Comparison of different strategies in parathyroid scintigraphy imaging in the setting of multi-gland hyperparathyroidism [abstract]

Medical records of 140 patients, diagnosed with multigland primary, secondary or tertiary hyperparathyroidism were reviewed. Of those, 56 patients had complete preoperative parathyroid scintigraphy with subsequent surgical resection of abnormal glands. Parathyroid scintigraphy at our institution utilizes 99mTc sestamibi (MIBI) and 123I, and consists of early and delayed pinhole MIBI images of the neck, MIBI-123I subtraction imaging, and MIBI single photon computed tomography (SPECT). Four experienced nuclear medicine physician, without knowledge of clinical or laboratory results or final diagnosis, reviewed seven different imaging variations in separate sessions. The imaging variations were early MIBI only (EARLY), delayed MIBI only (DELAYED), comparison of early and delayed MIBI (E-D), subtraction (SUB), all planar (PLANAR), SPECT only (SPECT), and all images (ALL). The location of the abnormal parathyroid glands was recorded and compared with the embryologic designation of the abnormal glands assigned at the time of surgery