Preoperative imaging of parathyroid glands with technetium-99m-labelled sestamibi and iodine-123 subtraction scanning in secondary hyperparathyroidism

Value of 123I-Subtraction and Single-Photon Emission Computed Tomography in Addition to Planar 99mTc-MIBI Scintigraphy Before Parathyroid Surgery

“…In hyperplastic parathyroid glands, good results have been reported with subtraction techniques using double-window acquisition for planar or SPECT imaging, leading to high sensitivities ranging from 77%-91% in small groups. 9,10,25 However, the subtraction images in our series did not increase sensitivity remarkably. Conversely, the images were more confusing than helpful, considering the lower confi dence scores and interobserver agreement after the addition of subtraction images.…”

“…Preoperative scintigraphy can have surgical implications if ectopic or supernumerary glands are detected. 9 In our series, the only ectopic glands detected were localized in the thymus. As this is a common location for ectopic or supernumerary glands in patients with secondary disease, it is advisable to perform transcervical thymectomy in all these patients.…”

“…36 Therefore, glands with low uptake may have low probability of recurrence and should be chosen for autoimplantation. 9 Because size is associated with MIBI uptake, a gland with the lowest probability of recurrence should probably be selected for reimplantation. With the techniques currently available, preoperative MIBI scintigraphy is of limited value for localizing parathyroid glands in patients undergoing initial surgery for sHPT.…”

“…Another method of enhancement is dual tracer subtraction scintigraphy using a thyroid specifi c 123 I tracer subtracted from 99m Tc-MIBI, which is retained in both thyroid and PT tissue. This method may enhance accuracy, especially in multiglandular disease, by reducing falsepositive (FP) results caused by thyroid nodules, 9,10 and false-negative (FN) results caused by early MIBI washout. 11 We conducted this study to evaluate the surgical implications of adding SPECT and 123 I-subtraction to 99m Tc-MIBI scintigraphy to detect PT tumors.…”

Dual-phase 99mTc-MIBI scintigraphy to assess calcimimetic effect in patients on haemodialysis with secondary hyperparathyroidism

“…There is a variety of radiotracers and methodologies to image parathyroid glands, but dual-phase 99m Tc-MIBI and subtraction 123 I/ 99m Tc-MIBI are the most widely accepted nuclear medicine procedures [18][19][20][21][22]. Additional acquisitions including oblique views, pin-hole, single photon emission computed tomography and single photon emission computed tomography/computed tomography have been studied in an attempt to improve the sensitivity of 99m Tc-MIBI scintigraphy, with promising results, although their contribution to routine practice is still under debate [18,20,23].…”