technetium-tc-99m-tetrofosmin and Adenoma

The paper focusses on the recent advances in parathyroid imaging in both diagnostic and surgical fields which justify the present favourable trend towards a considerable expansion of nuclear medicine applications in this area. The main methodological advances in parathyroid scintigraphy are the rebirth of the dual-tracer (subtraction) technique with technetium-99m sestamibi, the possibility of also using 99mTc-tetrofosmin within a dual-tracer (subtraction) methodology and the more extensive use of single-photon emission tomography, which the authors believe will become the standard methodology. The indications for parathyroid scintigraphy have been affected by advances in hyperparathyroidism surgery, including wider use of unilateral neck exploration and of minimally invasive radioguided surgery. As these techniques can only be performed in hyperparathyroid patients with a single adenoma, careful pre-operative assessment is required, and parathyroid scintigraphy undoubtedly is the most accurate localisation method. To date, the majority of papers have also demonstrated the cost-effectiveness of scintigraphically guided limited neck surgery. The authors conclude that: (1) parathyroid scintigraphy can be recommended not only in persistent or recurrent hyperparathyroidism but also in hyperparathyroid patients prior to first surgery; (2) scintigraphy should always be performed by applying the most accurate technique available because reliable scintigraphy gains or reinforces the surgeon's trust, reliably guides cost-effective operative strategies and justifies the recognition of new potential diagnostic indications.

Topics: Adenoma; Cost-Benefit Analysis; Humans; Hyperparathyroidism; Minimally Invasive Surgical Procedures; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radiopharmaceuticals; Subtraction Technique; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

To confirm the clinical significance of 99mTc-tetrofosmin imaging for the localization of hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism.. All patients were imaged with 99mTc-tetrofosmin at 10 minutes and 2 hours after radiotracer injection, and with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The parathyroid/thyroid uptake ratio of 99mTc-tetrofosmin (P/T uptake ratio) was calculated.. Twenty patients with primary hyperparathyroidism were referred to our clinic, underwent surgical neck exploration or mediastinotomy and were diagnosed as having parathyroid adenoma. These patients were investigated for the preoperative localization by 99mTc-tetrofosmin scintigraphy.. 99mTc-tetrofosmin imaging demonstrated focal uptake in 19 out of 20 patients with parathyroid adenoma. Two of the lesions were ectopic. US identified 17 parathyroid glands. CT and MRI initially detected 17 parathyroid glands. However, two additional parathyroid glands were localized on repeated CT and MRI in tandem with the results of the 99mTc-tetrofosmin imaging. Thus, the sensitivity and specificity of tetrofosmin imaging were 95% (19/20) and 95% (19/20); US, 85% (17/20) and 94% (16/17); initial CT, 85% (17/20) and 94% (16/17); and initial MRI, 88% (17/20) and 94% (16/17), respectively. The P/T uptake ratio at 2 hours after tetrofosmin injection was correlated with the serum concentration of intact PTH (rs=0.47, p<0.05) and the resected tumor weight (rs=0.53, p<0.05).. 99mTc-tetrofosmin scintigraphy is useful for localization of parathyroid adenoma. Tetrofosmin uptake depends on the tumor weight and serum intact PTH levels.

Topics: Adenoma; Adult; Aged; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Tomography, X-Ray Computed

Several years ago technetium-99m tetrofosmin was reported to localise parathyroid adenomas. The aim of this study was to compare the sensitivity of this radiopharmaceutical with that of (99m)Tc-sestamibi using a double-phase parathyroid scintigraphy protocol. Scans of 12 patients were evaluated visually and lesion to thyroid ratios were calculated. Nine of the patients were subsequently operated on; a total of eight parathyroid adenomas or hyperplastic glands were histologically confirmed in seven of the patients, while in one patient a parathyroid carcinoma was histologically proven. All of these patients had positive (99m)Tc-sestamibi scintigrams, whereas only two (99m)Tc-tetrofosmin scintigrams were positive. With (99m)Tc-sestamibi there was a significant increase in the lesion to thyroid ratio from 10 min to 90 min and 150 min p.i. which was not seen on scintigraphy with (99m)Tc-tetrofosmin. This makes (99m)Tc-tetrofosmin less suitable for double-phase parathyroid scintigraphy.

Topics: Adenoma; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Single-Blind Method; Technetium Tc 99m Sestamibi

The purpose of this study was to retrospectively evaluate (99m)Tc-tetrofosmin (Tc-TF) uptake in large parathyroid adenomas and to compare the results with their expression of multidrug resistance (MDR)-mediated, 170 kDa, P-glycoprotein (Pgp). Twenty patients with large parathyroid adenomas (larger than 1.5 g), who had undergone early and delayed (10 min and 2 h) Tc-TF parathyroid imaging before operation, were enrolled in this retrospective study. Immunohistochemical analyses were performed on multiple, non-consecutive sections of the 20 parathyroid adenomas and 40 normal control specimens (20 normal parathyroid glands and 16 normal thyroid specimens) to detect Pgp expression. Tc-TF parathyroid imaging accurately localized 17 large parathyroid adenomas, but not the remaining three. The 17 parathyroid adenomas with significant Tc-TF uptake in delayed (2 h) parathyroid images revealed negative Pgp expression, but the three adenomas without significant Tc-TF uptake, as well as 20 normal parathyroid glands and 20 normal thyroid specimens, revealed positive Pgp expression. Therefore, not only the size, but also the expression of Pgp, limited the sensitivity of Tc-TF parathyroid imaging to localize parathyroid adenomas before operation.

Topics: Adenoma; Adult; Aged; ATP Binding Cassette Transporter, Subfamily B, Member 1; Female; Humans; Immunohistochemistry; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals

The aim of this study was to investigate the relationships among technetium-99m tetrofosmin (Tc-TF) accumulation in parathyroid adenoma and the expression of P-glycoprotein (Pgp) or multidrug resistance related protein (MRP). Before operation, 33 patients with parathyroid adenomas (larger than 1.5 gm) were studied with parathyroid scintigraphy 10 minutes and 2 hours after intravenous injection of Tc-TF before operation. Immunohistochemical analyses (IHA) were performed on multiple nonconsecutive sections of operative parathyroid specimens to detect Pgp or MRP expression. According to the results of IHA, the 33 parathyroid adenomas were separated into four groups: (1) 2 adenomas with both positive Pgp and positive MRP expression, (2) 1 adenomas with positive Pgp but negative MRP expression, (3) 2 adenomas with negative Pgp but positive MRP expression, and (4) 28 adenomas with both negative Pgp and negative MRP expression. All of 28 adenomas in the group 4 could be detected by Tc-TF parathyroid imaging. All of 5 adenomas in the groups 1 to 3 could not be detected by TcTF parathyroid imaging (p < 0.05). Not only the size of parathyroid adenomas, but also significant Pgp or MRP expression limited the sensitivity of Tc-TF parathyroid imaging to localize parathyroid adenomas before operation.

Topics: Adenoma; Adult; ATP Binding Cassette Transporter, Subfamily B, Member 1; Female; Gene Expression Regulation, Neoplastic; Genes, MDR; Humans; Immunohistochemistry; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals

Topics: Adenoma; Humans; Hyperparathyroidism; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi

The purpose of this study was to retrospectively evaluate technetium 99m tetrofosmin (Tc-TF) uptake in parathyroid adenomas and compare the results with their expression of multidrug resistance-mediated 170-kDa P-glycoprotein (Pgp).. Twenty patients with larger parathyroid adenomas (> 1.5 g) and the other 40 patients with smaller parathyroid adenomas (0.5-1.5 g) underwent early and delayed (10-minute and 2-hour) Tc-TF parathyroid imaging before operation. In this retrospective study, immunohistochemical analyses were performed on multiple nonconsecutive sections of the 40 parathyroid adenomas and 40 normal control specimens (20 normal parathyroid glands and 20 normal thyroid specimens) to detect Pgp expression.. The Tc-TF parathyroid image accurately localized 17 larger and 16 smaller parathyroid adenomas, but not the remaining 3 larger and 4 smaller adenomas. The 17 larger and 16 smaller parathyroid adenomas with significant Tc-TF uptake on the delayed 2-hour parathyroid images revealed negative Pgp expression, but the 3 larger and 4 smaller adenomas without significant Tc-TF uptake, as well as 20 normal parathyroid glands and 20 normal thyroid specimens, revealed positive Pgp expression.. Not only the size of parathyroid adenomas, but Pgp expression also limited the sensitivity of Tc-TF parathyroid image to localize parathyroid adenomas before the operation.

Topics: Adenoma; Adult; Aged; ATP Binding Cassette Transporter, Subfamily B, Member 1; False Negative Reactions; Female; Humans; Immunohistochemistry; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging

Topics: Adenoma; Adult; Humans; Hypercalcemia; Male; Mediastinal Neoplasms; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Various radionuclides, including 67Ga, 201Tl and 99Tcm-sestamibi, have been used to differentiate benign from malignant thyroid nodules. 99Tcm-tetrofosmin, a lipophilic cationic radiotracer, and 99Tcm-sestamibi have also been reported to accumulate in thyroid tumours. In this study, we evaluated the role of 99Tcm-tetrofosmin in the differentiation of malignant from benign thyroid nodules. Seventy-nine patients with solitary non-functioning thyroid nodules were included in the study. Fine-needle aspiration biopsy was performed in all patients. Sixty patients were subsequently operated on and 19 patients refused surgery. After the injection of 370 MBq 99Tcm-tetrofosmin, static images at 5, 30, 60, 120 and 180 min were acquired. Both visual and semi-quantitative analysis was performed. On visual interpretation, the nodules with late retention were classified as positive for malignancy and nodules without late retention were classified as negative for malignancy. In the semi-quantitative analysis, regions of interests were drawn over the nodule and contralateral normal thyroid tissue. The average number of counts was recorded and tumour-to-normal thyroid tissue ratios calculated. Post-operative histology revealed 19 malignant and 41 benign nodules. Of the benign nodules, adenomas behaved similarly to the malignant nodules with late retention of tracer, while adenomatous nodules revealed no late retention on delayed images and could be differentiated from malignant tumours. In the semi-quantitative analysis, there was a significant difference in tumour-to-normal tissue ratios for adenomatous nodules and malignant tumours as well as adenomas. We conclude that it is not possible to differentiate between malignant and benign thyroid nodules with 99Tcm-tetrofosmin. However, 99Tcm-tetrofosmin scintigraphy is helpful in selecting nodules that can be cured by surgical intervention.

Topics: Adenoma; Adolescent; Adult; Aged; Carcinoma; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Thyroid Neoplasms; Thyroid Nodule

The aim of the study was to quantitatively compare the scintigraphic images of the thyroid and abnormal parathyroid glands obtained with technetium-99m tetrofosmin and thallium-201 in patients with hyperparathyroidism. Forty-six patients with hyperparathyroidism underwent (201)Tl (74 MBq), (99m)Tc-pertechnetate (74 MBq) and (99m)Tc-tetrofosmin (555-740 MBq) scintigraphy in a single session. Image analysis included the computation of the thyroid/background ratio in the whole study population and the parathyroid/background ratio, parathyroid/thyroid ratio and diagnostic sensitivity in 17 patients who underwent parathyroid surgery. The pertechnetate subtraction technique was used. (201)Tl and (99m)Tc-tetrofosmin showed a similar thyroid/background ratio (1.79+/-0.41 and 1.81+/-0. 47, respectively, P=NS); however, (99m)Tc-tetrofosmin showed a higher parathyroid/background ratio than (201)Tl (2.06+/-0.54 vs 1. 79+/- 0.50, P=0.007). Despite the superior quality of (99m)Tc-tetrofosmin images, both tracers showed identical sensitivity in detecting enlarged parathyroid glands in patients with primary hyperparathyroidism (89%) and in those with secondary hyperparathyroidism (50%).

Topics: Adenoma; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Male; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland

Case report of a patient with hypercalcemia and suspected parathyroid adenoma. Because of a previous strumectomy a precise preoperative localization of the suspected parathyroid adenoma was demanded. Tc-99m-tetrofosmin scintigraphy in double phase technique failed to detect a parathyroid adenoma by failing to show a region of increased focal uptake with delayed washout in relation to the thyroid gland. Only comparison of the Tc-99m-tetrofosmin images with a Tc-99m-pertechnetate scan revealed a right caudal parathyroid adenoma. A double phase Tc-99m-MIBI study of the same patient was able to localize this parathyroid adenoma without the need of a corresponding Tc-99m-pertechnetate scintigraphy due to a differential washout with persistent focal uptake in the parathyroid adenoma and a progressively decreasing uptake in the thyroid tissue. This case indicates that Tc-99m-tetrofosmin is a suitable agent for parathyroid imaging only if used together with Tc-99m-pertechnetate but it seems to lack the differential washout characteritics of Tc-99m-MIBI according parathyroid gland and thyroid gland.

Topics: Adenoma; Female; Humans; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tissue Distribution; Tomography, Emission-Computed; Ultrasonography

The aim of the work was to study the diagnostic value of Tc-99m tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroid disease.. We studied 31 patients, 19 with primary and 12 with secondary hyperparathyroid disease. Five of these patients were renal graft recipients. All patients underwent surgery. Each patient was injected with 555 to 740 MBq (15 to 20 mCi) Tc-99m tetrofosmin. Subsequently, radionuclide images were acquired 15 and 120 minutes after injection using a low-energy, all-purpose, parallel-hole collimator. Pertechnetate thyroid scintigraphy was obtained in nine cases (24 to 48 h later) when the thyroid activity made it difficult to identify the parathyroid glands.. All cases showed tracer uptake as early as 15 minutes after injection. In the group of patients with primary hyperparathyroid disease, 15 showed focal uptake in a parathyroid gland, and surgery revealed an adenoma in the same location. In one patient with hyperplasia, scintigraphy identified only two of four diseased glands. In the three remaining cases, scintigraphy showed focal uptake in the lower parathyroid gland, whereas at surgery the abnormal gland was located in the upper pole. In the secondary hyperparathyroidism group, seven patients showed diffuse tracer uptake in two or more glands, and histologic analysis confirmed hyperplasia in all of them. Five cases showed focal uptake, with three evaluated after surgery (uptake in the only remaining gland); one of them was a renal graft recipient, and the remaining patient had chronic renal failure and was receiving hemodialysis.. Our results suggest that Tc-99m tetrofosmin may be a suitable tracer for preoperative detection and screening of anomalous parathyroid glands. The earlier images at 15 minutes were better than those at 120 minutes. Tc-99m tetrofosmin is cleared more slowly from the normal thyroid than is Tc-99m sestamibi, and both of these tracers may give better results than the old pertechnetate TI-201 subtraction technique.

Topics: Adenoma; Adult; Aged; Evaluation Studies as Topic; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hyperplasia; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Gland; Time Factors

Abnormal parathyroid tissue can be identified by radionuclide imaging with either 99mTc-MIBI or 99mTc-tetrofosmin. This study compared the relative sensitivity of these two agents to localize parathyroid hyperplasia and adenoma.. Twenty patients with primary (n = 9) or secondary (n = 11) hyperparathyroidism were studied with 99mTc-MIBI and 99mTc-tetrofosmin parathyroid imaging, ultrasonography and MRI. Radionuclide images of the neck were acquired 10 min and 2-3 hr after radiopharmaceutical injection. The images were visually evaluated for abnormal focal areas of increased tracer localization in the neck and mediastinum. A parathyroid gland/normal thyroid tissue activity ratio (referred to as the P/T uptake ratio) was calculated for each positive scan.. Of the 46 parathyroid glands surgically explored, the overall sensitivity and specificity of MIBI imaging were 83% and 83% (38/46); tetrofosmin imaging 87% and 83% (40/46); ultrasonography 78% and 40% (36/46); and MRI 80% and 60% (37/46), respectively. Both radiopharmaceuticals performed well in the nine patients found to have adenoma. The sensitivity and specificity of MIBI imaging were 100% and 100% (9/9); tetrofosmin imaging 100% and 100% (9/9); ultrasonography 78% and 67% (7/9); and MRI 100% and 100% (9/9), respectively. In the 37 glands with hyperplasia, MIBI imaging had a sensitivity of 78% and specificity of 75%; tetrofosmin imaging 84% and 75%; ultrasonography 78% and 43%; and MRI 73% and 60%, respectively.. All imaging techniques localized abnormal parathyroid glands. The radiotracers have equal sensitivity for the localization of abnormal parathyroid glands. The sensitivity of these tracers was high as compared to ultrasonography or MRI.

Topics: Adenoma; Adult; Aged; Female; Humans; Hyperparathyroidism; Hyperplasia; Magnetic Resonance Imaging; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Ultrasonography

The aim of the work was to study the diagnostic value of 99mTc-tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroidism.. We have studied 33 patients: 12 with primary and 21 with secondary hyperparathyroidism, 9 of them renal graft recipients. Sixteen patients underwent surgery, 12 with primary and 4 with secondary hyperparathyroidism. All patients were injected with 740 MBq of 99mTc-tetrofosmin. Subsequently at 15, 30 and 60 minutes images were acquired for 300 seconds using a pin-hole collimator. A pertechnetate thyroid scintigraphy was obtained in 7 cases (24-48 h later) when the thyroid activity made difficult the identification of parathyroid glands.. In the group of patients with primary hyperparathyroidism, all cases showed a focal uptake in lower right localization. In the secondary hyperparathyroidism group, 12 patients showed diffuse tracer uptake in two or more glands and histology confirmed hyperplasia in four of them. Seven cases showed a greater focal uptake in a gland: two of them were renal graft recipients and three were chronic renal failure cases in haemodyalisis, and two were evaluated postsurgery showing uptake in the remnant parathyroid gland. The two remaining patients had a normal scintigraphy and corresponded to two false negative cases. In conclusion, our results suggest that 99Tc-tetrofosmin may be used as a suitable tracer for preoperative detection and screening of anomalous parathyroid glands.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hyperplasia; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland

To evaluate the scintigraphy images of 99mTc-tetrofosmin in the primary hyperparathyroidism, we studied 8 patients, 5 males, with ages between 17 and 82 (median = 50) years old, and with clinical and laboratory manifestations of hyperparathyroidism (calcium metabolism and PTH elevated); parathyroid scintigraphy was realized after 20mCi (740 MBq) intravenously injection of 99mTc-tetrofosmin, and were acquired images (10, 60 and 120 min.) in a large field gamma camera. All patients were submitted to surgery. The histology of surgical specimens showed seven adenomas and one adenocarcinoma of parathyroids; the scintigraphic images showed four lesions in the inferior right lobe and four in the inferior left lobe of thyroid and have global correlation with surgical findings. There was preferential retention of the tracer in the earlier images (10 min) in all cases (100%) and in the later images (120 min.) in 5 cases (62.5%). In conclusion, the earlier images (10 min) were more diagnostic than the later in the primary hyperparathyroidism study. It is possible that other tumoral lesions have similar behavior with 99mTc-tetrofosmin.

Topics: Adenocarcinoma; Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Evaluation Studies as Topic; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Time Factors

The efficacy of 99mTc-tetrofosmin for the detection of parathyroid lesions was investigated prospectively in patients with hyperparathyroidism referred for surgical treatment.. Twenty-seven patients with primary and 18 with tertiary hyperparathyroidism were studied. Twelve patients had undergone one or more previous neck explorations. Static imaging with 201Tl was performed first, immediately followed by a 30-min 99mTc-tetrofosmin dynamic study. Delayed views of up to 3 hr postinjection were also obtained. Technetium-99m-pertechnetate was used for thyroid delineation. The tetrofosmin/99mTc-pertechnetate subtraction scan (TF/TC), the single-tracer washout technique and the thallium/technetium subtraction (TL/TC) were compared. Quantification of relative uptakes of tracers in the thyroid and abnormal parathyroids was accomplished by measuring activity within regions of interest. Kinetics of tetrofosmin in the thyroid and abnormal parathyroids were studied by evaluating the plots of the parathyroid to thyroid ratios against time as well as by calculation of the half-clearance times from the slow component of the time-activity curves.. The overall sensitivity, specificity and accuracy of TF/TC and TL/TC were 76%, 92% and 83% and 52%, 85% and 65%, respectively. The respective sensitivities were 87% and 70% for adenomas and 72% and 46% for hyperplasia. The parathyroid-to-thyroid activity ratios of tetrofosmin were significantly higher than those of thallium (p < 0.001). The tetrofosmin single-tracer washout study was less accurate than the subtraction technique (overall sensitivity and specificity, 70% and 69%, respectively). The washout properties of tetrofosmin in abnormal parathyroids were not substantially different from those in the thyroid, with a few exceptions (p = 0.4). No correlation of half-clearance times with parathyroid size, degree of early uptake, parathyroid hormone levels or histology could be established. Comparing adenomas to hyperplasia in respect to tetrofosmin retention, a statistically significant difference was observed (p = 0.005).. Technetium-99m-tetrofosmin is suitable for parathyroid imaging. The kinetic properties of this agent in parathyroid and thyroid tissues do not warrant differential washout protocols. The diagnostic impact of the observed difference in tetrofosmin kinetics between parathyroid adenomas and hyperplasia requires further investigation.

Topics: Adenoma; Female; Humans; Hyperparathyroidism, Secondary; Hyperplasia; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium Radioisotopes; Thyroid Gland; Time Factors

We prospectively studied 26 patients with cold thyroid nodules (five malignant and 21 benign nodules) on Tc-99m pertechnetate scintigraphy to investigate the diagnostic value of Tc-99m tetrofosmin scintigraphy and color-Doppler sonography in differentiating malignant from benign thyroid nodules. In each patient, Tc-99m Tetrofosmin uptake in the nodule and intranodule vascularity were assessed semiquantatively. Both the uptake and vascularity were classified as low, Iso or high. Eight out of 26 nodules showed high Tc-99m tetrofosmin uptake; five of them were malignant. Eight (including four malignant tumors) out of 26 nodules showed increased vascularity compared with normal thyroid tissue on color-Doppler sonography. In six out of eight patients with high uptake of Tc99m-tetrofosmin, increased vascularity was observed. The sensitivity, specificity, negative predictive value, and positive predictive value of Tc-99m tetrofosmin scintigraphy and color-Doppler sonography were determined to be 100% and 80%, 85% and 80%, 62% and 50%, and 100% and 94%, respectively. We conclude that color-Doppler sonography seems to have limited value in the detection of malignant thyroid nodules. However, Tc-99m tetrofosmin scintigraphy is a sensitive method to use in diagnosing malignant nodules, although it is not specific for the detection of malignant nodules.

Topics: Adenocarcinoma, Follicular; Adenoma; Adolescent; Adult; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroiditis; Ultrasonography, Doppler, Color

Topics: Adenoma; Humans; Hyperparathyroidism; Methods; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Time Factors; Tomography, Emission-Computed, Single-Photon

We report the preliminary results of a prospective study demonstrating technetium(III)-99m furifosmin (Q12) uptake in histologically proven parathyroid adenomas. Scintigraphy was performed in 12 patients with hyperparathyroidism. Q12 correctly identified the parathyroid adenomas by focal prolonged tracer retention in ten of the 12 patients. In the two patients without localized tracer retention, no parathyroid adenoma could be identified surgically, either. The retention half-times ranged from 0.5 to 1.8 h (mean 1.27) in the parathyroid adenomas and from 0.3 to 1.2 h (mean 1.05) in the thyroid gland. Our preliminary results show that Q12 is a feasible, sensitive tracer for parathyroid scintigraphy. In comparison to sestamibi (MIBI) and tetrofosmin, Q12 displays short retention in the thyroid gland, which would seem rather advantageous. Further evaluation is needed to determine which among Q12, tetrofosmin and MIBI is most sensitive for the detection especially of small parathyroid adenomas, and which tracer properties will best reflect the degree of endocrine activity.

Topics: Adenoma; Adult; Aged; Feasibility Studies; Female; Furans; Humans; Hyperparathyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Sestamibi

Preoperative localization of hyperactive parathyroid glands is useful to minimize operative time and reduce patient morbidity. This investigation compared the sensitivity of radionuclide imaging with 99mTc tetrofosmin with that of ultrasonography and magnetic resonance (MR) imaging in patients with hyperparathyroidism.. Twenty-six patients with primary (n = 7) or secondary (n = 19) hyperparathyroidism were imaged with 99mTc tetrofosmin, ultrasound and MR imaging of the neck and thorax to localize the lesions. The presence of hyperparathyroidism was identified by an intact parathyroid hormone in vitro assay. The parathyroid/normal thyroid tissue activity ratio was calculated for all patients with evidence of an abnormality on tetrofosmin images. Pathological findings were compared with the results of imaging in 18 of the 26 patients who underwent parathyroidectomy.. Technetium-99m tetrofosmin scans demonstrated focal uptake in 46 glands of 26 patients. The uptake was categorized as slight in 78.3% (36/46) and intense (parathyroid/normal thyroid tissue activity ratio, > 1.4) in 21.7% (10/46). Ultrasonography and MR imaging identified 44 and 47 glands, respectively, in these patients. Eleven of the 18 patients who underwent parathyroidectomy within 1 mo after tetrofosmin imaging had hyperplastic glands, while 7 had parathyroid adenomas. Tetrofosmin imaging successfully localized 7 of 7 (100%) adenomas and 27 of 37 (73.0%) hyperplastic glands. The sensitivities of each technique for localizing abnormal parathyroid glands were 77.3% (34/44) for tetrofosmin imaging: 68.2% (20/44) for ultrasonography: and 68.2% (30/44) for MR imaging. Technetium-99m tetrofosmin uptake ratio in the 18 patients with surgical exploration was not proportional to several oxyphil cells.. Technetium-99m tetrofosmin parathyroid imaging may be useful for localizing abnormal glands in patients with primary and secondary hyperparathyroidism. The sensitivity of 99mTc tetrofosmin parathyroid imaging was high as compared to ultrasonography or MR imaging. The prolonged retention of tetrofosmin may not depend on the number of mitochondria-rich oxyphil cells.

Topics: Adenoma; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hyperplasia; Magnetic Resonance Imaging; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Ultrasonography

Parathyroid scintigraphy with the new myocardial perfusion radiopharmaceutical 99mTc-tetrofosmin was compared with 99mTc-sestamibi scintigraphy using early and delayed imaging.. The two preparations were administered on different days to the same 16 patients suffering from primary hyperparathyroidism. Anterior view gamma camera planar imaging (10-min acquisition) was performed in the period between 5 min and 3 hr after administration of the radiopharmaceutical. For most of the patients, a pertechnetate image of the thyroid was available for eyeball comparison when reading the tetrofosmin and sestamibi images. Imaging results were compared with those from histopathological examination after surgery.. On early images, all the adenomas visualized with sestamibi were equally well seen with tetrofosmin and vice versa. In 6 of 11 scintigraphically detected neck adenomas, delayed imaging improved the adenoma visualization with sestamibi. In contrast, this differential washout was never seen with tetrofosmin. Histopathological examination of excised tissue specimens after neck exploration (15 patients) or thoracotomy (one patient) revealed a parathyroid adenoma in all 16 patients. Our 12 scintigraphic findings were true-positives, while the remaining four scintigraphies were false-negatives, giving a diagnostic sensitivity of 75% with both preparations. The mediastinal adenoma was detected in a patient with a history of two unsuccessful neck explorations and one unsuccessful thoracotomy.. Tetrofosmin has the same success rate as sestamibi for detection of parathyroid adenomas on scintigrams acquired immediately after injection. In contrast to sestamibi, delayed imaging has no diagnostic impact. Moreover, the thyroid/ parathyroid differential washout of sestamibi failed in 5 of 11 neck adenomas here detected, indicating that delayed sestamibi washout is an unreliable diagnostic criterion. Therefore, whether sestamibi or tetrofosmin is preferred for parathyroid scintigraphy, thyroid scintigraphy seems mandatory.

Topics: Adenoma; Aged; Female; Humans; Hyperparathyroidism; Male; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Time Factors

Topics: Adenoma; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Technetium-99m tetrofosmin, a lipophilic cationic complex molecule, was introduced for myocardial imaging. In some biodistribution studies it has also been reported to accumulate in the thyroid gland. Our objectives were to determine which thyroid nodules retain tetrofosmin and whether preoperative evaluation of malignancy is possible. Tetrofosmin scintigraphy was performed in 57 patients with a cold thyroid nodule on previously performed pertechnetate scintigraphy. All patients had undergone ultrasonography and sonographically guided fine-needle aspiration biopsy. The tetrofosmin scintigrams were obtained 5 min (early image) and 1 h (late image) after intravenous injection of 370 MBq. Only nodules that showed clear tracer retention after 1 h in comparison with retention at 5 min were classified as TETRO positive. Nodules without late retention were classified as TETRO negative. All patients underwent surgery and the histological results were compared with the results of tetrofosmin scintigraphy. Ten out of 11 patients with thyroid carcinoma (two pT1, three pT2, five pT4) were TETRO negative. One patient with papillary carcinoma (pT2) was TETRO positive. The mean nodular to thyroid tissue (N/T) ratio for the late scan was 1.0+/-0.20. There were 21 patients with thyroid adenomas (seven follicular, seven microfollicular and seven oxyphilic); 15 of these patients were TETRO positive and six TETRO negative. The mean N/T ratio for the late images was 1.34+/-0.41. All patients with degenerative goitre (24 cases) and the one patient with Hashimoto's disease were TETRO negative after 1 h and the N/T ratio was 0.92+/-0.12 on the late scan. Our results indicate that 99mTc-tetrofosmin scanning is of little value preoperatively in distinguishing thyroid carcinoma from other thyroid nodules. Tetrofosmin tends to demonstrate thyroid adenomas but does not have a routine role in the assessment of thyroid nodules.

Topics: Adenocarcinoma, Follicular; Adenoma; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

The aim of our study was to evaluate the sensitivity, specificity, and positive predictive value (PPV) of technetium 99m (99mTc) tetrofosmin double-phase scintigraphy and single-photon emission computer tomography (SPECT) in preoperative localization of parathyroid adenoma in case of primary and secondary hyperparathyroidism (HPT).. Sixty-eight consecutive patients biochemically or sonographically suspected of parathyroid adenoma were included in our study. Apart from biochemical analysis of serum calcium, phosphate, and intact parathyroid hormone, double-phase scintigraphy was performed in each patient 5 and 45 minutes after injection of 370 MBq 99mTc tetrofosmin, followed by SPECT imaging. In consciousness of the scintigraphic results, ultrasound of the neck was performed as well to exclude false-positive results due to thyroid adenomas.. Depending on the results of the biochemical analysis in combination with the results of the scintigraphic and ultrasound examination, the patients were classified retrospectively into three groups: group A with primary HPT (n = 35), group B with secondary HPT (n = 13), and group C without any biochemical suspicion of primary or secondary HPT (n = 20). In group A, double-phase study localized 25 of 36 (69.2%) parathyroid adenomas (one double adenoma) as against 34 of 36 (94.4%) with SPECT. Nine adenomas could be visualized only by SPECT. The reason for nonvisualization on planar scans was suspected to be an ectopic location in 2 cases (retrotracheal dislocation, retrovascular dislocation), a maximal diameter less than 15 mm (9-13 mm) in 6 cases, and oxyphilic-cell-poor cellularity in 1 case. Four false-positive retention (3 thyroid adenomas and 1 papillary thyroid carcinoma) were observed. SPECT showed a sensitivity of 94.4%, a specificity of 85%, and a PPV of 91.9% in biochemically suspected primary HPT. In group B, planar scintigraphy demonstrated 12 hyperplastic glands in 5 of 13 patients, and SPECT demonstrated 20 hyperplastic parathyroid glands in 8 out of 13 patients, which corresponds to a sensitivity of 38% and 61.5%, respectively.. Technetium 99m tetrofosmin seems to be a promising alternative tracer with similar capabilities to 99mTc sestamibi in localization of parathyroid adenoma. SPECT showed clear advantages in terms of sensitivity over planar scintigraphy and should be used at least in cases with poor or no uptake in double-phase study. In endemic goiter areas, ultrasound of the neck should be performed to exclude false positive retention in thyroid adenomas. Technetium 99m tetrofosmin, like 99mTc sestamibi, is not ideal for localization of hyperplastic glands in secondary hyperparathyroidism because of low sensitivity.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; False Positive Reactions; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Radioimmunoassay; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Especially ectopic adenomas may be problematic in intraoperative localization despite preoperative imaging resulting in a longer operating time and more extensive surgical preparation. The aim of our study was to evaluate the possibility of intraoperative scintimetric detection of parathyroid adenomas with cationic, Tc-99m labelled tracers for its usefulness in ectopic adenomas. 12 women with biochemically confirmed hyperparathyroidism were included in our study. After injection of 370 MBq Tc-99m Tetrofosmin respectively Sestamibi, preoperative scintigraphy (double phase study and SPECT) was performed and T/NT ratios were evaluated for early, delayed and SPECT images. Surgery was performed using a hand-held gamma probe after preoperative injection of 555-925 MBq Tc-99m Tetrofosmin or Sestamibi. Count rates (cts/10 sec) were measured and used for calculating in situ- and ex situ-T/NT ratios. In 9 out of 12 patients, adenoma could be detected on static images. Three cases could only be detected with SPECT. 11 of 12 parathyroid adenomas could be confirmed intraoperatively. Intraoperative localization of parathyroid adenoma with Tc-99m-labelled cationic complexes and a gamma probe is possible and may be useful in case of ectopic adenoma by influencing surgical approach and operating time.

Topics: Adenoma; Adult; Aged; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

We report the preliminary results of a prospective study demonstrating tetrofosmin uptake in surgically and histologically proven parathyroid adenomas. In ten patients with primary chronic hyperparathyroidism, parathyroid imaging was performed using (1) technetium-99m methoxyisobutylisonitrile (MIBI) and (2) 99mTc-1, 2-bis(bis(2-ethoxyethyl)phosphino)ethane (tetrofosmin) within a time interval of 3-5 days. Both tracers correctly identified the parathyroid adenomas by focal prolonged tracer retention. On visual inspection image contrast was generally higher with MIBI than with tetrofosmin in all the patients studied. Tetrofosmin showed a slower elimination from the parathyroid adenomas than MIBI in six of the ten cases. Our preliminary results show that tetrofosmin, like MIBI, as a feasible, sensitive tracer for parathyroid scintigraphy. For routine use, the rapid kit preparation without heating and the lower radiation dose to the patient make tetrofosmin an alternative tracer for parathyroid scintigraphy. Further evaluation is needed to determine which of the two tracers is the more sensitive for the detection of parathyroid adenomas, and which tracer properties better reflect the degree of endocrine activity.

Topics: Adenoma; Aged; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Sestamibi

The aim of this study was to evaluate whether 99Tcm-tetrofosmin is a suitable agent for parathyroid scintigraphy. Ten patients with hyperparathyroidism and two normal subjects underwent parathyroid scintigraphy with both 99Tcm-tetrofosmin and 201TI. Thyroid image subtraction was performed with 99Tcm-pertechnetate. In the 10 patients with hyperparathyroidism, the scintigraphic results were compared with the surgical findings, which showed seven parathyroid adenomas, two parathyroid adenomas with a co-existing thyroid adenoma, and one thyroid carcinoma. Both 99Tcm-tetrofosmin and 201T1 revealed eight true-positive results, one false-negative results and one false-positive result, with concordance in 8 of 10 patients. The image quality with 99Tcm-tetrofosmin of both the raw and 99Tcm-pertechnetate subtracted images was always superior compared with that with 201T1. On the basis of the diagnostic results and the favourable dosimetric characteristics, we conclude that 99Tcm-tetrofosmin is a suitable agent for parathyroid scintigraphy.

Topics: Adenoma; Adult; Aged; False Negative Reactions; False Positive Reactions; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms

The uptake of Tc-99m tetrofosmin (TF) is reported in a case of parathyroid adenoma. A 65-year-old woman was studied on different days with TF, Tc-99m sestamibi (MIBI) and Tl-201 chloride (Tl). TF and MIBI injections were preceded by oral administration of potassium perchlorate. Clear identification of the adenoma was observed in all scans. No further information was obtained using a subtraction technique with Tc-99m pertechnetate. Regarding the thyroid/parathyroid ratio, different kinetics between TF and MIBI appear to be demonstrated. In particular, thyroid washout was observed with MIBI but not with TF.

Topics: Adenoma; Aged; Female; Humans; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thyroid Gland

Technetium-99m tetrofosmin is a lipophilic phosphine used for myocardial perfusion imaging. Biodistribution studies have shown significant thyroid uptake of tetrofosmin and preliminary reports have suggested that tetrofosmin imaging may be of value in patients with thyroid cancer. In this study, tetrofosmin whole-body scintigraphy was performed in 35 patients with evidence of thyroid diseases. All patients underwent laboratory evaluation of thyroid function as well as 99mTc pertechnetate scan, thallium-201 (n=16) 99mTc-methoxyisobutylisonitrile (MIBI) (n=19) whole-body studies. Thyroid images were semi-quantitatively analysed by a 4-point score: 0=no significant uptake; 1=uptake increased as compared to background activity, but inferior to normal thyroid tissue; 2=uptake equal to normal thyroid tissue; 3=uptake superior to normal thyroid tissue. Pathology examinations were obtained. A total of 41 thyroid nodules were detected, of which 15 were goitre nodules, 13 adenomas and 13 malignant lesions. In goitre nodules, concordant results of tetrofosmin and pertechnetate uptake (score 1 or 0) were observed in the majority of lesions (87%). In function adenomas (n=10), both tetrofosmin uptake and pertechnetate uptake were score 3. In non-function adenomas (n=3), tetrofosmin uptake was score 3, while pertechnetate uptake was score 0. In six malignant lesions, tetrofosmin uptake was score 3, while pertechnetate uptake was score 0; in the other seven lesions, where a prevalence of goitre abnormalities was observed, results of tetrofosmin and pertechnetate uptake were similar (score 0 or 1). In seven (70%) of the ten patients with malignant nodules, whole-body tetrofosmin images showed increased abnormal uptake in a total of 28 extra-thyroid tumour sites, as subsequently confirmed by other techniques. When tetrofosmin images were compared to 201Tl and 99mTc-MIBI scans, concordant results were observed in all cases. In conclusion, tetrofosmin imaging may be particularly useful to characterize and stage patients with malignant thyroid nodules; it shows similar results to thallium but provides better image quality. Comparable findings were observed between tetrofosmin and MIBI studies. Thus, tetrofosmin may be an alternative to thallium and MIBI in the aforementioned patients.

Topics: Adenoma; Female; Goiter, Nodular; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms; Thyroid Nodule

Topics: Adenoma; Adult; Choristoma; Female; Humans; Lymphatic Diseases; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thymus Gland

A 42-year old woman with hyperparathyroidism had a CT scan that was suggestive of a small nodular lesion in the left lower neck. Tc-99m sestamibi and Tc-99m tetrofosmin parathyroid imaging were performed 10 minutes and 2 hours after tracer injection. Early imaging with Tc-99m sestamibi demonstrated thyroid and focal uptake in the left lower neck. On delayed imaging, findings suggested a parathyroid adenoma. Imaging with Tc-99m tetrofosmin demonstrated similar findings. The abnormal parathyroid gland was an adenoma.

Topics: Adenoma; Adult; Female; Humans; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Subtraction Technique; Technetium Tc 99m Sestamibi