Parathyroid Scintigraphy in Patients with Primary Hyperparathyroidism:^99mTc Sestamibi SPECT and SPECT/CT

Abstract

The clinical diagnosis of primary hyperparathyroidism is based largely on serum laboratory test results, as patients often are asymptomatic. Surgery, often with bilateral exploration of the neck, has been considered the definitive treatment for symptomatic disease. However, given that approximately 90% of cases are due to a single parathyroid adenoma, a better treatment may be the selective surgical excision of the hyperfunctioning parathyroid gland after its preoperative identification and localization at radiologic imaging. Scintigraphy and ultrasonography are the imaging modalities most often used for preoperative localization. Various scintigraphic protocols may be used in the clinical setting: Single-phase dual-isotope subtraction imaging, dual-phase single-isotope imaging, or a combination of the two may be used to obtain planar or tomographic views. Single photon emission computed tomography (SPECT) with the use of technetium-99m ((99m)Tc) sestamibi as the radiotracer, especially when combined with x-ray-based computed tomography (CT), is particularly helpful for preoperative localization: The three-dimensional functional information from SPECT is fused with the anatomic information obtained from CT. In addition, knowledge of the anatomy and embryologic development of the parathyroid glands and the pathophysiology of primary hyperparathyroidism aid in the identification and localization of hyperfunctioning glands.

Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

“…Our results were generally agreed with the previous reports [9,10,[16][17][18] and showed even higher performance compared with the results of meta-analysis reported by Caldarella et al [21]. In quantitative analysis, SUVR showed correlation with sPTH level in patients with PA.…”

“…Recently, it was reported that MIBI scintigraphy is useful to differentiate benign from malignant parathyroid lesions as well as to detect parathyroid lesions [6]. However, the reported detection sensitivities for MIBI and 99m Tc-tetrofosmin scintigraphy were 73-88 % and 95 %, respectively [7][8][9]. In the case of morphological imaging, such as USG, CT and MRI, the sensitivities were 61-78 %, 46-87 %, and 65-88 %, respectively.…”

Spontaneous Remission of Primary Hyperparathyroidism in a Patient with Neurofibromatosis Type 1: Case Report

“…Comparisons of different imaging methods have demonstrated the superiority of parathyroid scintigraphy for preoperative localization [26]. One systematic review of the medical literature showed that the overall sensitivity of dual-phase 99m Tc sestamibi scintigraphy in comparison with high-resolution Ultrasonography (US) was 88% versus 78% for single adenomas, 30% versus 16% for double adenomas, and 44% versus 35% for multiplegland hyperplasia [27].…”

Management of Primary Hyperparathyroidism: 'Past, Present and Future'

“…The location of an ectopic superior parathyroid gland may be above the upper pole of the thyroid lobe (<1%); posterior to the pharynx or esophagus, in either the neck or the superior mediastinum (1%-4%); or intrathyroidal (<3%) (Eslamy & Ziessman, 2008).…”