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Figures
- FIGURE 1.
Example of single-tracer, dual-phase protocol. Pinhole images of neck were obtained in anterior (ANT), right anterior oblique (RAO), and left anterior oblique (LAO) projections at 15 min and 3 h after intravenous injection of 99mTc-sestamibi. In addition, parallel-hole collimator image from submandibular salivary glands to left ventricle was obtained in anterior projection at 15 min and 3 h (not shown). There is subtle suggestion of adenoma at upper pole of left lobe of thyroid at both 15 min and 3 h. 99mTc-sestamibi washes out of parathyroid adenoma in a manner similar to the way it washes out of thyroid.
- FIGURE 2.
Example of double-tracer, single-phase protocol from same patient as shown in Figure 1. 123I was given orally 2 h before intravenous administration of 99mTc-sestamibi. Simultaneous pinhole images of 99mTc-sestamibi and 123I were acquired of neck in anterior (ANT), right anterior oblique (RAO), and left anterior oblique (LAO) projections at 15 min after administration of 99mTc-sestamibi. In addition, simultaneous parallel-hole image of 99mTc-sestamibi and 123I from submandibular glands to left ventricle was obtained in anterior projection at 15 min (not shown). Parathyroid adenoma is clearly seen at upper pole of left lobe of thyroid in subtraction images.
- FIGURE 3.
Example of double-tracer, double-phase protocol from same patient as shown in Figure 1. In addition to simultaneously acquired 99mTc-sestamibi and 123I images at 15 min shown in Figure 2, same images were acquired again at 3 h. 99mTc-sestamibi washes out of parathyroid adenoma at same rate as it washes out of thyroid gland. ANT = anterior; RAO = right anterior oblique; LAO = left anterior oblique.
- FIGURE 4.
Performance of each of 3 protocols is shown for correctly localizing position of 41 parathyroid adenomas in 37 patients. Data represent average results for 2 readers. ST-DP = single-tracer, dual-phase, DT-SP = dual-tracer, single-phase, DT-DP = dual-tracer, dual-phase.
Tables
Degree of certainty of location Protocol Reader 0 1 2 3 ST-DP A 17 7 11 6 B 9 8 (1) 8 (1) 16 DT-SP A 1 10 11 19 B 4 11 5 21 DT-DP A 3 10 9 19 B 5 6 9 21 0 = no adenoma seen; 1 = possible adenoma; 2 = probable adenoma; 3 = definite adenoma; ST-DP = single-tracer, dual-phase; DT-SP = dual-tracer, single-phase; DT-DP = dual-tracer, dual-phase.
Numbers in parentheses indicate numbers of localizations that were incorrect.
Localization success Protocol Reader Adenomas Correct 95% CI ST-DP A 24/41 59% 42–74 B 30/41 73% 57–86 DT-SP A 40/41 98% 87–100 B 37/41 90% 77–97 DT-DP A 38/41 92% 80–98 B 36/41 88% 74–96 CI = exact binomial confidence interval; ST-DP = single-tracer, dual-phase; DT-SP = dual-tracer, single-phase; DT-DP = dual-tracer, dual-phase.
Calculations are on per-adenoma basis. There were 41 adenomas in 37 patients.
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