Technetium Tc 99m-Sestamibi Scan

The most sensitive noninvasive imaging technique available for identifying the anatomic location of a parathyroid adenoma or hyperplastic parathyroid tissue.

Accurately identifies the anatomic location and extent of parathyroid disease in 70% of patients with primary hyperparathyroidism.

Tc99m-sestamibi is absorbed faster by a hyperfunctioning parathyroid gland than by a normal parathyroid gland.

Scanning correlates with the number and activity of the mitochondria within the parathyroid cell.

Oxyphil cell parathyroid adenomas have a very high avidity for sestamibi, while chief cell parathyroid adenomas have almost no imaging quality at all with sestambi.

Approximately 60 percent of parathyroid adenomas may be imaged by sestamibi scanning.

The natural distribution of etiologic causation for primary hyperparathyroidism is roughly 85% solitary adenomas, 10-15% diffuse hyperplasia, and 1% cancer.

With multiglandular parathyroid disease, imaging is not as reliable.

SPECT (three-dimensional) imaging, as an adjunct to planar methods, may increase sensitivity and accuracy, especially in cases of small or parathymic adenomas.

A surgeon is able to remove only the one parathyroid gland that is producing excessive amounts of parathyroid hormone and no longer under the biochemical control of the body, and leave the other 3 normal parathyroid glands in place.

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