Parathyroid Scintigraphy - European Association of Nuclear Medicine

patients with renal failure (Hindié et al. 1999;
Perié et al. 2005)
What information can be obtained?
• The preoperative map may facilitate recognition
of the position of aberrant parathyroid
glands, also reducing the extent of
dissection (Hindié et al. 1999).
•
•
Parathyroid glands with major ectopia
would be missed without preoperative
imaging.
Although the usual number of parathyroid
glands is four, some individuals (about 10%)
have a supernumerary fifth gland (Akerström
et al. 1984). When this information is
provided by preoperative imaging, it may
prevent surgical failure or late recurrence
(Hindié et al. 1999).
Imaging findings in patients with persistent
or recurrent secondary hyperparathyroidism
Immediate failure and delayed recurrence are
not unusual, occurring in 10–30% of patients.
Imaging is mandatory before reoperation.
Knowledge of all details concerning the initial
intervention is necessary for interpretation. As
with primary hyperparathyroidism, we recommend
that lesions seen on the 99m Tc-sestamibi
scan be matched with a second radiological
technique (ultrasound or MRI) for confirmation
and identification of anatomical landmarks
before reoperation.
11
Chapter 1: Applications of parathyroid imaging
Some aspects specific to patients reoperated
for secondary hyperparathyroidism need to
be emphasised:
•
•
Specific views of the forearm should be
obtained in patients who have had a parathyroid
graft.
It is not unusual for imaging in these patients
to show two foci of activity, one
corresponding to recurrent disease at the
subtotally resected gland (or grafted tissue)
and the other corresponding to an ectopic
or fifth parathyroid, missed at initial intervention
(unpublished data).
Figure 1
Parathyroid subtraction scintigraphy, with simultaneous
acquisition of 99m Tc-sestamibi and 123 I
in a patient with primary hyperparathyroidism.
The anterior view and the lateral view show a
solitary adenoma located at the lower right pole
of the thyroid. At surgery, an adenoma of 1.9 g
was found at the predicted site.
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