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Parathyroid Detection in Secondary Hyperparathyroidism with ¹²³I/^99mTc-Sestamibi Subtraction Single Photon Emission Computed Tomography

Departments of Nuclear Medicine (D.R.N., C.O.W.), General Surgery (C.B.E.), and Endocrinology (A.M.), Division of Radiology (M.L.), Cleveland Clinic Foundation, Cleveland, Ohio 44195

Address all correspondence and requests for reprints to: Dr. Donald R. Neumann, Department of Nuclear Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.

¹²³I/^99mTc-sestamibi subtraction single photon emission computed tomography (SPECT) has been proposed to detect hyperplastic parathyroid tissue, but the clinical usefulness of this technique in secondary hyperparathyroidism is uncertain. The purpose of this study was to evaluate preoperative parathyroid localization using ¹²³I/^99mTc-sestamibi subtraction SPECT in patients with renal failure and secondary hyperparathyroidism. Nineteen patients with chronic renal failure and secondary hyperparathyroidism underwent ¹²³I/^99mTc-sestamibi subtraction SPECT imaging preoperatively. None of these patients had undergone previous neck surgery. The location, weight, and histopathological results of all identified parathyroid glands were recorded. Surgery was considered successful in all patients, with resection of a total of 74 hyperplastic parathyroid glands. ¹²³I/^99mTc-sestamibi subtraction SPECT correctly identified 57 of these parathyroid glands (77% sensitivity). The mean weight among the true positive glands (n = 57) was 1031 mg (range, 45–7900 mg), and that among the false negative glands (n = 17) was 465 mg (range, 20–1800 mg). This difference between the mean weights was statistically significant (P = 0.018). There was a positive correlation between parathyroid weight and detectability with ¹²³I/^99mTc-sestamibi subtraction SPECT (Spearman correlation = 0.28; P = 0.0167). ¹²³I/^99mTc-sestamibi subtraction SPECT is able to correctly localize hyperplastic parathyroid glands in patients with renal failure and secondary hyperparathyroidism, but there is a fairly weak relationship between preoperative detection rate and anatomical parathyroid gland size.

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