Abstract
Eighty six consecutive thallium-technetium subtraction parathyroid scans performed over a three year period for hypercalcaemia have been evaluated. Twelve had chronic renal failure, 11 had hypercalcaemia due to non-hyperparathyroid causes and in 10 the imaging study was technically inadequate. The remaining 53 technically adequate studies performed for hypercalcaemia clinically thought to be possibly due to hyperparathyroidism have been analysed. Of 20 (38%) positive scans, 13 came to surgery (10 correctly localized parathyroid adenomas, 2 with multiple gland hyperplasia, and 1 papillary carcinoma of the thyroid). Of 33 (62%) negative scans, 9 had surgical exploration on the basis of strong clinical grounds and all had parathyroid adenomas. Multiple biochemical parameters have been assessed in relation to a positive outcome on scan. The adjusted calcium-phosphate product and the ratio of the adjusted calcium-phosphate product to creatinine (Ca x P/Cr) were both significantly lower in the scan positive group (P less than 0.01). The scan positive group had a significantly higher mean level of PTH (P less than 0.001) and lower mean level of phosphate (P less than 0.001). The present experience shows that parathyroid imaging is useful in localizing parathyroid adenomas in 50% of cases (10 out of 19). This figure is at the lower end of the range of previously published results. It is less effective in demonstrating multiple gland hyperplasia. The decision as to whether to undertake surgical exploration when the scan is negative has been based successfully on clinical judgement. We feel that an analysis of this nature is important, as it gives insights into the practical relevance of parathyroid imaging in the context of routine clinical work.
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Selected References
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- Ashby J. P., Thakkar H. Diagnostic limitations of region-specific parathyroid hormone assays in the investigation of hypercalcaemia. Ann Clin Biochem. 1988 May;25(Pt 3):275–279. doi: 10.1177/000456328802500315. [DOI] [PubMed] [Google Scholar]
- Blake G. M., Percival R. C., Kanis J. A. Thallium-pertechnetate subtraction scintigraphy: a quantitative comparison between adenomatous and hyperplastic parathyroid glands. Eur J Nucl Med. 1986;12(1):31–36. doi: 10.1007/BF00638792. [DOI] [PubMed] [Google Scholar]
- Chatterton B. E., Wycherley A. G., Muecke T. S., Hoare L. L., Malycha P. Thallium-201-technetium-99m subtraction scanning: its value in 50 cases of hyperparathyroidism submitted to surgery. Aust N Z J Surg. 1987 May;57(5):289–294. doi: 10.1111/j.1445-2197.1987.tb01359.x. [DOI] [PubMed] [Google Scholar]
- Fine E. J. Parathyroid imaging: its current status and future role. Semin Nucl Med. 1987 Oct;17(4):350–359. doi: 10.1016/s0001-2998(87)80026-0. [DOI] [PubMed] [Google Scholar]
- Gimlette T. M., Brownless S. M., Taylor W. H., Shields R., Simkin E. P. Limits to parathyroid imaging with thallium-201 confirmed by tissue uptake and phantom studies. J Nucl Med. 1986 Aug;27(8):1262–1265. [PubMed] [Google Scholar]
- Gimlette T. M., Taylor W. H. Localization of enlarged parathyroid glands by thallium-201 and technetium-99m subtraction imaging. Gland mass and parathormone levels in primary hyperparathyroidism. Clin Nucl Med. 1985 Apr;10(4):235–239. doi: 10.1097/00003072-198504000-00001. [DOI] [PubMed] [Google Scholar]
- Hauty M., Swartz K., McClung M., Lowe D. K. Technetium-thallium scintiscanning for localization of parathyroid adenomas and hyperplasia. A reappraisal. Am J Surg. 1987 May;153(5):479–486. doi: 10.1016/0002-9610(87)90798-7. [DOI] [PubMed] [Google Scholar]
- Heath H., 3rd, Hodgson S. F., Kennedy M. A. Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med. 1980 Jan 24;302(4):189–193. doi: 10.1056/NEJM198001243020402. [DOI] [PubMed] [Google Scholar]
- McCall A., Henkin R., Calendra D., Lawrence A. M., Jarosz H., Paloyan E. Routine use of the thallium-technetium scan prior to parathyroidectomy. Am Surg. 1987 Jul;53(7):380–384. [PubMed] [Google Scholar]
- Nobin A. P., Tennvall J. G., Palmer J. G., Månsson B. N., Märtensson H. G. Location of parathyroid glands by thallium-technetium subtraction scintigraphy. Acta Chir Scand. 1987 Oct;153(10):581–586. [PubMed] [Google Scholar]
- Opelka F. G., Brigham R. A., Davies R. S., Kaplan K. A. The role of dual radionuclide scintigraphy in the preoperative localization of abnormal parathyroid glands. Am Surg. 1988 Apr;54(4):240–242. [PubMed] [Google Scholar]