Table of Contents
International Journal of Molecular Imaging
Volume 2015 (2015), Article ID 391625, 9 pages
http://dx.doi.org/10.1155/2015/391625
Research Article

99mTechnetium Sestamibi-123Iodine Scintigraphy Is More Accurate Than 99mTechnetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism

1Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, University of Helsinki, 00029 Helsinki, Finland
2HUS Medical Imaging Center, Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, 00029 Helsinki, Finland
3Department of Surgery, Helsinki University Central Hospital, 00029 Helsinki, Finland
4Department of Biostatistics, University of Turku, 20520 Turku, Finland

Received 28 September 2014; Revised 14 December 2014; Accepted 19 December 2014

Academic Editor: Irene J. Virgolini

Copyright © 2015 Eeva M. Ryhänen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. Studies comparing outcome of single-c-methoxyisobutylisonitrile (c-sestamibi) and dual-tracer c-sestamibi scintigraphy in combination with 123I before primary surgery of primary hyperparathyroidism (PHPT) are scarce. Methods. We compared c-sestamibi/123I and c-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. Results. c-sestamibi/123I and c-sestamibi were positive in 206 (76.6%) and 111 (41.3%) of 269 patients, respectively (P < 0.001). Accuracies for c-sestamibi/123I and c-sestamibi were 63.4% and 34.9%, respectively (96% CI, P < 0.001). Prevalence of multiglandular disease was 15.2%. In multiglandular disease, c-sestamibi/123I and c-sestamibi revealed 43.8 and 22.1% of pathological glands, respectively (P < 0.001). Cure rate was similar for patients with (191/206; 92.7%) and without (59 of 63; 93.7%) a positive c-sestamibi/123I finding. Duration of targeted surgery (one or two quadrants) was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both P < 0.001). Higher serum calcium (P = 0.014) and PTH (P = 0.055) concentrations and larger tumours (P < 0.001) characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. Conclusions. c-sestamibi/123I scintigraphy is more accurate than c-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.