PARATHYROID ADENOMA Prepared by Dr Gabriel Castro (Costa Rica)
58y/o female with
elevated PTH (293pg/ml) and neck ultrasound that showed two small nodules in the
right thyroid lobule (right hand side)
The Tc 99m-MIBI parathyroid SPECT scintigraphy shows a focus of increased MIBI
uptake at 10 min, below the left thyroid lobule and endothoracic, compatible
with a parathyroid adenoma (arrow). In the 99mTc pertecnetate image it is seen a
homogenuos uptake in the thyroid gland.
Tc 99m-MIBI parathyroid scintigraphy is a sensitive and specific tool for
topographic localization even of small parathyroid adenomas, sensitivity is
increase to 95% by supplementary use of the SPECT (1).
Preoperative SPECT in patients with primary hyperparathyroidism is essential for
accurate localization of parathyroid adenomas and for the selection of patients
who are candidates for minimally invasive radioguided surgery (2) .
References:
1) Detlef Moka, Eberhard Voth, et al. Technetium 99m-MIBI-SPECT: A highly
sensitive diagnostic tool for localization of parathyroid adenomas. Surgery
2000;128:29-35.
2) Mordechai Lorberboym, Irit Minski, et al. Incremental Diagnostic Value of
Preoperative 99mTc-MIBI SPECT in Patients with a Parathyroid Adenoma. J Nucl Med
2003; 44:904–908.