Abstract
Background: The aim of this study was to assess the value of technetium 99m-MIBI scintigraphy
using the single photon emission computed tomography (SPECT) technique for preoperative
localization of smaller (≤ 1 g) parathyroid adenomas. Methods: A total of 92 patients (34 men, 58 women; mean age, 60 ± 13 years) with an established
diagnosis of primary hyperparathyroidism and nondiagnostic ultrasonography (inclusion
criteria) were scanned preoperatively. After a thyroid examination to check for other
possible radionuclide-accumulating thyroid diseases, a planar technetium 99m-pertechnetate/technetium
99m-MIBI subtraction scintigraphy (15 minutes post injection) and tomographic images
(120 minutes post injection) were acquired after intravenous injection of 740 MBq
of technetium 99m-MIBI and using a 3-head gamma camera (Picker Prism 3000). Sensitivity
was defined by the ability to predict the correct site of a parathyroid adenoma. Results: All patients had parathyroid adenomas ≤ 1 g (53 patients, 0.5 -1.0 g; 39 patients,
< 0.5 g). Correct localization of parathyroid adenomas to one side or the other was
achieved in 87% of the patients using planar technetium 99m-pertechnetate/technetium
99m-MIBI subtraction scintigraphy. Sensitivity was increased to 95% by supplementary
use of the SPECT technique and a 3-D display (volume-rendered reprojection for visualization).
There was technetium 99m-MIBI accumulation in 11 benign thyroid nodes, but none of
the healthy parathyroid glands were shown on the scan. Conclusions: This study indicates that technetium 99m-MIBI parathyroid scintigraphy is a sensitive
and specific tool for topographic localization even of small parathyroid adenomas,
especially with the use of SPECT. This method could help to improve the efficiency
of parathyroidectomy (eg, by making unilateral exploration sufficient). (Surgery 2000;128:29-35.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community.N Engl J Med. 1980; 203: 189-193
- Cervical exploration for primary hyperthyroidism.J Surg Oncol. 1993; 52: 14-17
- Operative experience of U.S. general surgery residents in thyroid and parathyroid disease.Surgery. 1995; 118: 1063-1070
- Reoperation for persistent or recurrent primary hyperparathyroidism.Arch Surg. 1996; 131: 861-869
- Unilateral parathyroidectomy: the role of thallium-technetium subtraction scans.Otolaryngol Head Neck Surg. 1990; 102: 635-638
- Advantages of SPECT in technetium-99m sestamibi parathyroid scintigraphy.J Nucl Med. 1996; 37: 1773-1778
- Technetium-99m sestamibi parathyroid localization is accurate enough for scan-directed unilateral neck exploration.Br J Surg. 1996; 83: 989-991
- Sestamibi parathyroid imaging.Sem Nucl Med. 1995; 25: 221-234
- Management of hyperparathyroidism in an endemic goiter area.World J Surg. 1998; 22: 301-308
- Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT.Radiology. 1996; 201: 85-91
- Efficient parathyroidectomy guided by SPECT-MIBI and hormonal measurement.J Nucl Med. 1996; 37: 798-804
- Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study).J Nucl Med. 1992; 33: 1801-1807
- Unilateral parathyroidectomy: the value of the localizing scan.J Otolaryngol. 1993; 22: 307-310
- Surgical strategy in hyperparathyroidism due to solitary adenoma.Ann Surg. 1994; 200: 776-784
- Location of a small mediastinal parathyroid adenoma using Tc-99m MIBI SPECT.Clin Nucl Med. 1998; 23: 186-187
- Localization of an ectopic parathyroid adenoma by double-phase technetium-99m-sestamibi scintigraphy.J Nucl Med. 1995; 36: 1840-1842
- Difficulties of parathyroidectomy after previous thyroidectomy.Surgery. 1989; 106: 1018-1023
- Minimally invasive radioguided parathyroidectomy: an endocrine surgeon's perspective.J Nucl Med. 1998; 39: 15N
- Outpatient thyroid and parathyroid surgery: a prospective study of feasibility, safety, and costs.Surgery. 1995; 118: 1051-1054
- Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach?.World J Surg. 1990; 14: 406-409
- Impact of technetium-99m-sestamibi localization on operative time and success of operations for primary hyperparathyroidism.Am Surg. 1994; 60: 12-16
- Thallium-technetium isotope subtraction scanning in primary hyperparathyroidism.J R Coll Surg Edinb. 1989; 34: 40-43
- Preoperative localization in unilateral parathyroid surgery. A cost-benefit study on ultrasound, computed tomography, and scintigraphy.Acta Chir Scand. 1990; 156: 29-35
- Analysis of savings in operative time for primary hyperparathyroidism using localization with technetium 99m sestamibi scan.Am J Surg. 1995; 170: 488-491
- Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors.Surgery. 1989; 106: 639-644
- Magnetic resonance imaging in preoperative localization of diseased parathyroid glands: a comparison with isotope scanning and ultrasonography.Can J Surg. 1993; 36: 241-244
- Parathyroid imaging. Use of dual isotope scintigraphy for the localization of adenomas before surgery.Clin Nucl Med. 1992; 17: 380-383
- Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies.J Nucl Med. 1992; 33: 313-318
- Ultrastructural histology correlates with results of thallium-201/technetium-99m parathyroid subtraction scintigraphy.J Nucl Med. 1993; 34: 24-29
- Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases.Eur J Nucl Med. 1997; 24: 143-149
- A new approach to parathyroidectomy.Ann Surg. 1994; 219: 574-579
- Parathyroid localization: inability to predict multiple gland involvement.Am J Surg. 1993; 166: 357-359
- Impact of complementary parathyroid scintigraphy and ultrasonography on the surgical management of hyperparathyroidism.Surgery. 1996; 120: 845-851
- Correct preoperative localization: does it permit a change in operative strategy for primary hyperparathyroidism?.Surgery. 1995; 118: 932-935
Article info
Publication history
Accepted:
March 5,
2000
Footnotes
*Reprint requests: Detlef Moka, MD, Department of Nuclear Medicine, University of Cologne, Josef Stelzmannstr 9, D-50924 Köln, Germany.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
