Tc-99m sestamibi parathyroid gland scintigraphy: added value of Tc-99m pertechnetate thyroid imaging for increasing interpretation confidence and avoiding additional testing



      To evaluate the benefit of adding a pertechnetate parathyroid scan (dual-isotope imaging) in the interpretation of sestamibi dual-phase parathyroid scintigraphy.

      Material and methods

      One hundred and sixteen dual Tc-99m sestamibi (MIBI) and Tc-99m pertechnetate subtraction parathyroid studies, performed between January 2000 and February 2006, were retrospectively reviewed. Dual-phase technetium sestamibi examinations were initially interpreted, with blinding to the technetium pertechnetate findings. Subsequently, technetium pertechnetate scan findings were added, and changes in interpretation were recorded.


      By adding Tc-99m pertechnetate imaging, the interpretation of 17 scans (17/116=14.6%) was substantially altered. This included 5 scans (4%) that changed from negative to positive and 9 scans (8%) that changed from equivocal to positive, excluding ectopic tissue and directing minimally invasive surgery, without the need for further imaging, such as ultrasound, in 12% of cases. One examination changed from positive to negative. In addition, 2 scans changed from equivocal to negative, necessitating further preoperative imaging for the evaluation of additional pathology such as thyroid nodules and lymph nodes and the consideration of hyperplasia. Among the remaining 99 patients, Tc-99m pertechnetate scans may also have contributed to the diagnosis in the 66 positive Tc-99m MIBI scans by increasing confidence in the interpretation and obviating additional imaging. Ten cases remained equivocal.


      By adding Tc-99m pertechnetate imaging, scan interpretation was changed in 14.6% of cases, and interpretation confidence was enhanced in all but 10 remaining equivocal cases. The addition of a dual-isotope subtraction also eliminated the need for additional testing, such as ultrasound, in 12% of our cases. Increased confidence in interpretation that comes with dual-isotope subtraction may come at the cost of slight lengthening of imaging time but likely simplifies preoperative localization and decreases intraoperative time for many patients with primary hyperparathyroidism.


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        • Garvie NW
        Imaging the parathyroids.
        in: Peters AM Nuclear medicine in radiologic diagnosis. Martin Dunitz, London2003: 681-694
        • Palestro CJ
        • Tomas MB
        • Tronco GG
        Radionuclide imaging of the parathyroid glands.
        Sem Nucl Med. 2005; 35: 226-276
        • Niederle B
        • Roka R
        • Woloszczuk W
        • Klaushofer K
        • et al.
        Successful parathyroidectomy in primary hyperparathyroidism (A clinical follow up study of 212 consecutive patients).
        Surgery. 1987; 102: 903-909
        • Sofferman RA
        • Nathan MH
        • Fairbank JT
        • et al.
        Preoperative technetium 99m sestamibi imaging (paving the way to minimal-access parathyroid surgery).
        Arch Otoloryngol Head Neck Surg. 1996; 122: 369-374
      1. The surgical Management of Hyperparathyroidism.
        in: Bilezikian JP Marcus R Levine MA ed 2. The parathyroids. Academic Press, San Diego2001
        • Sackett WR
        • Barraclough B
        • Reeve TA
        • et al.
        Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy.
        Arch Surg. 2002; 137: 1055-1059
        • Udelsman R
        • Donovan PI
        • Sokoll LJ
        One hundred consecutive minimally invasive parathyroid explorations.
        Arch Surg. 2003; 31: 1074-1078
        • Coakley AJ
        • Kettle AG
        • Wells CP
        • et al.
        99mTc-sestamibi – a new agent for parathyroid imaging.
        Nucl Med Commun. 1989; 10: 791-794
        • Ishibashi M
        • Nishida H
        • Hiromatsu Y
        • Kojima K
        • Tabuchi E
        • Hayabuchi N
        Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands.
        J Nucl Med. 1998; 39: 320-324
        • Fjeld JG
        • Erichsen K
        • Pfeffer PF
        • Clausen OP
        • Rootwelt K
        Technetium-99mtetrofosmin for parathyroid scintigraphy: a comparison with sestamibi.
        J Nucl Med. 1997; 38: 831-834
        • Steward DL
        • Danielson GP
        • Afman CE
        • Welge JA
        Parathyroid adenoma localization: surgeon-performed ultrasound versus sestamibi.
        Laryngoscope. 2006 Aug; 116: 1380-1384
        • Berri RN
        • Lloyd LR
        Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization.
        Am J Surg. 2006 Mar; 191: 311-314
        • Taillefer R
        • Boucher Y
        • Potvin C
        • et al.
        Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (doublephase study).
        J Nucl Med. 1992; 33: 1801-1807
        • Melloul M
        • Paz A
        • Koren R
        • et al.
        99m Tc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance.
        Eur J Nucl Med. 2001; 28: 209-213
        • Mariani G
        • Gulec SA
        • Rubello D
        • et al.
        Preoperative localization and radioguided parathyroid surgery.
        J Nucl Med. 2003; 44: 1443-1458
        • Akin M
        • Kurukahvecioglu O
        • Dogan M
        • Gokslan D
        • Paoyraz A
        • Koksal H
        • Taneri F
        Preoperative detection of parathyroid adenomas with Tc-99m MIBI and Tc-99m pertechnetate scintitraphy: histopathological and biochemical correlation with Tc-99m MIBI uptake.
        Bratisl Lek Listy. 2009; 110: 166-169
        • Rubello D
        • Giannini S
        • De Carlo E
        • Mariani G
        • Muzzio PC
        • Rampin L
        • Pelizzo MR
        Panminerva Med. 2005; 47: 99-107
        • Nichols KJ
        • Tomas MB
        • Tronco GG
        • Rini JN
        • Kunjummen BD
        • Hller KS
        • SYnzter LA
        • Palestro CJ
        Preoperative parathyroid scinitrigraphic lesion localization: accuracy of various types of readings.
        Radiology. 2008; 248: 221-232
        • Chen CC
        • Holder LE
        • Scovil WA
        • Tehan AM
        • Gann DS
        Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99msestamibi SPECT.
        J Nucl Med. 1997; 38: 834-839
        • Liu Y
        • Chun KJ
        • Freeman LM
        ‘Shine through’ dual tracer parathyroid scintigraphy: a potential pitfall in interpretation.
        Clin Nucl Med. 2005; 30: 145-149
        • Mariani G
        • Gulec SA
        • Rubello D
        • Boni G
        • Puccini M
        • Pelizzo MR
        • Manca G
        • Casara D
        • Sotti G
        • Erba P
        • Volterrani D
        • Giuliano AE
        Preoperative localization and radioguided parathyroid surgery.
        J Nucl Med. 2003 Sep; 44: 1443-1458
        • Gallowitsch HJ
        • Mikosch P
        • Kresnick E
        • Unterweger O
        • Lind P
        Comparison between 99mTc-tetrofosmin/pertechnetate subtraction scintigraphy and 99mTc-tetrofosmin SPECT for preoperative localization of parathyroid adenoma in an endemic goiter area.
        Invest Radiol. 2000; 35: 453-459
        • Vaz A
        • Griffiths M
        Parthyroid imaging and localization using SPECT/CT: initial results.
        J Nucl Med Technol. 2011; 39: 195-200
        • Chen CC
        • Holder LE
        • Scovill WA
        • Tehan AM
        • Gann DS
        Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99msestamibi SPECT.
        J Nucl Med. 1997 Jun; 38: 834-839
        • Kandil E
        • Jan Malazai A
        • Alrasheedi S
        • Tufano R
        Minimally invasive/focused parathyroidectomy in patients with negative sestamibi scan results.
        Arch Otolaryngol Head Neck Surg. 2012; 138: 223-225