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Hyperparathyroidism: How to Optimize Parathyroid Imaging by Means of Tc-99m Sesta-MIBI Scintigraphy and Ultrasound?

Weiss, Mayo MD, PhD*; Schmid, Rupert MD†; Hacker, Marcus MD†; Pfluger, Thomas MD, PhD‡

doi: 10.1097/01.ten.0000255807.56838.97
CME Review Article #5

Background: The aim of this retrospective study was to compare the sensitivity and positive predictive value of technetium-99m-methoxyisobutyl-isonitrile (sesta-MIBI) scintigraphy and sonography in single and combined use for the detection of parathyroid adenomas in patients presenting with primary hyperparathyroidism. We also examined the value of single-photon-emission computed tomography (SPECT) and ultrasound in improving the diagnostic value of preoperative planar Tc-99m-Sesta-MIBI scintigraphy.

Patients and Methods: In 84 consecutive patients with biochemically proven hyperparathyroidism, Tc-99m-sesta-MIBI and sonographic imaging were retrospectively reviewed by 2 experienced physicians. All patients were studied with planar Tc-99m-sesta-MIBI scintigraphy, SPECT and sonography. The results were correlated with the histopathological studies of the surgical specimens.

Results: Sixteen of 84 patients had superimposed thyroid disease, and 25 of 84 had previous neck surgery. Fifteen of 84 had recurrent hyperparathyroidism, in 12 of 84 cases, hyperparathyroidism was due to ectopic parathyroid tissue. As a single modality, planar scintigraphy showed the highest sensitivity (76%) followed by SPECT (71%) and ultrasound (59%). The combination of sesta-MIBI and sonography had a sensitivity of 85% while the combination of all 3 modalities had a sensitivity of 86%. For the detection of histologically proven parathyroid adenomas, the sensitivity and positive predictive value increased to 93% and 100%, respectively, if only 1 of the tests needed to be positive.

Conclusion: Tc-99m-sesta-MIBI scintigraphy combined with sonography is superior in sensitivity and positive predictive value to the other single use of the tests. The combination of tests provided a substantial increase in sensitivity and positive predictive value.

*Physician, Specialist in Nuclear Medicine, Assistant Professor for Nuclear Medicine, Assistant Medical Director; †Physician, Specialist in Nuclear Medicine; and ‡Senior Physician, Specialist in Radiology, Assistant Professor for Radiology, Department of Nuclear Medicine, University of Munich, Munich, Germany.

The authors have disclosed that they have no significant relationships with or financial interests in any commercial company that pertains to this educational activity.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprints: M. Weiss, MD, PhD, Department of Nuclear Medicine, University of Munich, Germany, Ziemssenstr. 1, D-80335 Muenchen, Germany. E-mail:

Chief Editor’s Note: This article is the 5th of 36 that will be published in 2007 for which a total of up to 36 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.

© 2007 Lippincott Williams & Wilkins, Inc.