Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT

Radiology. 1996 Oct;201(1):85-91. doi: 10.1148/radiology.201.1.8816526.


Purpose: To evaluate the ability to detect and localize parathyroid adenomas with technetium-99m sestamibi single photon emission computed tomography (SPECT).

Materials and methods: Forty-seven adult patients underwent Tc-99m sestamibi SPECT. Early (15-30 minutes after injection) and delayed (2-4 hours after injection) images were acquired. Thirty-three patients were examined for initial parathyroid surgery; the remaining 14, for repeat surgery because of persistent or recurrent hyperparathyroidism. SPECT reprojection images viewed in a rotating cine-display mode were read independently by two nuclear medicine physicians who were blinded to the results of other localization studies. Thirty-seven patients underwent subsequent neck exploration. SPECT findings were compared with surgical and histopathologic findings.

Results: In the 37 patients who underwent surgery, parathyroid adenomas were confirmed in 34 (92%) and hyperplasia in three (8%). In 31 patients, adenomas were correctly detected and localized with early SPECT images (sensitivity, 91%). In contrast, the sensitivity of delayed SPECT images was 74% (25 of 34 patients) for detection and 32% (11 of 34 patients) for localization. Early SPECT images were significantly better for localization (P < .001) and detection (P = .03).

Conclusion: For Tc-99m sestamibi parathyroid imaging, early SPECT images were the most accurate in the detection and localization of parathyroid adenomas.

MeSH terms

  • Adenoma / diagnostic imaging*
  • Adenoma / pathology
  • Adenoma / surgery
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Hyperplasia / diagnostic imaging
  • Hyperplasia / pathology
  • Male
  • Middle Aged
  • Parathyroid Glands / pathology
  • Parathyroid Neoplasms / diagnostic imaging*
  • Parathyroid Neoplasms / pathology
  • Parathyroid Neoplasms / surgery
  • Parathyroidectomy
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi*
  • Time Factors
  • Tomography, Emission-Computed, Single-Photon* / methods


  • Technetium Tc 99m Sestamibi