99mTc-sestamibi Scintigraphy Research Articles

Pediatric phase I trial and pharmacokinetic study of P-glycoprotein inhibitor, tariquidar, in combination with doxorubicin, vinorelbine or docetaxel

8541 Background: P-glycoprotein (Pgp), an ATP-dependent membrane transporter present in normal tissues, confers multidrug resistance in cancer cells. Tariquidar (TQ) blocks Pgp by inhibiting ATP binding and hydrolysis. Objectives: Assess toxicity, optimal dose, pharmacokinetics (PK) and pharmacodynamics of TQ in children with solid tumors and assess toxicity and PK of anticancer drugs (AD) in combination with TQ. Methods: TQ (1 [n=4], 1.5 [n=6], or 2 [n=5] mg/kg IV) was given alone on d 1 and with doxorubicin (DOXO, 50 mg/m2, n=10), docetaxel (75 mg/m2, n=4), or vinorelbine (20 mg/m2 d 3 & 10, n=1) on d 3. Plasma PK samples from d 1 & 3 were assayed for TQ by LC/MS/MS and DOXO by LC-fluorescent detection. Pgp function in vivo was assessed pre & post TQ using rhodamine uptake in CD56+ blood cells 24 h post TQ by flow cytometry (n=12) and 99mTc-sestamibi scintigraphy (n=6) immediately ater TQ. Results: 15 children (age 2–18, median 13) with sarcoma (n=8), adrenocortical carcinoma (n=3) or other (n=4) were enrolled. TQ was well tolerated at all dose levels. Delayed neutrophil recovery (n=2), grade 3 thrombocytopenia from docetaxel (n=1) and grade 3 mucositis (n=3) were prominent AD toxicities. AD toxicities may be more severe at the 2 mg/kg TQ dose. PK parameters for TQ alone are presented below. DOXO clearance (CL, n=8) was 400±150 mL/min/m2 given with TQ. Inhibition of rhodamine efflux in CD56+ cells was 54, 62, and 79% of maximum at the 1, 1.5 and 2 mg/kg doses of TQ. Sestamibi uptake increased by 1.7- to 4.1-fold (median, 2.6-fold) in liver and 1.2 to 1.4-fold in tumor (n=2) after TQ. Conclusions: 2 mg/kg TQ is well tolerated in children. TQ CL may be dose dependent, and at 2 mg/kg TQ CL is comparable to CL in adults. DOXO CL was comparable to published results. Pgp function in CD56+ blood cells is inhibited for ≥24 h. TQ also enhanced retention of sestamibi in liver and in some tumors. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration QLT, Inc.; Xenova Group, plc QLT, Inc.; Xenova Group, plc Xenova Group, plc

Pediatric phase I trial and pharmacokinetic study of P-glycoprotein inhibitor, tariquidar, in combination with doxorubicin, vinorelbine or docetaxel

8541 Background: P-glycoprotein (Pgp), an ATP-dependent membrane transporter present in normal tissues, confers multidrug resistance in cancer cells. Tariquidar (TQ) blocks Pgp by inhibiting ATP binding and hydrolysis. Objectives: Assess toxicity, optimal dose, pharmacokinetics (PK) and pharmacodynamics of TQ in children with solid tumors and assess toxicity and PK of anticancer drugs (AD) in combination with TQ. Methods: TQ (1 [n=4], 1.5 [n=6], or 2 [n=5] mg/kg IV) was given alone on d 1 and with doxorubicin (DOXO, 50 mg/m2, n=10), docetaxel (75 mg/m2, n=4), or vinorelbine (20 mg/m2 d 3 & 10, n=1) on d 3. Plasma PK samples from d 1 & 3 were assayed for TQ by LC/MS/MS and DOXO by LC-fluorescent detection. Pgp function in vivo was assessed pre & post TQ using rhodamine uptake in CD56+ blood cells 24 h post TQ by flow cytometry (n=12) and 99mTc-sestamibi scintigraphy (n=6) immediately ater TQ. Results: 15 children (age 2–18, median 13) with sarcoma (n=8), adrenocortical carcinoma (n=3) or other (n=4) were enrolled. TQ was well tolerated at all dose levels. Delayed neutrophil recovery (n=2), grade 3 thrombocytopenia from docetaxel (n=1) and grade 3 mucositis (n=3) were prominent AD toxicities. AD toxicities may be more severe at the 2 mg/kg TQ dose. PK parameters for TQ alone are presented below. DOXO clearance (CL, n=8) was 400±150 mL/min/m2 given with TQ. Inhibition of rhodamine efflux in CD56+ cells was 54, 62, and 79% of maximum at the 1, 1.5 and 2 mg/kg doses of TQ. Sestamibi uptake increased by 1.7- to 4.1-fold (median, 2.6-fold) in liver and 1.2 to 1.4-fold in tumor (n=2) after TQ. Conclusions: 2 mg/kg TQ is well tolerated in children. TQ CL may be dose dependent, and at 2 mg/kg TQ CL is comparable to CL in adults. DOXO CL was comparable to published results. Pgp function in CD56+ blood cells is inhibited for ≥24 h. TQ also enhanced retention of sestamibi in liver and in some tumors. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration QLT, Inc.; Xenova Group, plc QLT, Inc.; Xenova Group, plc Xenova Group, plc

Failure of Technetium Tc 99m Sestamibi Scanning to Detect Abnormal Parathyroid Tissue in a Horse and a Mule with Primary Hyperparathyroidism

Failure of Technetium Tc 99m Sestamibi Scanning to Detect Abnormal Parathyroid Tissue in a Horse and a Mule with Primary Hyperparathyroidism

Usefulness of 99mTc-sestamibi scintigraphy in suggesting the therapeutic effect of chemotherapy against gastric cancer.

Imaging with (99m)Tc-sestamibi ((99m)Tc-MIBI) has been used to assess 170-kDa P-glycoprotein (P-gp) expression and predict chemotherapy responses in several types of malignancy, such as breast and lung cancers. The purpose of this study was to evaluate the relationship between (99m)Tc-MIBI accumulation in tumors and sensitivity to chemotherapy in gastric cancer patients. Thirty-six patients with advanced gastric cancer underwent (99m)Tc-MIBI scintigraphy before chemotherapy. Patients also underwent endoscopic biopsy, and the expression of P-gp or multidrug resistance-associated protein was analyzed by immunohistochemical staining. The relationship between the accumulation of (99m)Tc-MIBI in tumors and responses to chemotherapy with 5-fluorouracil/cis-diamminedichloroplatinum(II) or epirubicin was examined. Higher accumulation of (9m)Tc-MIBI in tumors was observed in 25 and 23 of 36 gastric cancer patients at the early (30 min) and delayed (120 min) images, respectively. Accelerated accumulation of (99m)Tc-MIBI negatively correlates with increased expression of P-gp, but not of multidrug resistance-associated protein, as determined by immunohistochemistry in gastric cancer tissues. The response rate to 5-fluorouracil/cis-diamminedichloroplatinum(II) chemotherapy in patients with high (99m)Tc-MIBI accumulation (15.4%) was much lower than that in patients with low (99m)Tc-MIBI accumulation (54.5%). In contrast, patients with high (99m)Tc-MIBI accumulation show a higher response rate (41.7%) to chemotherapy with epirubicin, which is known to be a substrate of P-gp transporter. (99m)Tc-MIBI scintigraphy is useful to suggest the responses to chemotherapy of patients with advanced gastric cancer.

Effect of Pgp and MRP expression on detection of parathyroid tumors by 99mTc-sestamibi scintigraphy

Effect of Pgp and MRP expression on detection of parathyroid tumors by 99mTc-sestamibi scintigraphy

Ectopic paraesophageal mediastinal parathyroid adenoma, a rare cause of acute pancreatitis

BackgroundThe manifestation of primary hyperparathyroidism with acute pancreatitis is a rare event. Ectopic paraesophageal parathyroid adenomas account for about 5%–10% of primary hyperparathyroidism and surgical resection results in cure of the disease.Case presentationA 71-year-old woman was presented with acute pancreatitis and hypercalcaemia. During the investigation of hypercalcemia, a paraesophageal ectopic parathyroid mass was detected by computerized tomography (CT) scan and 99mTc sestamibi scintigraphy. The tumor was resected via a cervical collar incision and calcium and parathormone tumor levels returned to normal within 48 hours.ConclusionsAcute pancreatitis associated with hypercalcaemia should pose the suspicion of primary hyperparathyroidism. Accurate preoperative localization of an ectopic parathyroid adenoma, by using the combination of 99mTc sestamibi scintigraphy and CT scan of the neck and chest allows successful surgical treatment.

Clinical significance of transient left ventricular dilation assessed during myocardial Tc-99m sestamibi scintigraphy.

To assess the clinical significance of transient ischemic dilation of the left ventricle during myocardial perfusion scintigraphy with stress/rest sestamibi. The study retrospectively analyzed 378 patients who underwent myocardial perfusion scintigraphy with stress/rest sestamibi, 340 of whom had a low probability of having ischemia and 38 had significant transient defects. Transient ischemic dilation was automatically calculated using Autoquant software. Sensitivity, specificity, and the positive and negative predictive values were established for each value of transient ischemic dilation. The values of transient ischemic dilation for the groups of low probability and significant transient defects were, respectively, 1.01 0.13 and 1.18 0.17. The values of transient ischemic dilation for the group with significant transient defects were significantly greater than those obtained for the group with a low probability (P<0.001). The greatest positive predictive values, around 50%, were obtained for the values of transient ischemic dilation above 1.25. The results suggest that transient ischemic dilation assessed using the stress/rest sestamibi protocol may be useful to separate patients with extensive myocardial ischemia from those without ischemia.

Effect of attenuation correction on the interpretation of 99mTc-sestamibi myocardial perfusion scintigraphy: the impact of 1 year's experience

The aim of this study was to determine the yield of attenuation correction in myocardial perfusion imaging (MPI), before and after a 1-year experience period. In 48 consecutive patients referred for MPI, both non-corrected (NC) and attenuation-corrected (AC) images were analysed by three independent readers shortly after implementation of attenuation correction. The same images were re-analysed 1 year later, after having obtained experience in attenuation correction on a routine basis in >500 patients with clinical feedback. Results were compared with gold standards for ischaemia and infarction based on coronary angiography, follow-up, ultrasound and gated blood pool imaging. Sensitivity and specificity for the detection of coronary artery disease were 95% and 45% respectively for NC images and 77% and 70% respectively for AC images at first readings. After 1 year of AC experience, NC sensitivity/specificity was 100%/61%, and AC results were 89%/92%. It is concluded that attenuation correction improves the performance of MPI interpretation. With attenuation correction, specificity is increased and sensitivity is similar as compared with NC images. However, attenuation correction requires experience and is associated with a learning curve.

TI-201, Tc-99m Sestamibi, and Tc-99m HMDP Uptake in Multiple Brown Tumors

A 62-year-old woman was hospitalized after bone tumors appeared incidentally on chest radiographs. Laboratory data were consistent with primary hyperparathyroidism. Computed tomography of the neck revealed a papillary polyp with a right thyroid cyst and a right inferior parathyroid adenoma. TI-201 and Tc-99m sestamibi scintigraphy revealed uptake not only in the parathyroid adenoma but also in the left clavicle, sternum, and ribs. A bone biopsy revealed a brown tumor. The sensitivity of Tc-99m HMDP is superior to that of TI-201 and Tc-99m sestamibi in detecting brown tumors. Brown tumors can be associated with both false-positive and false-negative findings on TI-201 and Tc-99m sestamibi scintigraphy.

Tc99m-sestamibi scintigraphy and cell proliferation in primary hyperparathyroidism: A causal or casual relationship?

Background. Sestamibi scintigraphy has become the fundamental technique for preoperative location of hyperfunctioning glands responsible for hyperparathyroidism, especially in the case of adenomas. However, little is known about the mechanisms of tracer uptake and retention by these glands, mechanisms that have been related to an increased gland metabolism. Our goal was to determine whether there is a relationship between the positive result of gammagraphy with sestamibi, for diagnosing the location of parathyroid adenomas, and the cell proliferation index. Patients and Methods. Six glands corresponding to sestamibi false negatives and 12 true positives were studied in patients with single-adenoma primary hyperparathyroidism. The following data were recorded in all the patients: age, gender, clinical and analytical data, gland weight, and parathyroid hormone (PTH)/gland weight ratio. An immunohistochemical study of the glands was also done with the use of Ki67, with determination of the mean proliferation index of each group for comparison purposes. Results. On comparing the 2 groups, we found no differences between the clinical or analytical parameters. Differences were found only for proliferation index—(5.7% in true positive glands versus 0.3% in false negative glands (P <.004). Conclusion. Tracer (sestamibi) uptake by hyperfunctioning parathyroid adenomas in primary hyperparathyroidism might be linked to a higher gland metabolism activity, probably related to cell proliferation. (Surgery 2003;134:41-4.)

Experienced Scintigraphers Contribute to Success of Minimally Invasive Parathyroidectomy by Skilled Endocrine Surgeons

Minimally invasive parathyroidectomy (MIP) has become the preferred surgical treatment for selected patients diagnosed with primary hyperparathyroidism (PHPT) at our tertiary-care center. Preoperative scintigraphy establishes the position of a parathyroid adenoma, dictates the incision site, and can minimize incision size and consequent tissue dissection. We reviewed our database and sought to identify factors that led to discordant preoperative imaging and operative findings and to assess the effect of experience on these findings. A retrospective review was performed on all patients with biochemically proven PHPT who underwent Tc-99m sestamibi scintigraphy and surgical intervention. Patient demographics, date of surgical intervention, scintigraphic localization, surgical findings, pre- and postoperative biochemical markers, histopathology, coexisting thyroid pathology, and 6-month follow up were recorded. Preoperative images that were discordant with operative findings were independently reviewed. Parathyroid scintigraphy was performed on 125 consecutive patients for PHPT between November 1999 and January 2002. Seventy-six patients had MIPs, 35 had standard cervical explorations, 11 had MIPs that were converted to standard cervical explorations, and three had surgery directed to an ectopic location. At 6-month follow-up 98.4 per cent were cured. Preoperative imaging and surgical findings were ipsilateral and concordant in 105 of 118 (89%) patients with parathyroid adenoma. The anatomic origin of an adenoma was predicted in only 83 of 118 (68%) patients. Most of the inaccurate scintigraphy readings occurred during the first 13 of the 26 months that MIPs were performed at our institution. Only two discordant cases occurred during the last 9 months of this period. Biochemical markers, prior neck operation, and concomitant thyroid pathology had no correlation with imaging sensitivity. Scintigraphic interpretation of smaller adenomas was less reliable; discordant cases were more common in small adenomas. Communication between endocrine surgeons and nuclear medicine physicians about the MIP technique and anatomic orientation of adenomas led to better scintigraphic localization as experience increased. Now that MIP by skilled endocrine surgeons is becoming the favored treatment for PHPT experienced nuclear medicine physicians may be the most important factor to achieve maximum success.

Preoperative localization study of intrathyroidal parathyroid adenoma: usefulness of power Doppler ultrasonography

Preoperative localization study of intrathyroidal parathyroid adenoma is said to be difficult because differentiating intrathyroidal parathyroid adenoma from thyroid nodules is impossible by conventional imaging such as gray-scale ultrasonography, computed tomography, magnetic resonance imaging and 201T1– 99mTc subtraction scintigraphy. We report a case of intrathyroidal parathyroid adenoma, for which preoperative localization study was successful by 99mTc–sestamibi scintigraphy, power Doppler ultrasonography and measuring intact-parathyroid hormone level in needle aspirates of the tumor by fine-needle aspiration under ultrasonography. Power Doppler ultrasonography confirmed not only rich blood flow signals in the tumor but also a feeding vessel running into the tumor from the branch of the inferior thyroid artery.

Review of 26 patients operated on for primary hyperparathyroidism

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean, 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thallium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathyroidectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n = 16; hyperplasia group, n = 6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery. In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands are not injured by the biopsy procedures.

Myocaridal Scintigraphy with 99mTc-Sestamibi in Patients with Kawasaki Disease

To verify the usefulness of a semi-invasive assessment of myocardial perfusion, rest and dipyridamole 99mTc-Sestamibi scintigraphy were performed on 62 patients (19 females and 43 males) with Kawasaki disease. Their ages at the onset of Kawasaki disease ranged from 3 months to 10 years. The nuclear medicine study was performed at the age of 3.5 months to 18 years (6.5±5.3 years); they were 0.5 month to 17 years after the onset of illness. Among them, coronary arterial dilatation had been detected by two-dimensional echocardiography in 9 patients. Four of them were also demonstrated by cardiac catheterization. Seven of them with coronary arterial lesions showed 99mTc-Sestamibi scintigraphic abnormalities. Perfusion defects were also detected in 18 of 53 patients (false positive rate 34.0%) with normal coronary arteries on echocardiography or cineangiography. The sensitivity, specificity, positive and negative predictive value of 99mTc-Sestamibi scintigraphy for detection of myocardial dysfunction which may indicating coronary arterial lesions were 77.8% (7/9), 66.0% (35/53), 28% (7/25) and 94.6% (35/37). The higher negative predictive value (94.6%) and sensitivity (77.8%) suggest that rest and dipyridamole 99mTc-Sestamibi scintigraphy is an useful and semi-invasive method for detecting coronary arterial insufficiency and long-term follow-up study of patients with Kawasaki disease.

Minimally invasive video-assisted parathyroidectomy and intraoperative parathyroid hormone monitoring. The first 36 cases and some pitfalls.

The success of parathyroid surgery depends on the identification and removal of all hyperactive parathyroid tissue. At this writing, bilateral cervical exploration and identification of all parathyroid glands represent the operative standard for primary hyperparathyroidism (pHPT). However, improved preoperative localization techniques and the availability of intraoperative parathyroid hormone monitoring prepare the way for minimally invasive procedures. Patients with pHPT and one unequivocally enlarged parathyroid gland on preoperative ultrasound and 99mTc-SestaMIBI scintigraphy underwent minimally invasive video-assisted parathyroidectomy by an anterior approach. Intraoperatively, a rapid chemiluminescense immunoassay was used to measure intact parathyroid hormone (iPTH) levels shortly before and then 5, 10, and 15 min after excision of the adenoma. The operation was considered successful when more than a 50% decrease in preexcision iPTH levels was observed after 5 min. Between October 1999 and November 2001, 36 of 82 patients with pHPT were eligible for a minimally invasive approach. A conversion to open surgery became necessary in five patients because of technical problems. In three cases, intraoperative iPTH monitoring showed no sufficient decrease in iPTH values. In these cases, subsequent cervical exploration showed one double adenoma and two hyperplasias, respectively. In two patients we had difficulty interpreting intraoperative iPTH values, resulting in persistent pHPT. Despite the use of high-resolution ultrasound and 99mTc-SestaMIBI scintigraphy, the presence of multiple glandular disease cannot be ruled out completely. Intraoperative iPTH monitoring to ensure operative success is indispensible for a minimally invasive approach. Despite our problems with iPTH monitoring in two patients, we believe that in selected cases, minimally invasive parathyroidectomy represents an attractive alternative to conventional surgery.

Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy

Early resolution of ST-segment elevation is an indicator of final infarct size and clinical outcomes. Whether this correlation is an expression of initial infarct characteristics or degree of myocardial salvage achieved with reperfusion therapy is unclear. We prospectively included 243 patients with acute myocardial infarction (AMI) treated with either coronary stenting (122 patients) or thrombolysis (121 patients). Serial 12-lead electrocardiograms (ECG) were performed at baseline and 90 minutes after initiation of therapy. ST-segment resolution was defined as complete (> or =70%), partial (<70% to 30%), or no resolution (<30%). Paired technetium-99m sestamibi scintigraphic studies were performed to calculate the initial perfusion defect, final infarct size, and the proportion of initial defect salvaged with reperfusion (salvage index). ST-segment resolution correlated significantly with salvage index (P=0.008), final infarct size (P<0.001), and 6-month mortality (P=0.03). In the groups with complete, partial, and no resolution, salvage index was 0.54+/-0.32, 0.39+/-0.36, and 0.33+/-0.60; final infarct size was 12.5+/-12.0%, 20.0+/-13.9%, and 22.7+/-19.4% of the left ventricle; 6-month mortality was 2.4%, 6.2%, and 12.8%, respectively. After adjustment for baseline characteristics, ST-segment resolution was the second strongest predictor of salvage index (P=0.007) after the type of reperfusion, stenting, or thrombolysis (P=0.001); it was greater after stenting than after thrombolysis (P<0.001). Early resolution of ST-segment elevation in surface ECG correlates with myocardial salvage as assessed by scintigraphy in patients with AMI after reperfusion therapy. These data provide an explanation for the favorable prognostic value of the ST-segment resolution and support the use of this parameter to compare the efficacy of different reperfusion strategies.

Phase I Trial of Technetium [Leu13] Bombesin as Cancer Seeking Agent: Possible Scintigraphic Guide for Surgery?

Bombesin-like neuropeptides work as neurotransmitters and growth factors at the same time. Several human cancers show overexpression of three receptors for mammalian counterparts of amphibia bombesins (ABNs), ie gastrin-releasing peptide (GRP), neuromedin B (NMB) and possibly another peptide. ABNs in turn are able to bind to mammalian and human receptors in vitro, and it is therefore interesting to study radioisotope-labeled bombesin (BN) and BN-like peptides as cancer seeking agents. Starting from the amino acid sequence of [Leu13] ABN, the Demokritos Institute has synthesized and labeled with technetium a new BN-like peptide that has the same biological characteristics as the amphibian peptide; changes were made only in the N-terminal part of the tetradecapeptide. After having obtained satisfactory results with 99mTc BN in a preclinical study, we started a phase I trial involving cancer patients as well as normal volunteers in Tomsk. Three normal volunteers, one patient with small cell lung cancer and one patient with primary prostate cancer were studied after iv injection of 185 MBq, corresponding to 0.7 micrograms of 99mTc BN. Dynamic images of the tumors were acquired for 20 mins, followed by SPET. Total body images were acquired in patients and normal volunteers 1 and 3 h after 99mTc BN acquisition. In addition, 99mTc sestamibi scintigraphy was performed in the patient with small cell lung carcinoma. No relevant side effects were observed. Both tumors were well visualized on early 1-2 mins images with planar as well as tomographic imaging. Total body images showed radioactivity in the liver, kidneys and thyroid gland. The stomach and spleen were ever imaged. Radioactivity was found in the urinary bladder 4 mins after injection in the patient with prostate cancer. Three-hour total body scans showed radioactivity in the duodenum. In the patient in whom also 99mTc sestamibi scintigraphy was performed, thyroid uptake was much higher with sestamibi than with 99mTc BN, whereas the uptake of small cell lung carcinoma was higher with 99mTc BN than with sestamibi. 99mTc BN is able to clearly image tumors with BN receptor overexpression. Our first impression is that in the future this radiopharmaceutical may serve as a cancer seeking agent and, due to its high tumoral uptake, also as a radiotracer for radioisotope-guided surgery.

Detection of a Recurrent Parathyroid Carcinoma with FDG Positron Emission Tomography

Primary hyperparathyroid disease is a relatively common endocrine disorder caused by parathyroid adenoma, chief cell hyperplasia or, rarely, parathyroid carcinoma. Parathyroid carcinoma accounts for approximately 0.14% of cases of primary hyperparathyroid disease. Surgical resection is the mainstay of therapy in these patients. Diagnosis is established biochemically by detection of elevated serum parathyroid hormone (PTH) and calcium concentrations. Although multiple imaging methods, such as computed tomography (CT), ultrasonography, magnetic resonance imaging (MRI), and Tc-99m sestamibi scintigraphy, can be used to examine patients with hyperparathyroid disease, their use for preoperative localization of abnormal parathyroid glands before first-time exploration remains controversial. However, most investigators agree that imaging, particularly Tc-99m sestamibi scintigraphy, is helpful for planning repeated surgery in patients with recurrent hyperparathyroid disease. Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG), however, has also been used for preoperative localization of abnormal parathyroid glands. This report addresses the use of FDG PET to detect parathyroid carcinoma.

Differentiation of Parathyroid and Thyroid Nodule by Tc-99m Sestamibi Scintigraphy

Differentiation of Parathyroid and Thyroid Nodule by Tc-99m Sestamibi Scintigraphy

Technetium-99m sestamibi limb scintigraphy in post-traumatic reflex sympathetic dystrophy: preliminary results.

Reflex sympathetic dystrophy (RSD) has widely variable clinical manifestations. Its pathogenesis remains partially unexplained. RSD is commonly divided into three stages; these stages are not always clearly separable, but staging remains important for correct treatment. Since the disease involves soft tissue alterations as well as bone changes, we decided to investigate whether technetium-99m sestamibi limb imaging can be used to evaluate the soft tissue appearance. Fifteen patients (seven females and eight males; age range 12-68 years) with clinically significant post-fracture RSD were evaluated with both three-phase bone scan (TPBS) and 99mTc-sestamibi limb scintigraphy. Although, in general, patients with similar duration of disease, clinical stage and TPBS activity tended to have similar patterns of sestamibi uptake, discordant uptake patterns were observed in some patients with clinical stage 1. Thus, of 12 patients with stage I disease, eight had increased 99mTc-sestamibi activity in the distal part of the affected limb, while three had normal activity and one had decreased activity. All three patients with stage II disease showed normal 99mTc-sestamibi uptake. Although most of the patients with increased 99mTc-sestamibi uptake had increased activity on all three phases of the bone scan, there were discordant results between the scan patterns in other patients. On the basis of these findings, we suggest that 99mTc-sestamibi imaging may contribute to the differentiation between clinical stages and may permit evaluation of the disease course and selection of appropriate therapy. 99mTc-sestamibi imaging is not, however, a primary diagnostic procedure for RSD.