Pre-operative localization and tissue uptake study in parathyroid imaging with technetium-99m-sestamibi.

Abstract

The diagnostic ability of 99mTc-sestamibi was compared with other techniques and the mechanism of parathyroid uptake was investigated. Double-phase 99mTc-sestamibi scanning was performed in 52 primary and 28 renal hyperparathyroidism patients. Gene expressions of mdr1 and mrp were examined by reverse transcriptase polymerase chain reaction in parathyroid tissue. The sensitivity of 99Tc-sestamibi in primary and renal hyperparathyroidism was 91% and 75%, respectively, higher than for ultrasonography, T1/Tc subtraction scintigraphy, or computed tomography. Early 99mTc-sestamibi uptake was washed out in delayed images in 7% and 30% of glands in primary and renal hyperparathyroidism, respectively. Expression of mdr1 and mrp mRNA was found in 5 of 23 and 16 of 31 glands, respectively, and their expression correlated with washout in delayed images. 99mTc-sestamibi was the best localization test. mdr1 and mrp were associated with 99Tc-sestamibi washout, but their role in the parathyroid remains unclear.