继发性甲状旁腺功能亢进的99Tcm-MIBI双时相显像

目的评价９９Ｔｃｍ甲氧基异丁基异腈（ＭＩＢＩ）双时相显像法在肾性继发性甲状旁腺功能亢进（ＳＨＰ）患者中的诊断价值。方法２０例因慢性肾功能衰竭行血液透析患者,临床诊断为ＳＨＰ,均行双时相法９９ＴｃｍＭＩＢＩ甲状旁腺显像。运用甲状旁腺／甲状腺（ＰＴ／Ｔ）比值及甲状旁腺指数（ＰＴＩ）观察阳性病灶对ＭＩＢＩ的清除。３例行颈部探查术并作甲状旁腺自体移植。结果８例显像阳性,其中３例手术摘除９枚甲状旁腺,均经病理证实为增生。９９ＴｃｍＭＩＢＩ显像发现其中的８枚,其灵敏度为８８９％。在透析年限长、甲状旁腺素分泌高的患者中,有更高的阳性率。发现有３种ＭＩＢＩ清除类型。结论９９ＴｃｍＭＩＢＩ双时相显像在ＳＨＰ患者中有较高的定位诊断价值。阅片时应考虑病灶清除ＭＩＢＩ的多样性,以免漏诊     

甲状旁腺显像定位诊断原发性甲状旁腺机能亢进

应用甲状旁腺显像，并经手术及病理确诊１７例原发性甲状旁腺机能亢进患者。我们采用了＾２０１Ｔｌ和＾９９ｍＴｃ－ＭＩＢＩ两种用状旁腺显像剂及＾２０１Ｔｌ／＾９９ｍＴｃＯ＾－４、＾９９ｍＴｃ－ＭＩＢＩ／＾９９ｍＴｃＯ＾－４减影法和＾９９Ｔｃ－ＭＩＢＩ双时相法三种显像方法。１７例的病理结果为１５例甲状旁腺瘤（１例为多发，２个腺瘤），１例癌及１例增生。甲状旁腺显像准确定位１７个腺体，１例假阴性。此例系位于上     

继发性甲状腺功能亢进的^99Tc^m—MIBI双时相显像

目的 评价＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）双时相显像法在肾性继发性甲状旁腺功能亢进（ＳＨＰ）患者中的诊断价值。方法 ２０例因慢性肾功能衰竭行血液透析患者,临床诊断与ＳＨＰ,均行双时相法＾９９Ｔｃ＾ｍ－ＭＩＢＩ甲状旁腺显像,运用甲状旁腺／甲状腺（ＰＴ／Ｔ）比值及甲状旁腺指数（ＰＴＩ）观察阳性病灶对ＭＩＢＩ的清除,３例行颈部探查术并作甲状腺自体移植,结果 ８例显像阳性,其中３例手术摘除９枚     

^99Tc^m—MIBI与^99Tc^m—MDP骨显像诊断骨良恶性病变的比较

目的 对比分析＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）和＾９９Ｔｃ＾ｍ－亚甲基二膦酸盐（ＭＤＰ）对骨良恶性病变的诊断价值和疗效评估。方法 ６１例临床拟诊骨良性病变患者分别进行２项骨显像,其中６例恶性肿瘤患者分别进行化疗前后显像,显像后均经手术,病理检查对比分析。结果 ＾９９Ｔｃ＾ｍ－ＭＩＢＩ显像;７３％恶性肿瘤病灶肉眼见中、高度ＭＩＢＩ浓聚,６０％良性病灶肉眼未见ＭＩＢＩ聚集,恶性病灶部位与对     

乳腺肿块~(99m) Tc-MIBI双时相显像与X线钼靶对照研究

目的：探讨~(９９ｍ)ＴＣ－ＭＩＢＩ双时相乳腺显像和乳腺钼靶的联合应用对提高患者术前诊断准确性的价值。材料和方法：对疑为乳腺癌的 ３４名患者术前行钼靶检查和~(９９ｍ)Ｔｃ－ ＭＩＢＩ双时相乳腺显像。乳腺钼靶：双乳分别行轴位（头足位）和侧位摄片。乳腺双时相核素显像采用平面显像行正位、双侧斜位、俯卧位时双侧乳腺侧位。所有病例均于两项检查后两星期内行手术获得病理诊断。结果：~(９９ｍ)Ｔｃ－ ＭＩＢＩ乳腺双时相显像示：乳腺的早期和延迟显像一致。恶性病变早期和延迟相的平均Ｔ／Ｎ值分别为１８０±０．６８、１．６４±０．４２,两者Ｐ＞０．０５。~(９９ｍ)Ｔｃ－ＭＩＢＩ乳腺双时相显像敏感性为８８％,特异性为７６％,准确性为８２％。钼靶检查：良性病变诊断的８例中,一例为恶性病变（浸润性导管癌）;病变性质无法确定的１４例中,６例为恶性病变（浸润性导管癌３例,浸润性腺癌２例,鳞癌１例）;恶性病变诊断的１２例中２例为良性病变。钼靶检查病变性质无法确定的１４例中,乳腺双时相显像诊断正确为１２例。结论：~(９９ｍ) Ｔｃ－ＭＩＢＩ乳腺双时相显像和钼靶检查对乳腺肿块的诊断和鉴别诊断中有各自的特点。在临床实践中合理的诊断程序有助于提高诊断准确率,减少不     

原发性甲状旁腺机能亢进影像诊断的评价

目的比较Ｂ超、ＣＴ、９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）对于高功能甲状旁腺病灶定位诊断的价值。方法经临床诊断为原发性甲状旁腺机能亢进（简称原发甲旁亢）的２３例患者均做了Ｂ超检查，２０例做了ＣＴ扫描，２１例进行了９９ｍＴｃＭＩＢＩ核素显像。结果２３例患者共摘除２３枚腺瘤和２枚增生腺体，均经病理诊断证实。Ｂ超、ＣＴ、９９ｍＴｃＭＩＢＩ的灵敏度分别为６０％、６８％和９１％，特异性为９７％、９７％和１００％，准确性为８９％、９１％和９８％。Ｂ超与ＣＴ无明显差异，９９ｍＴｃＭＩＢＩ在灵敏度和准确性方面优于Ｂ超和ＣＴ，但特异性三者近似。结论９９ｍＴｃＭＩＢＩ双时相法对于甲状旁腺腺瘤的定位诊断很有帮助，原发甲旁亢患者首次探查术前进行无创影像定位检查是必要的     

甲状旁腺肿大的定位诊断：~（99m）Tc－MIBI与~（201）TI显

１０５甲状旁腺肿大的定位诊断：￣（９９ｍ）Ｔｃ－ＭＩＢＩ与￣（２０１）ＴＩ显像、超声波与ＣＴ的比较［英］／ＧｅａｔｔｉＯ…／／ＥｕｒＪＮｕｃｌＭｅｄ．－１９９４，２１（１）．－１７～２２研究比较了９９ｍＴｃ－ＭＩＢＩ／９９ｍＴＣＯ４与２０１Ｔｌ／９９...     

甲状旁腺的核素显像

甲状旁腺疾病的核素显像诊断起始于６０年代，当时应用＾７５Ｓｅ－蛋氨酸，效果不佳。自９０年代以来，由于应用＾２０１Ｔｌ／＾９９ｍＴｃ，（９９ｍＴｃ）ＭＩＢＩ／＾９９ｍＴｃ，（＾９９ｍＴｃ）ＭＩＢＩ／＾１２３Ｉ等减影技术，取得了满意的效果，尤其是（＾９９ｍＴｃ）ＭＩＢＩ的应用，对甲状旁腺疾病的诊断和甲状旁腺腺瘤的定位诊断，显示了核医学显像无创而准确的效果，如结合ＳＰＥＣＴ显像，对一些异位甲状旁腺腺瘤的     

应用多种脑功能显像剂的脑膜瘤显像特征

目的探讨应用多种脑功能显像剂进行脑膜瘤显像的特征表现及诊断脑膜瘤的互补作用。方法对２１例脑膜瘤病人（良性１８例，恶性３例）进行了脑血流显像、９９ｍＴｃ乙撑双半胱氨酸二乙酯（ＥＣＤ）、９９ｍＴｃＤＴＰＡ和（或）９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）脑显像。分析病灶的显像特征和计算放射性摄取比值（Ｔ／Ｎ）。病人均有ＣＴ或ＭＲＩ检查。结果１６／２０例肿瘤部位动脉期有放射性异常增高。１７／１９例９９ｍＴｃＥＣＤ显像表现为形态规整、边缘光滑的卵圆或圆形内凹缺损，１例为额顶叶受压变平，仅１例无异常发现；１７／１７例９９ｍＴｃＤＴＰＡ、１４／１４例９９ｍＴｃＭＩＢＩ显像表现为均匀的放射性浓聚，形态与９９ｍＴｃＥＣＤ显像所示缺损区吻合。３种显像剂的Ｔ／Ｎ值互不相关，仅９９ｍＴｃＥＣＤ的Ｔ／Ｎ值恶性病变显著低于良性病变。结论９９ｍＴｃＥＣＤ结合９９ｍＴｃＤＴＰＡ或９９ｍＴｃＭＩＢＩ脑显像能明确脑膜瘤的诊断，９９ｍＴｃＥＣＤＴ／Ｎ值能否提示脑膜瘤的良恶性尚待积累资料     

~（99m）Tc－MIBI双时相显像行甲状旁腺增生定位诊断二例

~（９９ｍ）Ｔｃ－ＭＩＢＩ双时相显像行甲状旁腺增生定位诊断二例高广文，郭仁宣，赵梅芬，刘浩，李德顺，韩春起，陈涛甲状旁腺增生的手术前定位诊断其临床意义十分重要，本文报告９９ｍＴＣ－甲氧基异丁基异腈（ＭＩＢＩ）显像定位诊断异位甲状旁腺瘤、甲状旁腺增生各?..     

双核素显象对甲状旁腺功能亢进病灶定位诊断的价值

总结了85例临床诊断为甲状旁腺功能亢进的患者使用~(201)Tl/(99m)~TC核素减影技术做病灶术前定位的结果,术中外科医生共发现99个病灶,双核素显像检出50个病灶,总的灵敏度仅为50%;对异位甲状旁腺病灶其灵敏度为82%(14/17).     

Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US ( p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.     

^99Tc^m—MIBISPECT结合定位CT显像诊断功能亢进异位甲状旁腺的价值

目的评价^99Tc^m-甲氧基异丁基异腈（MIBI）SPECT结合定位CT显像对功能亢进异位甲状旁腺的定位诊断价值。方法回顾性分析28例功能亢进异位甲状旁腺患者的手术、病理及影像资料。28例均行常规CT检查,其中25例先行双时相^99Tc^m-MIBI显像,对甲状腺外存在异常放射性浓聚灶患者,随即进行SPECT结合定位CT采集,经计算机处理得到二者融合图像,对放射性浓聚灶进行精确定位。以手术及病理检查结果为检查“金标准”,所有患者均按4个甲状旁腺计算,经手术及病理检查证实的为阳性,其余判为阴性。CT检查与核医学显像结果的比较采用四格表,检验。结果手术中28例患者共摘除28个异位病灶,均为单发。病理检查结果均为腺瘤。28例患者常规CT检查共发现22个阳性病灶,其中真阳性17个,假阳性5个,另假阴性11个,真阴性79个;25例^99Tc^m-MIBISPECT结合定位CT显像发现阳性病灶23个,无假阳性,另假阴性2个,真阴性75个。常规CT检查与核医学显像对检出病理性甲状旁腺的灵敏度分别为61％（17／28）、92％（23／25）,特异性为94％（79／84）、100％（75／75）,准确性为86％（96／112）、98％（98／100）,阳性预测值为77％（17／22）、100％（23／23）,阴性预测值为88％（79／90）、97％（75／77）;两者间比较差异有统计学意义,灵敏度：χ^2=6．98,P〈0．01,特异性：χ^2=4．61,P〈0．05,准确性：χ^2=10．30,P〈0．01,阳性预测值：χ^2=5．88,P〈0．05,阴性预测值：χ^2=5．36,P〈0．05。结论^99Tc^m—MIBI SPECT结合定位CT显像对功能亢进异位甲状旁腺的定位诊断优于常规CT,但存在一定的假阴性。     

The usefulness of radio-guided surgery in secondary hyperparathyroidism

Recent reports have shown that radio-guided surgery with an intraoperative gamma probe (IGP) is useful for identifying parathyroid adenomas. The aim of this study was to evaluate the usefulness of IGP mapping in patients with secondary hyperparathyroidism. Seven patients with secondary hyperparathyroidism underwent technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) scintigraphy immediately before undergoing surgical resection of all parathyroid tissues. We compared the sensitivity of Tc-99m MIBI scintigraphy alone with that of the combination of Tc-99m MIBI scintigraphy and IGP mapping. The sensitivity of the combination of Tc-99m MIBI scintigraphy and IGP mapping was 100% (28 of 28 lesions) and was significantly higher than that of Tc-99m MIBI scintigraphy alone (71.4%, 20 of 28 lesions). The combination of the Tc-99m MIBI scintigraphy and IGP mapping has increased sensitivity for identifying parathyroid lesions during parathyroidectomy in patients with secondary hyperparathyroidism.     

The usefulnes of99mTc-HMPAO-labeled leukocyte scintigraphy in the diagnosis of skeletal metastases of cancers

The usefulness of bone marrow scintigraphy with 99mTc-HMPAO-labeled leukocytes (leukocyte bone marrow scintigraphy) in the diagnosis of skeletal metastases of cancers was investigated in 70 lesions in 27 patients with various types of cancer. The final diagnosis of skeletal metastases was based on one or more criteria consisting of histological confirmation, typical findings of metastases by bone radiograph, CT and MRI, or progressive swellings of the lesions with severe pain due to nerve compression. Of the 70 lesions, 55 were finally diagnosed as metastases, and 15 as benign lesions. Leukocyte bone marrow scintigraphy showed photopenic defects in 52 of the 55 metastatic lesions (sensitivity 95%), and the remaining 3 negative lesions were found positive for metastases by MRI. In contrast, MRI could evaluate only 39 of the 55 lesions because 16 lesions in the ribs, scapula and sternum were not visualized. Of these 39 lesions, MRI showed positive findings for metastases in 33 (sensitivity 85%), and negative findings in 6 with photopenic defects found by leukocyte bone marrow scintigraphy. Of the 15 benign lesions, 3 were false positive for metastases on leukocyte bone marrow scintigraphy (specificity 80%). We conclude that 99mTc-HMPAO-labeled leukocyte bone marrow scintigraphy may be useful in the diagnosis of skeletal metastases of cancers, particularly when MRI fails to evaluate the lesions.     

Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism

Technetium-99m sestamibi scintigraphy has become a valuable tool in locating parathyroid glands in patients with primary hyperparathyroidism. The aim of this study was to evaluate its usefulness in secondary hyperparathyroidism. Twenty patients were injected intravenously with 740 MBq of ^99mTc-sestamibi and images were obtained at 15 min and 2 h post injection. All patients underwent parathyroid ultrasonography (US) as well as bilateral surgical neck exploration and 64 parathyroid glands were removed. US revealed at least one enlarged gland in 15/20 patients (75%), while ^99mTc-sestamibi scintigraphy showed focal areas of increased uptake in at least one gland in 17/20 patients (85%). When imaging results for all glands were evaluated according to surgical results, sensitivity was 54% for parathyroid scintigraphy and 41% for US, and specificity was 89% for both imaging techniques. There was a discrepancy between the two imaging modalities in 28 glands (35%). The mean surgical weight of US-positive glands (1492±1436 mg) was significantly higher than that of US-negative glands (775±703 mg) (P<0.05). However, there were no significant differences in weight between sestamibi-positive and sestamibi-negative glands. When only sestamibi-positive glands were considered, a positive correlation between uptake and weight was found (r=0.4, P<0.05). In conclusion, parathyroid US and ^99mTc-sestamibi scintigraphy are complementary imaging techniques in the preoperative localization of abnormal parathyroid glands in patients with secondary hyperparathyroidism. The limited sensitivity of the techniques means that patients will still require bilateral neck exploration; therefore routine preoperative parathyroid scanning in renal patients is not justified. Received 1 June and in revised form 6 August 1997     

Technetium-99m-DTPA aerosol scintigraphy in amiodarone induced pulmonary toxicity in comparison with Ga-67 scintigraphy

Amiodarone hydrochloride, which is used in life-threatening cardiac tachyarrhythmia, has been known to cause amiodarone induced pulmonary toxicity (AIPT) as a complication. In this study we aimed to investigate the clinical value of technetium-99m diethylene triamine penta-acetic acid (DTPA) aerosol lung scintigraphy in patients with AIPT in comparison with gallium-67 (Ga-67) scan. The study group included 26 cases, 7 patients with diagnosis of AIPT (Group A), 8 patients receiving amiodarone therapy but without AIPT (Group B) and 11 healthy subjects as a control group (Group C). All patients underwent Ga-67 and Tc-99m-DTPA aerosol scintigraphy in addition to various laboratory tests, Ga-67 scintigraphy was positive in 4 of 7 AIPT patients but quite normal in Group B. A positive correlation was found (r = 0.52, p < 0.05) between kep values determined by Tc-99m-DTPA aerosol scintigraphy and the cumulative dose of amiodarone. The mean kep values were 2.04% +/- 0.85%/min, 1.30% +/- 0.42%/min and 0.86% +/- 0.19%/min for groups A, B and C, respectively. The mean clearance rate of group A was significantly faster than that of normals (p < 0.0005) and group B (p = 0.028). In addition, there was a significant difference between groups B and C (p = 0.015). In conclusion, Ga-67 lung scintigraphy is a useful method for the detection of AIPT but Tc-99m-DTPA aerosol scintigraphy offers better results than Ga-67 scintigraphy. Early changes in Tc-99m-DTPA clearance may be observed in patients receiving amiodarone. The kep value in patients with AIPT is noticeably increased with respect to the control group. With its favorable physical properties, low cost, lower radiation burden and its ability to be used as an objective measure for the pulmonary clearance rate, Tc-99m-DTPA aerosol scintigraphy appears to be promising in patients receiving amiodarone therapy.     

Utility of<Superscript>99m</Superscript>Tc dextran scintigraphy in diabetic patients with suspected osteomyelitis of the foot

PURPOSE: Osteomyelitis of the foot is a frequent complication of diabetes mellitus and its diagnosis is often difficult. The goal of this study was to demonstrate the utility of 99mTc dextran scintigraphy in suspected diabetic foot infections. MATERIALS AND METHODS: Twenty-six patients (20 males, 6 females, age range 18-80 years) with diabetes mellitus who had a total of 36 foot ulcers or necrosis were studied. All the patients underwent both three phase bone scan and 99mTc dextran scintigraphy. Final diagnosis was based upon either pathologic examination or clinical follow-up at least four months. RESULTS: On bone scan increased uptake was seen in 55 sites, and among these there were 11 lesions of proven osteomyelitis. There were 11 true-positive, 0 false negative, 0 true negative and 44 false positive results for bone scan. The sensitivity, specificity and accuracy of bone scan were 100%, 0% and 20%, respectively. With regard to 99mTc dextran scan, nine lesions produced true-positive results with two lesions indicating false negatives resulting in a sensitivity of 82%. Thirty-six true negative and eight false positive results produced a specificity of 82%, and an accuracy 82% from 99mTc dextran studies was obtained. Eight false-positive results were possibly due to neuroarthropathy, pressure points and deep penetrating ulcers. A patient with one false-negative result had angiopathy while other had neither neuropathy nor angiopathy. CONCLUSIONS: According to these results, 99mTc dextran scintigraphy seems to be a sensitive and specific diagnostic method, and because of its advantages over other radiopharmaceuticals (shorter preparation time, highly stability in vivo/in vitro, early diagnostic imaging and low cost), it may be a radiopharmaceutical of choice for diagnosing in diabetic foot infections.     

Quantitative comparison of technetium-99m tetrofosmin and thallium-201 images of the thyroid and abnormal parathyroid glands

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 ²⁰¹Tl (74 MBq), ^99mTc-pertechnetate (74 MBq) and ^99mTc-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. ²⁰¹Tl and ^99mTc-tetrofosmin showed a similar thyroid/background ratio (1.79±0.41 and 1.81±0.47, respectively, P=NS); however, ^99mTc-tetrofosmin showed a higher parathyroid/background ratio than ²⁰¹Tl (2.06±0.54 vs 1.79± 0.50, P=0.007). Despite the superior quality of ^99mTc-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%).     

The usefulness of single photon emission computerized tomography with pinhole collimator (P-SPECT) in preoperative localization of hyperfunctioning parathyroid glands in patients with secondary hyperparathyroidism

PURPOSE: In this study the usefulness of parathyroid scintigraphy was evaluated in a group of patients affected by secondary hyperparathyroidism, combining the conventional double-tracer subtraction planar scintigraphy with pinhole-SPECT (P-SPECT) acquisition and comparing the scintigraphic data with those obtained by ultrasonography. MATERIALS AND METHODS: Twenty-four patients with secondary hyperparathyroidism were enrolled, 19 with chronic renal failure on haemodialysis and 5 with renal transplant. All patients underwent parathyroidectomy because of their unresponsiveness to medical therapy and/or severe osteodystrophy. Histology ascertained a single adenoma each in 3 patients and 61 hyperplastic glands in the remaining 21 cases. Before surgery, all patients were submitted to high resolution ultrasonography and afterwards to double-tracer subtraction planar parathyroid scintigraphy ((99m)Tc-pertechnetate/(99m)Tc-tetrofosmin) followed by neck P-SPECT acquisition. RESULTS: P-SPECT was true positive in all 24 patients, while both planar and ultrasonography were false negative in one case. Globally, P-SPECT identified 60/64 hyperfunctioning parathyroid glands, planar 47/64 and ultrasonography 45/64. P-SPECT sensitivity (93.7%) was significantly higher than both planar (73.4%; p<0.001) and ultrasonography (70.3%; p< 0.0005). The difference was also significant (p<0.05) when P-SPECT sensitivity was compared with that obtained combining planar scintigraphy and ultrasonography (84.4%). Moreover, P-SPECT defined the exact number of hyperplastic glands in 85.7% of positive patients, while planar in 60% and ultrasonography in 45%. Only 4 hyperplastic glands were false negative at P-SPECT showing a maximum diameter of 10 mm and a weight ranging from 480 to 500 mg. These glands were also false negative at both planar scintigraphy and ultrasonography which missed further 13 and 15 hyperfunctioning glands, respectively, all detected by P-SPECT. Globally, the latter procedure gave the correct preoperative localization of hyperfunctioning parathyroid glands in 87.5%, planar in 62.5% and ultrasonography in 50%. None of the three procedures had false positive RESULTS: CONCLUSIONS: The data of the present study seem to indicate that P-SPECT is a reliable diagnostic method in preoperative localization of hyperfunctioning parathyroid glands in patients with secondary hyperparathyroidism. This procedure identified a significantly higher number of hyperplastic glands than both double-tracer subtraction planar parathyroid scintigraphy and ultrasonography in our cases, thus proving a more useful guide for the surgeon. Given its low false negative rate, a wider use of P-SPECT is suggested in the preoperative management of patients with secondary hyperparathyroidism undergoing either a first operation of parathyroidectomy or a second operation for recurrence.