Diagnostic Imaging Pathways - Suspected Primary Hyperparathyroidism

Sestamibi Nuclear Medicine Scan and Subtraction Pertechnetate Scan

• Used for pre-operative localisation of abnormal parathyroid glands in the following cases:
  1. Where minimally invasive surgery is intended. 13,14
  2. Recurrent or persistent hyperparathyroidism. 3,12
  3. Difficult cases. 15
• Includes the neck and the mediastinum for detection of ectopic abnormal parathyroid glands. 9
• High sensitivity (50-75%) and specificity (>90%) for the detection of abnormal parathyroid glands. 16-19
• Correlating the functional imaging provided by sestamibi scan with a technique with superior anatomical resolution such as SPECT, SPECT-CT, US, CT or MRI improves the sensitivity for detection of abnormal parathyroid tissue. 12,13,16,17,22,23
• Sestamibi accumulates in both parathyroid tissue and thyroid nodules and anatomical localisation of the abnormality is based on washout properties. 21
• 99mTc-pertechnetate is a thyroid selective radioisotope that can be used in combination with sestamibi. It is especially useful in patients with suspected or known thyroid disease or previous thyroid surgery. Digital subtraction methods can be used as an aid in identifying sestamibi accumulation due to abnormal parathyroid tissue. 21,22,23
• Limitations:
  1. Relatively poor image resolution and anatomical information (compared to US, CT or MRI). 17
  2. False negatives can occur in patients with small adenomas and with hyperplasia. 16

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