Technetium-99m-sestamibi single agent localization versus high resolution ultrasonography for the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism

Abstract

Technetium 99m sestamibi, a newer radionuclide agent, has shown promise in parathyroid scintigraphy. Recent studies using technetium 99m sestamibi in conjunction with subtraction iodine I123 imaging have demonstrated accuracy for localizing parathyroid glands in patients with hyperparathyroidism. The effectiveness of technetium 99m sestamibi scanning as a single agent was compared prospectively with conventional high resolution ultrasonography for the preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Seventeen patients with primary hyperparathyroidism had preoperative evaluation with high resolution ultrasonography and technetium 99m sestamibi radionuclide scanning. All patients underwent bilateral neck exploration. Ultrasound results were made available to the surgeon preoperatively; however, technetium 99m sestamibi results were withheld unless specifically asked for by the surgeon intraoperatively. Comparison of the imaging studies were correlated with the operative and histological findings. Of 17 patients, 12 had solitary adenomas and four had diffuse hyperplasia. In one patient no abnormal glands were discovered. In patients with technetium 99m sestamibi localization, a solitary adenoma was identified correctly in 10 of 12 patients (83%). Three of four patients with diffuse hyperplasia had parathyroid sestamibi scans showing nonfocal or diffuse uptake in multiple glands. High resolution ultrasonography correctly identified only six of 12 patients with solitary parathyroid adenomas (50%). Of the patients with diffuse hyperplasia, two ultrasound studies showed a single enlarged gland, one study was negative, and one localized two questionable, enlarged glands. Technetium 99m sestamibi is effective as a single agent for preoperative parathyroid scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)