sodium-pertechnetate-tc-99m and thallium-chloride

Topics: Female; Humans; Hyperparathyroidism; Male; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroidectomy; Patient Selection; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Treatment Outcome

Preoperative Tc-99m sestamibi scanning can identify candidates for minimally invasive parathyroid surgery. However, a significant number of patients with single gland disease have negative scans and are not considered for the minimally invasive procedure.. To determine if T1-201/Tc-99m sodium pertechnetate subtraction scanning (TPSS) is a viable alternative imaging technique for patients with primary hyperparathyroidism (1 degrees HPTH), we reviewed our experience. The outcomes of 100 consecutive patients with 1 degrees HPTH who underwent preoperative TPSS and parathyroid exploration between 1995 and 2000 at our institution were retrospectively reviewed.. The mean preoperative calcium and parathyroid hormone levels were 10.8 mg/dL and 220 pg/mL, respectively. The overall cure rate was 96%. Single gland disease was present in 88%. Of the 100 patients studied, 15 underwent both a Tc-99m sestamibi scan and TPSS, whereas the other 85 had only the TPSS.. The sensitivity and positive predictive value of the TPSS were 73.3% and 90.4%, respectively. In the patients undergoing both TPSS and Tc-99m sestamibi scans, the results concurred in 60%. However, in 20% of the remaining patients, TPSS correctly localized the abnormal parathyroid(s) when Tc-99m sestamibi failed. TPSS has a comparable sensitivity and positive predictive value to Tc-99m sestamibi scanning. In patients with a negative Tc-99m sestamibi scan, TPSS can provide additional localizing information. As a result of the high positive predictive value of TPSS, a single parathyroid gland localized by TPSS alone can then be approached by minimally invasive parathyroidectomy.

Topics: Female; Humans; Hyperparathyroidism; Male; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroidectomy; Patient Selection; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Treatment Outcome

Although bilateral exploration is highly effective in the treatment of primary hyperparathyroidism, minimally invasive parathyroidectomy has evolved into the procedure of choice when a single parathyroid lesion can be localized preoperatively. In this article, we discuss the utilization of thallium-pertechnetate subtraction scanning (TPSS) after technetium Tc-99m sestamibi scintigraphy failed to localize an ectopic parathyroid adenoma. Subsequently, radioguided resection of an undescended parathyroid adenoma inferior to the left submandibular gland was performed with surgical cure after a single procedure. This case report illustrates the importance of TPSS as a second-line modality in preoperative adenoma localization, thereby using minimally invasive techniques to successfully treat this patient's primary hyperparathyroidism.

Topics: Choristoma; Female; Humans; Hyperparathyroidism; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroid Diseases; Parathyroid Glands; Parathyroidectomy; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Treatment Outcome

Mucosa-associated lymphoid tissue (MALT) lymphoma has been established as a distinct entity among non-Hodgkin's lymphomas, and the most common primary site is the stomach. We describe scintigraphic findings in a patient with MALT lymphoma of the thyroid. A 71-year-old woman with Hashimoto's thyroiditis suffered from rapid cervical swelling, and ultrasonography and CT revealed a thyroid nodule. The nodule showed accumulation of 99mTc pertechnetate comparable to the surrounding thyroid tissue, mimicking a benign nodule. Both 67Ga and 201Tl imaging visualized the lesion as an increased uptake area. After radiotherapy, abnormally increased uptake disappeared on 67Ga images, which predicted a favorable outcome. MALT lymphoma of the thyroid may be visualized as a warm nodule on 99mTc pertechnetate scintigraphy.

Topics: Aged; Citrates; Female; Gallium; Humans; Lymphoma, B-Cell, Marginal Zone; Palpation; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms; Thyroiditis, Autoimmune; Ultrasonography

Topics: Humans; Parathyroid Glands; Parathyroid Neoplasms; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

In primary hyperparathyroidism (pHPT), parathyroidectomy is the treatment of choice, but anatomic variations of ectopic glands may cause surgical failure. Reliable preoperative noninvasive localization procedures would have a positive impact on the operative time and increase recovery rate. We retrospectively evaluated 186 patients with pHPT who were studied before successful parathyroidectomy by double tracer scintigraphy (99mTc-pertechnetate+201TI chloride or 99mTc-pertechnetate +99mTc-sestamibi, 160 patients), ultrasonography (148 patients) and computerized tomography (CT) scan (92 patients). During bilateral neck exploration, 159 (85.5%) single adenomas, 6 (3.2%) parathyroid carcinomas, and 3 (1.6%) double adenomas were found. Moreover, 18 (9.7%) patients had diffuse chief cells parathyroid hyperplasia. Removed parathyroid glands were in ectopic sites in 41 (22.0%) cases, mainly localized in the upper mediastinum or behind the esophagus. The overall sensitivity was 83.5 and 85.2% for 99mTc-pertechnetate+201TI chloride and 99mTc-pertechnetate+99mTc-sestamibi scintigraphy respectively, 80.4% for CT scan and 81.1% for ultrasonography. In patients with ectopic glands, sensitivity was 81.2, 79.5, 73.3 and 81.6% respectively. In 36 out of 41 patients with ectopic glands in whom the removed parathyroids were correctly localized, mean operative time was 95 min, and in 5 patients without preoperative localization it was 260 min. In conclusion, in pHPT, preoperative localization of an enlarged parathyroid is helpful, especially in ectopic adenomas and in anatomic variations in location, and it has been proved to reduce operative time and morbidity rate.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Carcinoma; Evaluation Studies as Topic; Female; Humans; Hyperparathyroidism; Intraoperative Period; Male; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium; Thallium Radioisotopes; Tomography, X-Ray Computed; Ultrasonography

The experience of the surgeon and precise localization of abnormal parathyroid glands determine the success of surgery for primary hyperparathyroidism (HPT). In HPT patients undergoing repeat surgery, the use of localization studies improved the ability to identify the remaining abnormal parathyroid tissue. This study investigated the roles of preoperative localization techniques for initial surgery for primary HPT. From 1985 through 1997, two noninvasive localization procedures, ultrasonography (US) and 201thallium chloride-99mtechnetium pertechnetate subtraction scanning (Tl-Tc), were used prior to initial exploration for primary HPT in 76 patients. Their accuracy was determined on the basis of surgical and pathologic results. The surgical success rate was 96% (73/76). The sensitivities of US and Tl-Tc were 71% and 49%, respectively. The sensitivity of Tl-Tc was higher for the lower parathyroid glands. In 21 of 26 patients who underwent fine-needle aspiration (FNA) of the suspected enlarged parathyroid gland, the diagnosis of parathyroid adenoma was confirmed preoperatively. We conclude that the concomitant use of US and FNA is a safe and convenient method for preoperative localization of the parathyroid glands prior to initial surgical exploration in patients with primary HPT. Bilateral neck exploration by an experienced surgeon should be the routine procedure. US and Tl-Tc alone offer limited localization information, and unilateral exploration should be reserved for selected cases in which the results of these two imaging studies are consistent with one another.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium; Thallium Radioisotopes; Ultrasonography

A 61-year-old man with medullary thyroid carcinoma and local invasion of the left lobe of the thyroid had Tc-99m MIBI SPECT and Tl-201 chloride/Tc-99m pertechnetate subtraction SPECT after left lobectomy of the thyroid, using a triple-headed gamma camera. Tl-201 chloride/Tc-99m pertechnetate subtraction demonstrated a large mass with high Tl-201 uptake in the left neck. Although there was intense uptake in the tumor in the left thyroid bed on Tc-99m MIBI neck SPECT, there was also uptake in both salivary glands and the right lobe of the thyroid gland. Thus, uptake in the right lobe of the thyroid gland and the salivary glands might not be differentiated from tumor invasion or metastasis from medullary cell carcinoma. Compared with MIBI SPECT, Tl-201 chloride/Tc-99m pertechnetate subtraction SPECT shows more apparent delineation of tumor uptake and may be a preferable technique.

Topics: Carcinoma, Medullary; Humans; Male; Middle Aged; Neoplasm, Residual; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium; Thallium Radioisotopes; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

The intrahepatic distribution of radioactivity after the per-rectal administration of 201T-chloride and/or 99Tcm-pertechnetate was investigated in 177 studies in 149 patients with no liver disease or diffuse liver disease and compared with that of 99Tcm-stannous (99Tcm-Sn) colloid scintigrams. The patients were classified into two groups: distribution of intrahepatic radioactivity of 201Tl and/or 99Tcm-pertechnetate scintigrams similar to (homogeneous) or different from (heterogeneous) that of 99Tcm-Sn-colloid scintigrams. The heterogeneous group was divided into three subgroups: increased radioactivity of the right lobe (right dominant pattern), increased radioactivity of the left lobe (left dominant pattern) and uneven distribution of radioactivity in both lobes (uneven pattern). Of the 80 patients in whom the studies were performed in the supine position at rest, 14 (17.5%) showed a heterogeneous pattern (8 right dominant, 4 left dominant, 2 uneven) and 66 (82.5%) a homogeneous pattern. In the 97 patients allowed free body movement, 6 (6.2%) showed a heterogeneous (1 right dominant, 5 left dominant) and 91 (93.8%) a homogeneous pattern. A significant difference in the incidence of heterogeneous distribution between the resting and free body movement groups was found (P < 0.05). One patient with a left dominant pattern after free body movement with 201Tl showed a right dominant pattern at rest in the 99Tcm-pertechnetate study. It is concluded that a heterogeneous intrahepatic distribution of inferior mesenteric vein blood is sometimes observed and that the distribution of portal vein blood flow seems to be affected by the patient's positioning and free body movement.

Topics: Administration, Rectal; Hepatitis; Humans; Liver Circulation; Liver Cirrhosis; Liver Diseases; Mesenteric Veins; Movement; Portal System; Portal Vein; Posture; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Compounds; Thallium; Tin Compounds

Simultaneous investigations with two isotopes are currently restricted because of spectral overlap. The factor analysis of spectral and dynamic structures (FASDS) method is shown to achieve accurate spectral separation. In addition, it estimates underlying dynamic mechanisms. Twenty-six patients were injected simultaneously with 99Tcm-pertechnetate and 201Tl-chloride to assess the malignancy of solitary thyroid nodules. List-mode acquisition of spectral, temporal and spatial coordinates of events allows the reconstruction of an image sequence indexed by time and energy. FASDS proceeds in two steps. First it yields both dynamic and spatial information related to each isotope (99Tcm and 201Tl) and partially removes the scatter component. Then it estimates the underlying kinetics and associated spatial distributions of each isotope. Using the 201Tl component, an index was derived from the uptake ratio between nodules and normal thyroid tissue. Concerning the detection of malignant nodules the method indicated no false negative in our limited group of 26 patients. One false positive result was found which could not be classified by the investigation of the 201Tl dynamic components contained in the reconstructed 201Tl factor sequence.

Topics: Factor Analysis, Statistical; Humans; Image Processing, Computer-Assisted; Models, Structural; Radionuclide Imaging; Signal Processing, Computer-Assisted; Sodium Pertechnetate Tc 99m; Thallium; Thallium Radioisotopes; Thyroid Nodule

To determine the accuracy of noninvasive and invasive localization studies in patients with persistent or recurrent hyperparathyroidism (HPT).. Reoperations based on patients who were treated surgically for recurrent or persistent HPT at the University of California-San Francisco Hospitals from 1982 to 1993.. This study evaluated 174 localization studies performed in 152 patients before reoperation (110 women and 42 men).. The accuracy of localization studies, including ultrasonography, thallous chloride T1 201-technetium Tc 99m pertechnetate scanning, technetium Tc 99m sestamibi scanning, magnetic resonance imaging, computed tomography, and selective venous catheterization, were evaluated, as were the results of parathyroid reoperations.. A total of 174 consecutive reoperations were performed in 152 patients with HPT (persistent, 113; recurrent, 39; mean age, 54 years; range, 21 to 88 years). One hundred thirty-three patients had primary HPT, 15 had secondary HPT, and four had tertiary HPT. Overall, 141 (93%) became normocalcemic, two (1%) became hypocalcemic, and nine (6%) remained hypercalcemic. Abnormal parathyroid glands at reoperation were situated in a normal location in 77 cases (44%), in the mediastinum in 37 cases (22%), in a deep cervical location in 34 cases (19%), or in an intrathyroidal location in 14 cases (8%), or were undescended in four cases (2%); supernumerary glands were found in 26 cases (15%). Some patients had more than one remaining abnormal gland. Selective venous catheterization with a parathyroid hormone assay was done in cases in which the results of noninvasive localization studies were equivocal or negative, and it frequently converted an equivocal result of a localization study to a definitely positive result. There were no complications from the localization studies. At reoperation, permanent hypoparathyroidism that required parathyroid autotransplantation of cryopreserved tissue developed in two patients and two patients had recurrent laryngeal nerve palsies.. We currently recommend using ultrasonography and technetium Tc99m sestamibi scanning and magnetic resonance imaging for patients with recurrent or persistent HPT. Selective venous catheterization with a parathyroid hormone assay is done selectively. Localization tests decrease morbidity and improve overall results in these patients.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Male; Middle Aged; Parathyroid Glands; Predictive Value of Tests; Radionuclide Imaging; Recurrence; Reoperation; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium; Tomography, X-Ray Computed; Ultrasonography

The aim of this study was to evaluate the use of scintigraphy with thallium-201 chloride (201 Tl) and technetium-99m pertechnetate (99mTc) in the diagnosis of the localization of the pathological parathyroid glands in primary hyperparathyroidism and compare the results with those of high resolution ultrasonography.. Twelve patients of 56.1 +/- 7.8 years of age diagnosed with primary hyperparathyroidism were studied between March 1987 and June 1990. High resolution ultrasonography with a 7.5 MHz transducer and scintigraphy of digital subtraction with 201Tl-99mTc were carried out preoperatively in all the patients. None of the patients had had previous cervical surgery and diagnosis was proven following surgery by histopathologic study.. Ultrasonography detected 9 out of 11 adenomas and 3 out of 4 hyperplastic glands. Scintigraphy identified 9 adenomas and only 2 of the hyperplastic glands. With this latter technique there was one false positive. The sensitivity of ultrasonography was 80% and that of scintigraphy was 73% with specificity being 100% vs 96.9%, respectively.. Subtraction 201 Tl-99mTc scintigraphy is useful in the diagnosis of the localization of pathologic parathyroid glands in patients with no previous cervical surgery although in this series this technique did not surpass that of high resolution ultrasonography.

Topics: Adenoma; Adult; Aged; Female; Humans; Hyperparathyroidism; Middle Aged; Parathyroid Neoplasms; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Ultrasonography

The uptake, retention and uptake antagonism of 201Tl-DDC, 201Tl-Cl, 123I-IMP, 99mTc-HMPAO and 99mTc-O4- were compared in rat neocortex cultures. 201Tl-DDC and 123I-IMP revealed the highest uptake of radioactivity in the cultures. 99mTc-HMPAO and 123I-IMP showed the highest retention of radioactivity within the tissue in washout experiments. Blocking of bioelectric activity by tetrodotoxin did not significantly affect the uptake of the radiopharmaceuticals (RPHA). Inhibition of Na-K-ATPase by ouabain inhibited the uptake of 201Tl-Cl (77%) and 201Tl-DDC (27%). Imipramine showed a significantly stronger inhibitory effect on 123I-IMP uptake in comparison with the effect on other RPHA. 99mTc-O4- was not concentrated within the cultured tissue. Under the in vitro conditions used in this study, the various RPHA were characterised by distinct differences in their interaction with cortical brain tissue.

Topics: Amphetamines; Animals; Cerebral Cortex; Ditiocarb; Imipramine; In Vitro Techniques; Iodine Radioisotopes; Iofetamine; Organometallic Compounds; Ouabain; Oximes; Rats; Rats, Inbred Strains; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Exametazime; Tetrodotoxin; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed

The authors report, probably for the first time, a successful pre-operative localization of 7 mm intrathyroidal parathyroid adenoma which was successfully removed by using parathyroid imaging using a dual tracer (T1-201 and Tc-99m) and subtraction technique.

Topics: Adenoma; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Thallium Radioisotopes; Thyroid Neoplasms

The enlarged parathyroid glands of twenty-four patients with primary, and 5 with tertiary, hyperparathyroidism were prospectively studied with MRI, CT, ultrasonography and subtraction scintigraphy prior to surgery. Sensitivities in a prospective study were 63, 60, 53 and 44% for the primary, and 71, 67, 44 and 11% for the tertiary, disease form. On MRI, diseased parathyroids showed the "typical" behaviour of tumours with high signal intensity on T2-weighted and low signal intensity in T1-weighted images. On CT, the lesions were hypodense and on US hypoechoic relative to the thyroid. Retrospective analysis of MRI and CT images yielded sensitivities of 87 and 85%, respectively.

Topics: Diagnostic Imaging; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Tomography, X-Ray Computed; Ultrasonography

Forty five thallium-technetium parathyroid scans were performed preoperatively in patients with a high suspicion of parathyroid adenoma or hyperplasia. The patients were imaged after sequential IV injection of 201Tl-thallous chloride (74 MBq) and 99mTc-pertechnetate (222 MBq) using a gamma camera with a pinhole collimator. According to surgical findings, the prevalence of parathyroid abnormalities was 42/45: single (34 patients) and double (1 patient) adenomas, hyperplasia (7 patients, 16 hyperplastic glands). Three methods of analysis of scintigraphic images were compared. Method one was the visual comparison of the thallium and the technetium images. Method two used the subtraction image obtained after normalisation. Method three used a new image comparison method which performs the geometric and gray level registrations of the two images and generates the image of the significant differences. Three observers were involved in the evaluation procedures. Surgery and histological examinations were taken as the gold standard. Results show that the sensitivity is increased by applying method three. The interobserver reproducibility of the results is also higher for method three. We conclude that an adequate image subtraction technique significantly increases the diagnostic value of parathyroid scintigraphy.

Topics: Adenoma; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Thallium Radioisotopes

Topics: Aged; Female; Humans; Hyperthyroidism; Middle Aged; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Time Factors

The merit of the preoperative localization of parathyroid tumors with thallium-technetium subtraction imaging is a subject of current debate in the treatment of primary hyperparathyroidism. Eighty patients with hyperparathyroidism underwent preoperative subtraction scintigraphy with 201Tl Cl and 99mTcO4; scan results were correlated with the operative identification and histopathology of the resected parathyroid tissue. The true-positive, false-positive and false-negative rates of these scans were compared between patients with tumors in normal and ectopic anatomic locations and between patients undergoing an initial and reoperative neck exploration. The scan was clearly valuable in patients with one or more prior neck explorations. True-positive scans were obtained in seven (77%) of nine such patients. The scan was also valuable in patients who had ectopic tumors (six mediastinal, seven intrathyroid, and two in the carotid sheath). Twelve (80%) of these 15 ectopic tumors were correctly localized either prior to their first operation or before subsequent explorations. In contrast, only 33 (50%) of 65 patients had a true-positive scan prior to their first operation and when the tumor was not in an ectopic location. In summary, in this series, the thallium-technetium scan was correct in only 50 per cent of patients undergoing an initial operation. However, it was positive in 77 per cent of patients who had at least one prior neck exploration and in 80 per cent of patients with an ectopic parathyroid tumor. These results support the selective use of this valuable imaging and localization tool.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; False Negative Reactions; False Positive Reactions; Female; Humans; Hyperparathyroidism; Hyperplasia; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Preoperative Care; Radioisotopes; Radionuclide Imaging; Reoperation; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

A simple, effective technique is described to identify and eliminate motion artifacts which might potentially invalidate dual isotope subtraction parathyroid scintigraphy. Cobalt-57 markers, appropriately placed on the patient, allow detection of movement and permit realignment if movement occurs between imaging sequences. This technique should assure the accuracy of dual isotope parathyroid subtraction scintigraphy.

Topics: Humans; Movement; Parathyroid Glands; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Radionuclide imaging with both Tc-99m sodium pertechnetate and Tl-201 chloride was studied in 152 patients with thyroid nodules. Ultrasonography also was performed in 81 of those patients. Tc-99m sodium pertechnetate scans demonstrated nodules in 69.7% of 78 differentiated thyroid carcinomas (DC) and 72.2% of 54 thyroid adenomas (Ad). Tl-201 chloride was accumulated in 73.7% of DC and 53.6% of Ad. By combining the Tc-99m sodium pertechnetate and Tl-201 chloride scans, the detectability of the nodules was increased to 90.8% for DC and 88.9% for Ad, respectively. The Tc-99m sodium pertechnetate scans showed better visualization of cystic lesions than did the Tl-201 chloride imaging. The Tl-201 chloride images clearly demonstrated intrathoracic tumor invasions in six cases of carcinoma and two cases of Ad. The Tl-201 chloride scan was also of value in detecting regional lymph node involvement and the recurrence and metastasis after thyroidectomy. The detectability of space-occupying lesions by ultrasonography was 96.3% in 81 patients with thyroid nodules. Ultrasonography differentiated well between solid and cystic lesions. The presence and extent of nodular lesions were detected with radionuclide imaging and ultrasonography in 98.8% of patients. Radionuclide imaging combined with ultrasonography provides a rapid, convenient, and useful method for the localization and visualization of thyroid tumors.

Topics: Adenocarcinoma; Adenoma; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms; Ultrasonography

During the period from July 1983 through October 1984, a group of 38 patients with elevated serum calcium, parathormone (PTH) and/or clinical suspicion of hyperparathyroidism were studied by TI-201 Tc-99m dual tracer parathyroid imaging (DTPI). Seventeen of 18 parathyroid lesions were identified correctly. There was one false-negative, and the size of the adenoma missed by DTPI was less than 1.0 cm in diameter (1.0 x 0.5 x 0.2). There was one true-negative case. The other fifteen with negative scans are being followed clinically. Because of the small population studied, statistical analysis was not ascertained. However, this simple, noninvasive procedure has become a very useful diagnostic tool for the detection and localization of parathyroid lesions causing hyperparathyroidism, and the DTPI should be used in conjunction with ultrasonography and CT scanning in the preoperative evaluation in primary and secondary hyperparathyroidism.

Topics: Adenoma; Humans; Hyperplasia; Parathyroid Diseases; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium

In a prospective study of 201Tl-99mTc subtraction scintigraphy, 61 hyperparathyroid patients were investigated prior to neck exploration. At surgery, 46 adenomatous and 28 hyperplastic parathyroid glands were excised. We examined the relationship between the pathological category of these glands, their mass, uptake of 201Tl thallous chloride, and the frequency of true-positive and false-negative scintigraphic findings. The variation of sensitivity with parathyroid mass was found to be similar for both adenomatous and hyperplastic glands, with a detection threshold that lay in the range 0.3-0.8 g. The higher overall sensitivity for the detection of adenomas (85%) compared with hyperplasias (44%) was due to the smaller mean weight of the latter. When the parathyroid uptake of thallium was quantified scintigraphically, the practical detection limit of subtraction scanning was found to be an uptake of 0.015%. For glands greater than 1.5 g in weight, uptake increased linearly with mass, and specific uptakes were within the range 0.01-0.04%/g. Below lg, certain small glands had much higher specific uptakes, up to 0.2%/g. The range of specific uptakes found was similar for both adenomatous and hyperplastic categories. Multinodular or diffuse goitre was a cause of failure in 10% of investigations. In a further 5%, a solitary thyroid nodule gave rise to a false-positive result.

Topics: Adenoma; False Negative Reactions; Humans; Hyperplasia; Parathyroid Glands; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

The presence of diffuse or multinodular goitre can lead to a false negative study of 10 to 20% of parathyroid investigations when the thallium-pertechnetate subtraction technique is used. A simple quantitative index is described that aids recognition of scintiscans whose diagnostic value may be limited by goitre. The index, referred to as the thallium thyroid index (TTI), is obtained from the ratio of thyroidal thallium counts above background to the mean background count density (expressed as counts cm-2) measured in regions just above and below the thyroid image. It correlates linearly with thyroid mass over the range 7 to 50 g, and goitre is likely to adversely affect the diagnostic quality of parathyroid scintiscans for values of TTI greater than 30 cm2 (corresponding to thyroid masses exceeding 35 g). TTI is insensitive to the time of commencement of image acquisition for times between 2 to 30 min following injection of the patient, and its correlation with thyroid mass has been confirmed by independent series of scans in two centres.

Topics: Adenoma; Adult; Female; Goiter; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium

Topics: Adenoma; Adult; Aged; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

We describe the application of thallium-technetium subtraction scintigraphy in nine patients with failed previous parathyroid surgery or with tertiary hyperparathyroidism due to chronic renal failure. The technique successfully located all adenomas, but only 45% of hyperplastic glands. The series included three abnormal glands located retrosternally. The technique appeared to be more useful in patients with primary hyperparathyroidism than in tertiary hyperparathyroidism, possibly related to differences in gland mass. We conclude that this method of scintigraphy is a valuable adjunct to the management of patients with parathyroid disorders, particularly those requiring revision surgery.

Topics: Adenoma; Humans; Hyperparathyroidism; Hyperplasia; Parathyroid Glands; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Twenty-two patients, all with surgically proven primary hyperparathyroidism, were studied by TI-201 thallous chloride and Tc-99m pertechnetate subtraction imaging. Fifteen parathyroid adenomata and one hyperplastic gland between 0.33 and 14.8 g were correctly localized in 16 patients. Two adenomata and seven hyperplastic or histologically normal parathyroids between 0.1 g and 1.4 g in seven patients were not localized. One patient had a correctly localized 13.0-g adenoma with a nonlocalized 0.3 g hyperplastic parathyroid gland and there were two false positive localizations. Sensitivity was 64% (glands), and 73% (patients). There was only fair correlation with parathormone (PTH) levels, but these were elevated in all but four of the patients with correctly localized parathyroids. The authors conclude that the imaging procedure is useful but its sensitivity is limited by difficulty in localizing correctly small glands, particularly those of less than 0.5 g, which comprised 29% of those excised.

Topics: Adenoma; Adult; Aged; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Dual radionuclide imaging of the neck (Tc-99m pertechnetate and TI-201 thallous chloride) was performed in 22 patients with chemical evidence of hyperparathyroidism (elevated blood calcium and parathormone [PTH] levels). Of these, 19 of 22 had localization of a TI-201 "excess" area on radiothallium-radiotechnetium subtraction images. In 13 patients who have had operative confirmation at this writing, the dual radionuclide imaging was positive in 12 (12/13 = 92.3%). One patient had two parathyroid adenomas, both of which were seen on the images; thus, overall detection was 13 out of 14 or 92.8%. The parathyroid adenomas visualized weighed from 0.06 to 3.0 g; the one not detected weighed 0.25 g. In three patients with parathyroid hyperplasia secondary to renal disease, the subtraction imaging detected eight of 12 glands (66.7%). The forearm bone mineral content and bone density were determined in eight patients with parathyroid adenomas; results were abnormally low in five of these eight. One of the three patients with secondary hyperparathyroidism had an abnormally low radial bone mass. The combination of dual radionuclide imaging and radial bone mass determination may present a useful approach in both localizing abnormal parathyroid tissue and in examining its functional consequences.

Topics: Adenoma; Adult; Aged; Bone and Bones; Densitometry; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Male; Middle Aged; Minerals; Parathyroid Hormone; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Radius; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Ninety-five percent of primary hyperparathyroidism is caused by either a solitary hyperfunctioning adenoma or chief cell hyperplasia. While there is a great deal of variation in the location of the parathyroid glands, 90-95% of all abnormal parathyroid tissue will be identified at initial exploration regardless of the preoperative localization procedure. Adenomas not identified at initial exploration are likely to be ectopic. Reexploration is a difficult and time-consuming procedure. The challenge, therefore, is to develop a reliable, noninvasive test that will locate aberrant parathyroid tissue preoperatively with the goal of simplifying the surgical procedure and reducing the incidence of reexploration. A radiopharmaceutical which localizes selectively in parathyroid tissue would be ideal. Currently, no single radiopharmaceutical is adequate. Recently, dual isotope subtraction scintigraphy using T1-201 chloride and Tc-99m pertechnetate has yielded promising results. The authors have investigated this procedure in 42 patients, 25 of whom to date have had surgical exploration. Of the 25 adenomas or focal hyperplasia sites found at surgery, 23 (92%) were correctly located preoperatively. There were two false-negative sites and five false-positive sites. The purpose of this paper is not only to describe the methods used and results obtained but also to discuss the merits and limitations of the technique in comparison with other imaging modalities so that its role, in today's climate of cost containment, may better be defined.

Topics: Adenoma; False Negative Reactions; False Positive Reactions; Humans; Hyperparathyroidism; Parathyroid Glands; Parathyroid Neoplasms; Posture; Preoperative Care; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Ten patients with biochemical and clinical evidence of primary hyperparathyroidism were studied scintigraphically using a double-radionuclide subtraction technique. Preoperative imaging was performed with Sodium pertechnetate Tc 99m and thallium chloride Tl 201 using a gamma camera with a pinhole collimator. The data were stored in a matrix of 64 X 64. The avidity of 201Tl for nodules of the parathyroid gland was demonstrated on analogue and digital images both with and without the subtraction of thyroid tissue. In our ten patients, this technique detected nine out of ten histologically proven adenomas, and missed a relatively small lesion embedded within the thyroid of one patient. This method may have considerable advantages over non-specific or invasive radiodiagnostic methods, and may facilitate the diagnosis and planning of the surgical approach in cases of primary hyperparathyroidism.

Topics: Adenoma; Adult; Aged; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Reliable techniques for detecting and localising abnormal parathyroid tissue have been a persistent problem. We have evaluated thallium-pertechnetate subtraction scintigraphy in a prospective study of 40 patients with clinical and biochemical evidence of hyperparathyroidism prior to parathyroid surgery. Four patients were excluded as they were shown to have goitre, making subtraction scanning non-diagnostic. 89% of parathyroid adenomas (totalling 27 glands in 26 patients) and 41% of hyperplastic glands (17 glands in 6 patients) were accurately localised prior to surgery. These included three retrosternal glands, four patients with renal failure and tertiary hyperparathyroidism and five patients who had previously undergone neck exploration. The apparent discrepancy between detecting hyperplastic and adenomatous glands was associated with the smaller size of the former. For both types of gland, scintigraphy successfully located parathyroids 0.6 g or more in weight. These results suggest that this simple and non-invasive method is a useful technique for locating parathyroid tissue before parathyroid surgery.

Topics: Adenoma; Humans; Hyperparathyroidism; Hyperplasia; Methods; Parathyroid Glands; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

201Tl-thallous chloride/99mTc sodium pertechnetate subtraction scanning is a simple and accurate means to demonstrate enlarged parathyroid glands. We report a case in which the intra-operative location of a mediastinal adenoma was greatly facilitated by using a probe radiation detector following intravenous injection of 201Tl-thallous chloride. We believe this is the first reported use of this technique in parathyroid surgery.

Topics: Adenoma; Female; Humans; Mediastinal Neoplasms; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

Thallium-201, injected as thallous chloride, has been found to adhere to or be taken up by the vein into which it is injected, permitting images to be obtained of human veins up to 4 h following injection. A digoxin-insensitive rat vein model also retained 201Tl but for shorter periods of time. 201Tl uptake is independent of the solution into which it is introduced, whether 5% dextrose or 0.9% sodium chloride. This technique permits multiple delayed views of normal veins to be obtained but is of uncertain value in the evaluation of thrombophlebitis of the calf because of rather poor resolution and high cost.

Topics: Animals; Digoxin; Humans; Radioisotopes; Radionuclide Imaging; Rats; Rats, Inbred Strains; Sodium Pertechnetate Tc 99m; Sodium-Potassium-Exchanging ATPase; Technetium Tc 99m Aggregated Albumin; Thallium; Thrombophlebitis; Time Factors; Veins

A visually increased uptake of 201Tl chloride corresponding to a 'cold' (131I or 99Tcm ) thyroid nodule is mostly seen in well-differentiated carcinomas but also often in follicular adenomas. Since a visually increased uptake of 201Tl can be due to an increased initial uptake and/or a delayed elimination, an extended dynamic investigation was performed in patients with well-differentiated carcinomas or with follicular adenomas. Data were collected in a dynamic simultaneous double isotope ( 99Tcm + 201Tl) study up to 50 min after intravenous administration. Adenomas could be significantly separated from carcinomas by the elimination (p = 0.0001), but not by the initial uptake.

Topics: Adenoma; Carcinoma, Papillary; Diagnosis, Differential; Humans; Kinetics; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Statistics as Topic; Technetium; Thallium; Thyroid Neoplasms

Twenty-two out of 31 patients with chronic renal failure and secondary hyperparathyroidism who underwent parathyroidectomy before operation underwent non-invasive image diagnosis of parathyroid glands by computed tomography (CT), scintigraphy with 201TlCl and 99mTcO4+, and/or ultrasonography. CT visualized 39 of 45 parathyroid glands (86.7%), weighing more than 500 mg. Scintigraphy with a subtraction method using a computer performed the diagnosis in 19 of 27 glands (70.4%). Ultrasonography detected 21 of 27 glands (77.8%). Image diagnosis was also useful in the postoperative follow-up study. The non-invasive image diagnosis of parathyroid glands in patients with chronic renal failure is thus valuable for 1) definite diagnosis of secondary hyperparathyroidism, 2) localization, and 3) diagnosis for effectiveness of conservative treatment.

Topics: Adult; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Middle Aged; Organ Size; Parathyroid Glands; Radionuclide Imaging; Renal Dialysis; Sodium Pertechnetate Tc 99m; Technetium; Thallium; Thyroid Gland; Time Factors; Tomography, X-Ray Computed; Ultrasonography