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Diagnostic Dilemmas in Parathyroid Scintigraphy

Krausz, Yodphat, M.D.*; Shiloni, Eitan, M.D.; Bocher, Moshe, M.D.*; Agranovicz, Svetlana, M.D.*; Manos, Betty, C.N.M.T.*; Chisin, Roland, M.D.*

Original Articles
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Purpose  Tc-99m MIBI scintigraphy can be useful for preoperative localization of parathyroid adenomas, despite its limited sensitivity. To refine interpretation, the authors conducted prospective reviews of the scintigraphic studies of patients with concomitant thyroid nodular disease and revised the false-negative and false-positive results.

Materials and Methods  Seventy-seven patients with primary hyperparathyroidism, associated with a solitary parathyroid adenoma, underwent dual-phase MIBI scintigraphy with subsequent injection of Tc-99m pertechnetate before surgery. The false-negative and false-positive scintigraphic findings were identified and revised.

Results  After surgery, revision of 19 false-negative scans of the total 77 studies led to the demonstration of an adenoma in seven patients. In five of the seven studies, the adenoma had been overlooked as a result of rapid tracer washout. Two additional small focal lesions would have also been identified if subtraction had been used for differences in contour of the MIBI and pertechnetate images. Four studies were interpreted falsely as abnormal, leading to a positive predictive value of 91%; three were associated with thyroid nodular disease.

Conclusions  Differential washout of MIBI from thyroid and parathyroid tissue is not universal. When MIBI is washed out rapidly from parathyroid adenomas, subtraction of a thyroid image should be performed and differences in contour delineated to localize the adenoma accurately. Some, but not all, thyroid lesions account for the false-positive findings.

From the Departments of Nuclear Medicine* and Surgery,† Hadassah University Hospital, Jerusalem, Israel

Received for publication August 23, 2000.

Revision accepted August 6, 2001.

Correspondence: Yodphat Krausz, Department of Nuclear Medicine, Hadassah University Hospital, P.O. Box 12000, Jerusalem 91120, Israel. E-mail: yodphat@hadassah.org.il

© 2001 Lippincott Williams & Wilkins, Inc.