Localization of Enlarged Parathyroid Glands by Thallium-201 and Technetium-99m Subtraction Imaging

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Abstract
Patients (22), all with surgically proven primary hyperparathyroidism, were studied by 201Tl thallous chloride and 99mTc pertechnetate subtraction imaging. Parathyroid adenomata (15) and 1 hyperplastic gland between 0.33 and 14.8 g were correctly localized in 16 patients. Two adenomata and 7 hyperplastic or histologically normal parathyroids between 0.1 g and 1.4 g in 7 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 2 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 4 of the patients with correctly localized parathyroids. The imaging procedure is useful but its sensitivity is limited by difficulty in localizing correctly small gland, particularly those of < 0.5 g, which comprised 29% of those excised.

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