Complex method for diagnostic of the primary hyperparathyroidism including subtraction planar technique and SPECT-CT

Full text: Scintigraphy of the parathyroid glands is important for preoperative localization of the parathyroid adenomas or hyperplasia. The purpose of this study is to clarify the diagnostic capabilities of the combined subtraction planar scintigraphy with 99mTc-pertechnetate/99mTc-tetrofosmin (37 MBq and 740 MBq resp.) and SPECT-CT technique. 2 men and 8 women with proven have been studied. Four patients were additionally with thyroid disease (2 - with partial resection, 2 - with struma nodosa). Both techniques are performed sequentially; initially planar scintigraphy is performed by subtraction of the thyroid parenchyma visualized with 99mTc- pertechnetate of early (to 35-th minute) images with 99mTc-tetrofosmin. Right after a registration tomography of the neck and upper thorax has been performed, combined with SPECT-CT. The total duration of study is within 90 minutes. In all patients could be visualized a hyperfunction of the parathyroid glands. Our first impressions are that the subtraction technique is useful in cases of thyroid surgery, where there are small 'islands' of residual parenchyma and as well as direct to more than one parathyroid gland disease. SPECT-CT registration allows the exact localization of adenomas, including ectopic, in early stage - 35 minutes after injection of Tc 99 -tetrofosmin. The two techniques provide complementary information and are not burdensome for patient