FDG-PET/CT is widely used to diagnose cardiac inflammation such as cardiac sarcoidosis. Physiological myocardial FDG uptake often creates a problem when assessing the possible pathological glucose metabolism of the heart. Several factors, such as fasting, blood glucose, and hormone levels, influence normal myocardial glucose metabolism. The effect of outdoor temperature on myocardial FDG uptake has not been reported before. We retrospectively reviewed 29 cancer patients who underwent PET scans in warm summer months and again in cold winter months. We obtained myocardial, liver, and mediastinal standardized uptake values (SUVs) as well as quantitative cardiac heterogeneity and the myocardial FDG uptake pattern. We also compared age and body mass index to other variables. The mean myocardial FDG uptake showed no significant difference between summer and winter months. Average outdoor temperature did not correlate significantly with myocardial SUVmax in either summer or winter. The heterogeneity of myocardial FDG uptake did not differ significantly between seasons. Outdoor temperature seems to have no significant effect on myocardial FDG uptake or heterogeneity. Therefore, warming the patients prior to attending cardiac PET studies in order to reduce physiological myocardial FDG uptake seems to be unnecessary.

Jukka Schildt

Antti Loimaala

Eero Hippel&#xe4;inen

P&#xe4;ivi Nikkinen

Aapo Ahonen

Seasonal Temperature Changes Do Not Affect Cardiac Glucose Metabolism

<i>Background</i>. Intraoperative imaging can identify cancer cells in order to improve resection; thus fluorescent contrast agents have emerged. Our objective was to do a preclinical comparison of two fluorescent dyes, EC17 and OTL38, which both target folate receptor but have different fluorochromes. <i  >Materials</i>. HeLa and KB cells lines were used for <i  >in vitro</i> and <i  >in vivo</i> comparisons of EC17 and OTL38 brightness, sensitivity, pharmacokinetics, and biodistribution. <i  >In vivo</i> experiments were then performed in mice.<i  > Results</i>. The peak excitation and emission wavelengths of EC17 and OTL38 were 470/520&#x2009;nm and 774/794&#x2009;nm, respectively. <i  >In vitro</i>, OTL38 required increased incubation time compared to EC17 for maximum fluorescence; however, peak signal-to-background ratio (SBR) was 1.4-fold higher compared to EC17 within 60 minutes (<svg  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"   style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 50.7895 11.7782" width="50.7895pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="593" vert-adv-y="593" /></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="587" vert-adv-y="587" /></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="228" vert-adv-y="228" /></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g></svg>). Additionally, the SBR for detecting smaller quantity of cells was improved with OTL38. <i  >In vivo</i>, the mean improvement in SBR of tumors visualized using OTL38 compared to EC17 was 3.3 fold (range 1.48&#x2013;5.43). Neither dye caused noticeable toxicity in animal studies. <i  >Conclusions</i>. In preclinical testing, OTL38 appears to have superior sensitivity and brightness compared to EC17. This coincides with the accepted belief that near infrared (NIR) dyes tend to have less autofluorescence and scattering issues than visible wavelength fluorochromes.

Elizabeth De Jesus

Jane J. Keating

Sumith A. Kularatne

Jack Jiang

Ryan Judy

Jarrod Predina

Shuming Nie

Philip Low

Sunil Singhal

Comparison of Folate Receptor Targeted Optical Contrast Agents for Intraoperative Molecular Imaging

Multi-modality imaging provides coregistered PET-CT and SPECT-CT images; however such multi-modality workflows usually consist of sequential scans from the individual imaging components for each modality. This typical workflow may result in long scan times limiting throughput of the imaging system. Conversely, acquiring multi-modality data simultaneously may improve correlation and registration of images, improve temporal alignment of the acquired data, increase imaging throughput, and benefit the scanned subject by minimizing time under anesthetic. In this work, we demonstrate the feasibility and procedure for modifying a commercially available preclinical SPECT-CT platform to enable simultaneous SPECT-CT acquisition. We also evaluate the performance of simultaneous SPECT-CT tomographic imaging with this modified system. Performance was accessed using a <sup>57</sup>Co source and image quality was evaluated with <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.833899pt" id="M1" height="15.3888pt" version="1.1" viewBox="-0.0498162 -11.5549 29.3493 15.3888" width="29.3493pt"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path id="g190-193" d="M247 635C117 635 41 518 41 422C41 317 114 239 220 239C239 239 256 244 278 255L348 290C315 139 207 37 63 13L67 -15C93 -15 155 -5 207 17C343 71 443 203 443 385C443 520 371 635 247 635ZM231 602C331 602 355 476 355 390C355 371 354 349 351 325C334 310 298 294 261 294C177 294 128 369 128 457C128 516 155 602 231 602Z"/></g><g transform="matrix(.0091,0,0,-0.0091,4.505,-5.741)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0091,0,0,-0.0091,8.946,-5.741)"><path id="g190-110" d="M797 0V26C739 32 732 36 732 103V296C732 394 682 449 605 449C576 449 550 437 529 423C504 407 475 389 446 366C425 418 382 449 334 449C303 449 279 437 253 421C222 403 201 385 180 371V452C135 432 85 419 41 411V388C99 379 102 374 102 310V103C102 38 93 32 27 26V0H238V26C189 32 180 38 180 103V338C210 363 250 390 289 390C351 390 377 348 377 275V103C377 37 368 32 306 26V0H520V26C465 32 456 38 456 101V296C456 314 455 326 453 338C491 369 529 390 565 390C628 390 653 345 653 274V107C653 36 642 32 583 26V0H797Z"/></g><g transform="matrix(.013,0,0,-0.013,16.958,0)"><path id="g190-85" d="M592 498C586 556 582 629 581 675H560C545 656 537 650 510 650H115C87 650 74 652 60 675H40C38 620 33 555 28 495H57C69 539 77 568 89 585C102 607 122 616 205 616H267V123C267 44 259 34 168 28V0H454V28C360 34 352 44 352 123V616H422C498 616 514 608 531 584C542 568 552 543 562 495L592 498Z"/></g><g transform="matrix(.013,0,0,-0.013,23.7,0)"><path id="g190-100" d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z"/></g></svg> phantoms in a series of simultaneous SPECT-CT scans.

Dustin R. Osborne

Derek W. Austin

Feasibility and Initial Performance of Simultaneous SPECT-CT Imaging Using a Commercial Multi-Modality Preclinical Imaging System

<i>Objectives</i>. We investigated whether ultrasmall paramagnetic particles of iron oxide- (USPIO-) enhanced magnetic resonance imaging (MRI) can detect experimental chronic allograft damage in a murine renal allograft model.<i> Materials and Methods</i>. Two cohorts of mice underwent renal transplantation with either a syngeneic isograft or allograft kidney. MRI scanning was performed prior to and 48 hours after USPIO infusion using <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.04990005pt" id="M1" height="10.5763pt" version="1.1" viewBox="-0.0498162 -10.5264 21.6041 10.5763" width="21.6041pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-85" d="M620 675H597C578 656 570 650 541 650H144C112 650 104 653 94 675H72C59 618 42 552 23 493L53 491C71 534 88 564 105 585C124 608 144 615 238 615H290L197 121C182 40 174 34 88 28L82 0H361L367 28C275 34 266 38 281 121L374 615H441C522 615 543 608 553 583C562 560 566 531 565 493L597 494C603 551 612 629 620 675Z"/></g><g transform="matrix(.0135,0,0,-0.0135,8.635,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.0095,0,0,-0.0095,15.138,-5.984)"><path id="g50-43" d="M486 158C486 177 478 202 466 220C413 228 386 236 336 262C386 288 413 297 466 304C478 323 486 347 485 366C470 376 444 381 422 380C389 338 368 319 321 288C323 345 329 372 349 422C339 442 322 461 305 470C289 461 271 442 262 422C281 372 287 345 290 288C243 319 222 338 189 380C167 381 142 376 125 366C125 347 133 322 145 304C198 296 225 288 275 262C225 236 198 227 145 220C133 201 125 177 126 158C141 148 167 143 189 144C222 186 243 205 290 236C288 179 282 152 262 102C272 82 289 63 306 54C322 63 340 82 350 102C330 152 324 179 321 236C368 205 390 186 422 144C444 143 470 148 486 158Z"/></g></svg>-weighted protocols. <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2130003pt" id="M2" height="10.7394pt" version="1.1" viewBox="-0.0498162 -10.5264 21.4681 10.7394" width="21.4681pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-83" d="M610 18C585 26 567 34 540 68C517 97 499 128 476 171C452 215 425 276 413 304C496 332 570 394 570 494C570 555 545 595 509 619S419 650 364 650H139L133 622C216 615 219 612 203 527L129 132C112 40 105 36 23 28L17 0H279L285 28C199 34 194 40 211 132L239 284H284C320 284 334 275 351 236C374 182 394 140 420 93C459 23 495 -1 592 -8H600L610 18ZM480 485C480 424 449 372 403 342C374 323 338 316 293 316H245L291 562C296 589 301 601 311 608S337 618 358 618C432 618 480 575 480 485Z"/></g><g transform="matrix(.0135,0,0,-0.0135,8.495,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.0095,0,0,-0.0095,14.998,-5.984)"><use xlink:href="#g50-43"/></g></svg> values were calculated to indicate the degree of USPIO uptake. Native kidneys and skeletal muscle were imaged as reference tissues and renal explants analysed by histology and electron microscopy.<i> Results</i>. <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2130003pt" id="M3" height="10.7394pt" version="1.1" viewBox="-0.0498162 -10.5264 21.4681 10.7394" width="21.4681pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-83"/></g><g transform="matrix(.0135,0,0,-0.0135,8.495,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.0095,0,0,-0.0095,14.998,-5.984)"><use xlink:href="#g50-43"/></g></svg> values in the allograft group were higher compared to the isograft group when indexed to native kidney (median 1.24 (interquartile range: 1.12 to 1.36) versus 0.96 (0.92 to 1.04), <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6617603pt" id="M4" height="9.65971pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.65971" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g></svg>). <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2130003pt" id="M5" height="10.7394pt" version="1.1" viewBox="-0.0498162 -10.5264 21.4681 10.7394" width="21.4681pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-83"/></g><g transform="matrix(.0135,0,0,-0.0135,8.495,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.0095,0,0,-0.0095,14.998,-5.984)"><use xlink:href="#g50-43"/></g></svg> values were also higher in the allograft transplant when indexed to skeletal muscle (6.24 (5.63 to 13.51)) compared to native kidney (2.91 (1.11 to 6.46) <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6617603pt" id="M6" height="9.65971pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.65971" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg>). Increased <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2130003pt" id="M7" height="10.7394pt" version="1.1" viewBox="-0.0498162 -10.5264 21.4681 10.7394" width="21.4681pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-83"/></g><g transform="matrix(.0135,0,0,-0.0135,8.495,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.0095,0,0,-0.0095,14.998,-5.984)"><use xlink:href="#g50-43"/></g></svg> signal in kidney allograft was associated with macrophage and iron staining on histology. USPIO were identified within tissue resident macrophages on electron microscopy.<i> Conclusion</i>. USPIO-enhanced MRI identifies macrophage.

S. R. Alam

G. H. Tse

C. Stirrat

T. J. MacGillivray

R. J. Lennen

M. A. Jansen

D. E. Newby

L. Marson

P. A. Henriksen

Nanoparticle Enhanced MRI Scanning to Detect Cellular Inflammation in Experimental Chronic Renal Allograft Rejection

<i>Objectives</i>. Studies comparing outcome of single-<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M1" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><path id="g190-193" d="M247 635C117 635 41 518 41 422C41 317 114 239 220 239C239 239 256 244 278 255L348 290C315 139 207 37 63 13L67 -15C93 -15 155 -5 207 17C343 71 443 203 443 385C443 520 371 635 247 635ZM231 602C331 602 355 476 355 390C355 371 354 349 351 325C334 310 298 294 261 294C177 294 128 369 128 457C128 516 155 602 231 602Z"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><path id="g190-110" d="M797 0V26C739 32 732 36 732 103V296C732 394 682 449 605 449C576 449 550 437 529 423C504 407 475 389 446 366C425 418 382 449 334 449C303 449 279 437 253 421C222 403 201 385 180 371V452C135 432 85 419 41 411V388C99 379 102 374 102 310V103C102 38 93 32 27 26V0H238V26C189 32 180 38 180 103V338C210 363 250 390 289 390C351 390 377 348 377 275V103C377 37 368 32 306 26V0H520V26C465 32 456 38 456 101V296C456 314 455 326 453 338C491 369 529 390 565 390C628 390 653 345 653 274V107C653 36 642 32 583 26V0H797Z"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><path id="g190-85" d="M592 498C586 556 582 629 581 675H560C545 656 537 650 510 650H115C87 650 74 652 60 675H40C38 620 33 555 28 495H57C69 539 77 568 89 585C102 607 122 616 205 616H267V123C267 44 259 34 168 28V0H454V28C360 34 352 44 352 123V616H422C498 616 514 608 531 584C542 568 552 543 562 495L592 498Z"/></g></svg>c-methoxyisobutylisonitrile (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M2" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi) and dual-tracer <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M3" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi scintigraphy in combination with <sup>123</sup>I before primary surgery of primary hyperparathyroidism (PHPT) are scarce. <i>Methods</i>. We compared <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M4" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi/<sup>123</sup>I and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M5" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. <i>Results</i>. <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M6" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi/<sup>123</sup>I and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M7" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi were positive in 206 (76.6&#x25;) and 111 (41.3&#x25;) of 269 patients, respectively (<i>P</i> &#x3c; 0.001). Accuracies for <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M8" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi/<sup>123</sup>I and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M9" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi were 63.4&#x25; and 34.9&#x25;, respectively (96&#x25; CI, <i>P</i> &#x3c; 0.001). Prevalence of multiglandular disease was 15.2&#x25;. In multiglandular disease, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M10" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi/<sup>123</sup>I   and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M11" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi revealed 43.8 and 22.1&#x25; of pathological glands, respectively (<i>P</i> &#x3c; 0.001). Cure rate was similar for patients with (191/206; 92.7&#x25;) and without (59 of 63; 93.7&#x25;) a positive <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M12" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi/<sup>123</sup>I finding. Duration of targeted surgery (one or two quadrants) was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both <i>P</i> &#x3c; 0.001). Higher serum calcium (<i>P</i> = 0.014) and PTH (<i>P</i> = 0.055) concentrations and larger tumours (<i>P</i> &#x3c; 0.001) characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. <i>Conclusions</i>. <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M13" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi/<sup>123</sup>I scintigraphy is more accurate than <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.993501pt" id="M14" height="16.0335pt" version="1.1" viewBox="-0.0498162 -12.04 26.142 16.0335" width="26.142pt"><g transform="matrix(.0095,0,0,-0.0095,0,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,4.695,-5.984)"><use xlink:href="#g190-193"/></g><g transform="matrix(.0095,0,0,-0.0095,9.357,-5.984)"><use xlink:href="#g190-110"/></g><g transform="matrix(.0135,0,0,-0.0135,17.652,0)"><use xlink:href="#g190-85"/></g></svg>c-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.

Eeva M. Ryh&#xe4;nen

Ilkka Heiskanen

Mika V&#xe4;is&#xe4;nen

Eliisa L&#xf6;yttyniemi

Camilla Schalin-J&#xe4;ntti

Matti J. V&#xe4;lim&#xe4;ki

<sup>99m</sup>Technetium Sestamibi-<sup>123</sup>Iodine Scintigraphy Is More Accurate Than <sup>99m</sup>Technetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism

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International Journal of Molecular Imaging