Association of Histological Findings with Tc-99m Sestamibi Parathyroid Imaging in Hyperfunctional Parathyroid Gland

“…Moreover, there are also other important factors that need to be taken into account when analyzing false negative MIBI result. Weight of the gland, parathormone level, expression of P-glycoprotein, serum calcium level, serum vitamin D level and use of calcium channel blocker may influence the MIBI uptake [17][18] . The factors that affect sestamibi localization are still remains a debatable issue because no consensus opinion has been reached yet.…”

Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on99mTc-Sestamibi Scan

“…In addition, as the parathyroid adenoma size may be correlated to the iPTH level, the preoperative iPTH level might be useful for estimating the amount of hyperfunctioning parathyroid tissue to be secreted [10]. Tc-sestamibitracer has been correlated with oxyphile cell content [13] and metabolic activity within the cells could determine the amount of sestamibi uptake [14]. However, in metabolically hyperactive cells, the amount of sestamibi uptake reveals variation, reflecting the numbers of mitochondria and the degree of cellular activity [13].…”

“…Tc-sestamibitracer has been correlated with oxyphile cell content [13] and metabolic activity within the cells could determine the amount of sestamibi uptake [14]. However, in metabolically hyperactive cells, the amount of sestamibi uptake reveals variation, reflecting the numbers of mitochondria and the degree of cellular activity [13]. The histology results showed the cystic area of tumor had low cellular components in the cystic area of tumor which could contribute to the false-negative result in the Tc-sestamibi scan [16].…”