Dual-tracer radionuclide imaging in hyperparathyroidism: thallium-201 parathyroid scintigraphy revisited

Abstract

Objectives 99mTc-sestamibi is the current radiopharmaceutical of choice for the localization of hyperactive lesions of the parathyroid glands in patients with hyperparathyroidism. However, there are multiple factors that adversely affect the accumulation and retention 99mTc-sestamibi in the hyperfunctioning parathyroid tissue, resulting in a false-negative scan. The objective of this study was to investigate the possibility of an incremental diagnostic role of thallium-201 parathyroid scintigraphy in patients with presumably false-negative 99mTc-sestamibi scan results. Patients and methods The study comprised of 22 patients including 16 with primary hyperparathyroidism (PHPT) and 6 with secondary hyperparathyroidism where 99mTc-sestambi scan was initially negative, inconclusive or where additional lesions were suspected on the single-photon computed tomography/computed tomography (SPECT/CT) scan with the CT component identifying lesion(s) without significant 99mTc-sestamibi uptake. Results The results of our study show that in 22 patients (5 male, 17 female; age range 26–81; median age 53.4) further imaging with thallium-201 SPECT/CT scan showed 46.5% additional lesions in patients with hyperparathyroidism caused by an adenomatous or hyperplastic parathyroid lesion. In patients with PHPT caused by an adenomatous or hyperplastic parathyroid lesion, further imaging with thallium-201 showed 59% additional hyperactive parathyroid lesions. In patients with secondary hyperparathyroidism, further imaging with thallium-201 SPECT/CT showed additional 33.3% hyperplastic parathyroid lesions. Conclusion The results of this pilot study strongly advocate a role for thallium parathyroid SPECT/CT imaging in patients with primary and secondary hyperparathyroidism where the initial 99mTc-sestamibi scan is deemed to be false-negative in the presence of biochemical hyperparathyroidism.

Semiquantitative assessment of 99mTc-MIBI uptake in parathyroids of secondary hyperparathyroidism patients with chronic renal failure

“…The uptake mechanism of 99m Tc-MIBI by parathyroids has been proposed to occur based on the increased vascularity, capillary permeability and metabolism, mitochondrial entrapment in oxyphilic cells, the active phase of parathyroid cells ( 20 , 21 ), p-glycoprotein or multidrug resistance-related protein expression ( 7 , 18 ), parathyroid lesion weight, single or multiple parathyroid lesions, presence of parathyroid cyst ( 12 ), etc. MIBI washes out more rapidly from the thyroid than from the hyperfunction parathyroid, which is the basic principle for dual-phase parathyroidal imaging ( 22 ).…”

Reduction of contribution of scattered photons by optimization of energy window settings in 201Tl SPECT imaging: a simulation study

“…Thallium-201 radioisotope, with the physical half-life of 73 hours and the biological half-life of 11 days, is one of the most widely used radioisotopes in SPECT imaging, especially in myocardial perfusion imaging (MPI) [1,2], parathyroid gland [3,4] and tumor imaging [5,6]. This radioisotope decays to mercury-201 by electron capture (EC).…”