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Differential Findings of Tc-99m Sestamibi Dual-Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

Nuclear Medicine and Molecular Imaging volume 45, pages 276–284 (2011)Cite this article

Abstract

Purpose

This study aimed to investigate the differential findings in clinical and biochemical features, and Tc-99m sestamibi (MIBI) dual-phase parathyroid scintigraphy for malignant and benign parathyroid lesions in patients with primary hyperparathyroidism.

Methods

Subjects were 102 parathyroid lesions from 91 patients with primary hyperparathyroidism. Scintigraphic findings included radioactivity grade, uptake pattern, uptake contour, lesion size on early and delayed images, and degree of washout. Clinical and biochemical features were also evaluated. Histopathology confirmed the final diagnosis for all the patients.

Results

Final diagnoses were 94 benign parathyroid lesions and 8 parathyroid carcinomas. The patients with parathyroid carcinoma were significantly older (p = 0.002) and had significantly higher serum parathyroid hormone concentrations than those with benign parathyroid lesions (p < 0.001). All malignant parathyroid lesions showed intense radioactivity similar to or greater than the submandibular gland activity on delayed images (p = 0.007), and little radioactivity difference between early and delayed images (p = 0.012). The cancer incidence for parathyroid lesions with both intense radioactivity and no washout was 17.0% (8/47). When parathyroid lesions with all of the above-mentioned findings were regarded as malignant, the cancer incidence significantly increased from 17.0% to 33.3% (8/24, p < 0.001).

Conclusion

For Tc-99m MIBI dual-phase parathyroid scintigraphy, uptake grade on delayed images and washout were significantly useful diagnostic criteria for differentiating benign from malignant parathyroid lesions, along with age and parathyroid hormone serum concentration.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Miju Cheon, Joon Young Choi, Ji Young Lee, Sook Kyung Cho, Jang Yoo, Soo Bin Park, Kyung-Han Lee & Byung-Tae Kim

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    Jae-Hoon Chung

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  1. Miju Cheon
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  2. Joon Young Choi
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  3. Jae-Hoon Chung
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  4. Ji Young Lee
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  6. Jang Yoo
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  7. Soo Bin Park
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Correspondence to Joon Young Choi.

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Cheon, M., Choi, J.Y., Chung, JH. et al. Differential Findings of Tc-99m Sestamibi Dual-Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism. Nucl Med Mol Imaging 45, 276–284 (2011). https://doi.org/10.1007/s13139-011-0103-y

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  • DOI: https://doi.org/10.1007/s13139-011-0103-y

Keywords

  • Primary hyperparathyroidism
  • Parathyroid carcinoma
  • Parathyroid adenoma
  • Parathyroid hyperplasia
  • Tc-99m Sestamibi
  • Parathyroid scintigraphy