Ces radiol. 2010, 64(3):192-197

One-day scintigraphic procedure combining 99mTc-MIBI/pertechnetate subtraction method with perchlorate discharge and double-phase 99mTc-MIBI scintigraphy with SPECT in patients with tertiary hyperparatyroidismOriginal article

Pavel Koranda1, Milan Halenka2, Jana Zahálková3, Zdena Kosatíková2, Miroslav Mysliveček1
1 Klinika nukleární medicíny LF UP a FN, Olomouc
2 III. interní klinika LF UP a FN, Olomouc
3 Hemodialyzační oddělení, Středomoravská nemocniční a.s., Nemocnice Šternberk

Aim: To evaluate the capability of one-day comprehensive scintigraphic procedure to detect a nodular hyperplasia (NH) of parathyroid glands in patients with tertiary hyperparathyroidism.

Methods: A group of 15 patients with tertiary hyperparathyroidism underwent a one-day scintigraphic procedure. 21 hyperplastic parathyroid glands (volumes 0.1-2.2 ml, mean value 0.7 ml, median 0.5 ml) were diagnosed in 13 patients using either ultrasonography (US) with fine needle aspiration biopsy or surgery. The comprehensive scintigraphic procedure was acquired during 3 hours and consisted of 99mTc-MIBI/pertechnetate subtraction method with perchlorate discharge and double-phase 99mTc-MIBI scintigraphy with SPECT.

Results: Subtraction scintigraphy was not evaluated in 2 patients due to absent pertechnetate uptake. 16 NH of parathyroid glands were detected on scintigraphs (12 NH using the subtraction method, 13 NH by the double-phase MIBI scintigraphy and 9 NH by both methods). 2 NH diagnosed using the scintigraphy did not show any US correlation. The comprehensive scintigraphic procedure was negative in 5 cases (volumes 0.2, 0.4, 0.4, 0.5 and 0.5 ml).

Conclusion: Our comprehensive one-day scintigraphic procedure (subtraction method with perchlorate discharge and double-phase MIBI scintigraphy with SPECT) has been able to detect NH of parathyroid glands in the majority of patients with tertiary hyperparathyroidism regardless of the small size of lesions and incidental ectopy. The subtraction procedure and double-phase MIBI scintigraphy are complementary methods, and the sensitivity of NH detection is increased using simultaneous combination of both of them. Similar complementarity exists also between scintigraphy and ultrasonography.

Keywords: hyperparathyroidism, radionuclide imaging, technetium Tc 99m sestamibi, sodium pertechnetate Tc 99m

Accepted: June 15, 2010; Published: September 1, 2010  Show citation

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Koranda P, Halenka M, Zahálková J, Kosatíková Z, Mysliveček M. One-day scintigraphic procedure combining 99mTc-MIBI/pertechnetate subtraction method with perchlorate discharge and double-phase 99mTc-MIBI scintigraphy with SPECT in patients with tertiary hyperparatyroidism. Ces radiol. 2010;64(3):192-197.
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