Abstract
Background: Sestamibi/iodine subtraction single photon emission computed tomography (SPECT) has
been used successfully for the preoperative localization of adenomatous and hyperplastic
parathyroid tissue in primary hyperparathyroidism, but the clinical usefulness of
this technique in secondary hyperparathyroidism remains uncertain. The purpose of
this study was to evaluate parathyroid localization that uses sestamibi/iodine subtraction
SPECT in patients with secondary hyperparathyroidism before reoperative parathyroid
surgery. Methods: Fourteen consecutive patients with chronic renal failure and secondary hyperparathyroidism
who had previously undergone total parathyroidectomy combined with parathyroid autotransplantation
in a sternocleidomastoid muscle were studied. Before reoperation, each patient received
400 μCi of sodium iodide I 123 orally and 20 to 25 mCi of technetium Tc 99m (99mTc)-sestamibi intravenously, followed by sestamibi/iodine subtraction SPECT of the
neck and chest. At surgery, the location, weight, and histopathologic results of all
identified parathyroid tissue were recorded. Results: At surgery, 1 hyperplastic parathyroid gland was resected from each of 13 patients;
including 1 undescended gland, 6 parathyroid autotransplants, and 5 mediastinal glands.
The mean weight of the resected parathyroid glands was 1707 mg (range, 85-5300 mg).
Sestamibi/iodine subtraction SPECT correctly identified and localized all 13 parathyroid
glands (100% sensitivity) and was negative in the 1 patient whose surgery was unsuccessful.
Conclusions: The 99mTc-sestamibi/123I subtraction SPECT is able to correctly localize hyperplastic parathyroid tissue
in patients with secondary hyperparathyroidism who have previously undergone parathyroid
surgery and is a clinically useful study before reoperation. (Surgery 2000;128:22-8)
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References
- Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors.Surgery. 1989; 106: 639-646
- Location of parathyroid adenomas by thallium-201 and technetium-99m subtraction scanning.Br Med J. 1983; 286: 1384-1386
- 99mTc-sestamibi: a new agent for parathyroid imaging.Nucl Med Commun. 1989; 10: 791-794
- 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
- Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies.J Nucl Med. 1992; 33: 313-318
- Localization studies in patients with persistent or recurrent hyperparathyroidism.Surgery. 1985; 98: 1083-1094
- Thallium-pertechnetate subtraction scintigraphy: a quantitative comparison between adenomatous and hyperplastic parathyroid glands.Eur J Nucl Med. 1986; 12: 31-36
- Secondary hyperparathyroidism: detection with I-123-Tc99m-sestamibi subtraction scintigraphy versus US.Radiology. 1998; 207: 207-213
- Hyperparathyroidism in high-risk surgical patients: evaluation with double-phase technetium-99m-sestamibi imaging.Radiology. 1995; 197: 627-633
- Parathyroid scans and thyroid uptake of thallium 201 of subjects in chronic hemodialysis.J Nucl Med. 1984; 25: 19-20
- Thallium-technetium-subtraction scintigraphy in secondary hyperparathyroidism.Eur J Nucl Med. 1994; 21: 509-513
- Double-phase parathyroid technetium-99m-MIBI scintigraphy to identify functional autonomy in secondary hyperparathyroidism.J Nucl Med. 1996; 37: 565-569
- Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography.J Clin Endocrinol Metab. 1998; 83: 3867-3871
- Technetium-99m methoxy isobutyl isonitrile (MIBI) imaging of the parathyroid glands in patients with renal failure.Nephrol Dial Transplant. 1997; 12: 97-100
- Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism.AJR. 1997; 169: 1671-1674
- Parathyroid hormone and 1,25 (OH)2 D3 in chronic renal failure.Kidney Int. 1988; 33: 1049-1058
- Hyperparathyroidism in the maintenance dialysis patient.Surg Gynecol Obstet. 1976; 142: 328-336
- Marked suppression of secondary hyperparathyroidism by intravenous administration of 1,25 dihydroxycholecalciferol in uremic patients.J Clin Invest. 1984; 74: 2136-2143
- Results of subtotal parathyroidectomy in hemodialysis patients.Am J Med. 1988; 84: 23-27
- Parathyroid surgery in patients with renal failure.Ann Surg. 1984; 200: 644-647
- Subtotal parathyroidectomy for secondary hyperparathyroidism in chronic renal failure.J Laryngol Otol. 1991; 105: 562-567
- Secondary hyperparathyroidism: the role of surgery.Am Surg. 1989; 55: 359-365
- Total parathyroidectomy and autotransplantation of parathyroid tissue for renal hyperparathyroidism.Ann Surg. 1983; 197: 7-16
- Transplantation of the parathyroid glands: current status.Surg Clin North Am. 1979; 59: 167-177
- Transplantation of parathyroid glands in man: clinical indications and results.Surgery. 1975; 78: 34-44
- Treatment of secondary hyperparathyroidism in patients with chronic renal failure by total parathyroidectomy and parathyroid autograft.Ann Surg. 1981; 193: 777-793
- Total parathyroidectomy and parathyroid autotransplantation in patients with chronic renal failure.Surg Gynecol Obstet. 1981; 153: 177-180
- Reoperation for secondary hyperparathyroidism in hemodialysis patients.World J Surg. 1986; 10: 654-660
- A community hospital experience with total parathyroidectomy and autotransplantation for renal hyperparathyroidism.Am Surg. 1987; 53: 622-627
- Supernumerary parathyroid glands: implications for surgical treatment of secondary hyperparathyroidism.World J Surg. 1987; 11: 398-401
- Importance of a fifth parathyroid gland in the surgical treatment of hyperparathyroidism.Can J Surg. 1978; 21: 350-351
- The reasons for failure in parathyroid operations.Arch Surg. 1989; 124: 911-915
- Technetium-99m-sestamibi imaging before reoperation for primary hyperparathyroidism.J Nucl Med. 1995; 36: 2186-2191
- Localization procedures in patients with persistent or recurrent hyperparathyroidism.Arch Surg. 1994; 129: 870-875
- A new approach to parathyroidectomy.Ann Surg. 1994; 219: 574-581
- Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT.Radiology. 1996; 201: 85-91
- Identification of auto-transplanted parathyroid tissue by Tc-99m methoxy isobutyl isonitrile scintigraphy.Nephrol Dial Transplant. 1995; 10: 1372-1375
Article info
Publication history
Accepted:
November 7,
1999
Footnotes
*Reprint requests: Donald R. Neumann, MD, PhD, Director of Nuclear Oncologic Imaging, Dept of Nuclear Medicine/Gb3, The Clevelend Clinic Foundation, 9500 Euclid Ave, Cleveland OH 44195.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
