~(99m)TcO_4-/~(99m)Tc-MIBI联合显像在甲状腺癌术后随访中的价值

目的对99mTcO 4-/99mTc-MIBI甲氧基异丁基异腈(MIBI)联合显像与颈部彩色多普勒超声(CDU)检查在甲状腺癌术后复发或颈部转移中的诊断价值进行对比研究。方法回顾性分析了甲状腺癌术后疑似复发或颈部转移而行二次手术的患者21例,以术后病理结果为标准,分别对99mTcO 4-/99mTc-MIBI联合显像、颈部CDU检查,对87个疑似甲状腺癌术后复发或颈部转移灶的诊断结果进行对比分析。结果在术后甲状腺癌复发或颈部转移灶的诊断中颈部CDU检查灵敏度、特异性、准确率(44.78%,40.00%,43.68%),均低于99mTcO 4-/99mTc-MIBI联合显像(64.18%,80.00%,67.82%),差异有统计学意义(P<0.05)。结论 99mTcO 4-/99mTc-MIBI联合显像在诊断术后甲状腺癌复发或颈部转移方面优势明显。     

99mTc-MIBI显像在甲状腺“冷、凉”结节性质鉴别中的价值

目的评价99m锝-甲氧基异丁基异腈（99mTc-MIBI）显像在甲状腺＂冷、凉＂结节性质鉴别中的价值。方法对72例经99mTcO4-显像发现为＂凉＂及＂冷＂结节患者做99mTc-MIBI显像,根据结节部位核素分布与周围组织核素分布比较,判断阳性、阴性。结果阳性26例,阴性46例。与手术后病理对照,准确率76.9%,假阳性率23.1%,假阴性率6%。结论 99mTc-MIBI显像在甲状腺＂冷、凉＂结节性质鉴别中有较大的价值。     

045 运动性核素心肌灌注显像诊断冠心病研究进展

运动性核素心肌灌注显像在检测冠心病、评价心脏病变程度等方面已取得许多进展,现摘要概述如下. 定量单光子发射型计算机断层显像(SPECT)是心肌灌注显像的重要进展.有研究以SPECT检查1 447例冠心病(CAD)患者,其敏感性平均为92%(82%～98%)、特异性为68%(44%～91%).SPECT检测CAD的特异性低的原因,可能与扫描异常者做冠脉造影检查比扫描正常者多有关.饶有兴趣的是,SPECT检测既往无心肌梗死者CAD的敏感性仍高达85%.SPECT201铊(201Tl)显像检测1支、2支和3支冠脉病变的敏感性分别平均为83%、93%和95%.使SPECT201Tl显像检测CAD敏感性降低的主要因素有1支冠脉病变、左旋支狭窄、冠脉分支或远端狭窄、内径狭窄50%～70%的轻度冠脉狭窄、由非心脏症状所致停止运动时的不适当心率反应、应用硝酸盐类或钙通道阻滞剂治疗的心绞痛等.因此,应提高检测既往有心肌梗死、广泛性冠脉病变、高度冠脉狭窄、近端冠脉狭窄、局部室壁运动异常患者的敏感性.在这方面,定量扫描分析的敏感性和特异性要比应激试验和再分布201Tl闪烁图视觉评价的敏感性高. 由于201Tl闪烁法不能识别假稀疏图像,故其总敏感性并不十分理想.虽然定量201Tl显像的敏感性有所提高,但假阳性率仍然较高.在心尖部到心底部常观察到假阳性缺损.女性由于乳房组织的覆盖,前壁和室间隔等部位可出现假稀疏图像.高位横膈可造成下壁假阳性缺损.门电路99m锝(99mTc)灌注显像,可在断层X线照相SPECT上评价从舒张末期至收缩末期的收缩期室壁厚度.识别低灌注区域正常的收缩期室壁厚度,并可确定缺损是假稀疏而不是心肌疤痕.以门电路断层X线照相评价时,后者最可能伴有收缩期室壁厚度变小.Taillefer等的前瞻性研究评价了201Tl和99mTc灌注显像检测女性CAD的准确性.该研究中许多患者做过冠脉造影,检测明显CAD的总敏感性201Tl和99mTc相仿.然而,201Tl或99mTc-sestamibi(99mTc-MIBI)灌注显像、门电路99mTc-MIBI SPECT显像检测冠脉内径狭窄≥50%者的特异性分别平均为70.6%、86.3%和94.1%(P=0.05、P=0.002);检测冠脉内径狭窄≥70%者的特异性分别平均为67.2%、84.4%和92.2%.201Tl的特异性显著低于99mTc-MIBI和门电路99mTc-MIBI(P=0.02、P=0.0004),99mTc-MIBI灌注显像和门电路99mTc-MIBI SPECT显像两者间则无显著差异. 对运动性99mTc-MIBI SPECT显像研究的集中分析表明,99mTc-MIBI和201Tl检测CAD的敏感性分别为90%和83%,特异性分别为93%和80%,正常化比率99mTc-MIBI为100%、201Tl为77%.静息201Tl/应激99mTc-MIBI SPECT显像双重同位素检查,可从非可逆性缺损中识别可逆性缺损.该方案于静息时注射3.5mCi201Tl,10min后获得显像;获得这些静息性显像后立即进行运动试验,于运动高峰时注射25～30mCi99mTc-MIBI.Berman等报道这一方法检测CAD的敏感性和特异性分别为91%和75%.预试验时CAD可能性低者的正常化比率为95%.静息性201Tl/ 99mTc-MIBI闪烁图的可逆行缺损检出率与标准静息性201Tl/ 99mTc-MIBI SPECT显像相仿.最近的研究显示,新型99mTc标记灌注剂99mTc-N-NOET,首次通过心肌摄取指数比99mTc-MIBI或99mTc-tatrofosmin高,分布时间与201Tl相仿. (陈清江摘)     

原发性甲状旁腺功能亢进的核素定位诊断

应了~（99m）Tc-MIBI进行了甲状旁腺显像,并对方法学进行了探讨。10例患者经临床、生化确诊为原发甲旁亢,但均未触及增大的甲状旁腺或甲状腺。其中7例在应用~（99m）Tc-MIBI和~（99m）Tc两种示踪剂分别进行甲状旁腺显像和甲状腺显像,3例仅用~（99m）Tc-MIBI,但在显像过程中给予了过氯酸盐。在静泳注射~（99m）Tc-MIBI后不同时间采集图象并选用产P/T值（甲状旁腺计数/甲状腺计数）做参数,以了解示踪剂的代谢及确定最佳显像时间。10例患者经手术共摘除12枚肿大的甲状旁腺,病理证实10枚为甲状旁腺腺瘤,2枝为甲状旁腺增生,B超检查9例中发现2枚腺瘤,CT检查8例共发现3枚腺瘤,核素显像10例患者各发现腺瘤一个,其阳性部位与手术所见完全吻合。尽管例数较少,但初步看,此方法简便、准确,对于原发甲旁亢的定位诊断确有临床价值。     

99mTcO4-甲状腺显像对不同时期亚急性甲状腺炎的诊断价值

目的探讨放射性核素99mTcO4-甲状腺显像对不同时期亚急性甲状腺炎(SAT)的诊断价值。方法选择SAT患者155例,按甲状腺功能分为甲状腺功能亢进(甲亢)组77例、甲状腺功能正常组78例。分别行甲状腺99mTcO4-显像和细针穿刺细胞学检查(FNAB),以FNAB结果为参照,观察99mTcO4-甲状腺显像诊断不同时期SAT的灵敏度和特异度。结果 99mTcO4-甲状腺显像诊断甲亢组的灵敏度为91.7%、特异度为60.0%,与FNAB检查比较差异有统计学意义(χ2=12.8,P<0.05);诊断甲状腺功能正常组的灵敏度为76.1%、特异度为57.1%,与FNAB检查比较差异无统计学意义(χ2=2.0,P>0.05)。结论 99mTcO4-甲状腺显像诊断甲亢期SAT敏感性和特异性均高于甲状腺功能正常期,可考虑作为首选方法。     

99mTc-MIBI甲状旁腺显像及99mTc-MDP全身骨显像综合判断甲状旁腺功能亢进

目的　比较９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ双时相法与 Ｍ Ｉ Ｂ Ｉ９ ９ ｍ Ｔｃ Ｏ４ － 图像相减法两种显像法对甲状旁腺功能亢进（ 甲旁亢） 的诊断价值，同时结合９ ９ ｍ Ｔｃ Ｍ Ｄ Ｐ 全身骨显像综合判断甲旁亢患者的病情。方法　对１８ 例甲旁亢患者进行静注９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ７４０９２５ Ｍ Ｂｑ ，分别在第１５ 分钟、第２ 小时作颈前位平面显像；显像结束后立即予床边静注９ ９ ｍ Ｔｃ Ｏ４ － ７４１１１ Ｍ Ｂｑ ，１５ 分钟后再作显像。以９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ 延迟显像图减去９ ９ ｍ Ｔｃ Ｏ４ － 显像图，获得 Ｍ Ｉ Ｂ Ｉ９ ９ ｍ Ｔｃ Ｏ４ － 相减图。结果　９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ早 期 显 像（ 第１５ 分钟） 检 测甲旁亢病灶的灵敏度为６１ ．１ ％ （１１／１８） 、延迟相（２ 小时） 的灵敏度８３ ．３ ％ （１５／１８） 。１５ 例阳性显像中１４ 例为腺瘤，１ 例为癌；３ 例阴性者均为腺体增生。 Ｍ Ｉ Ｂ Ｉ９ ９ ｍ Ｔｃ Ｏ４ － 相减法除同样显示１５ 例９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ 延迟显像的病灶外，也检出１ 例增生型甲旁亢病灶。全身骨显像结果，２ 例出现“棕色瘤”样病灶，１０ 例呈多灶性骨放射性异常集聚改变     

左束支传导阻滞的核素心肌显像

目的探讨左束支传导阻滞的核素心肌显像并对照冠状动脉造影诊断冠心病的临床意义。方法15例左束支传导阻滞患者与10例正常人对照,先行多巴酚丁胺负荷试验再静脉注射201TI和99mTc-MIBI双核素心肌显像并与9例冠状动脉造影者进行比较,分析诊断冠心病的可靠性。在核素心肌显像中,分别对图像的中间短轴断层面进行定量分析,画感兴趣区(ROI)测定间壁/侧壁比值(S/LR)。结果①15例左束支传导阻滞201TI和99mTc-MIBI的S/LR分别为0.65±0.09和0.46±0.10,明显低于对照组(0.89±0.08和0.88±0.09)(P<0.01)。②5例多谱勒超声心动描记术显示前间壁、前壁收缩运动减弱。③9例冠状动脉造影者2例正常,7例显示冠状动脉狭窄>50%。结论①15例左束支传导阻滞显示间壁201TI和99mTc-MIBI摄取的显著不匹配(99mTc-MIBI>201TI)。②冠状动脉造影提示有冠状动脉狭窄的表现。因此,左束支传导阻滞行核素心肌显像是明确有无冠心病的有效检测方法之一。     

药物负荷心肌灌注显像评价心脏X综合征的应用研究

目的:对比双嘧达莫负荷心肌铊-201(201Tl)单光子发射计算机断层摄影(SPECT)和多巴酚丁胺负荷心肌99m锝-甲氧基异丁基异腈(99mTc-MIBI) SPECT显像在辅助诊断心脏X综合征中的应用. 方法:将74例心脏X综合征患者按不同的负荷药物分成A、B两组,其中A组行双嘧达莫负荷心肌201Tl SPECT显像,B组行多巴酚丁胺负荷心肌99mTc-MIBI SPECT显像.原始图像经三维重建后由2位以上有经验的核医学科医师进行分析.两组阳性率之间的比较采用卡方检验. 结果:A组53例患者负荷显像均正常,静息显像有45例出现“反向再分布”,其余8例静息显像正常,阳性率为84.91％(45/53).B组21例患者有3例出现可逆性缺损,其余18例负荷和静息显像均正常,阳性率为14.29％ (3/21).两组阳性率比较有统计学差异(x2=29.89,P＜0.001).结论:双嘧达莫负荷心肌201T1 SPECT显像的“反向再分布”现象对心脏X综合征具有一定的诊断价值.     

放射性核素显像诊断儿童异位甲状腺及核素显像剂的选择

目的探讨放射性核素显像诊断儿童异位甲状腺（ETG）的价值及显像剂的合理应用。方法对83例疑诊ETG患儿进行甲状腺核素显像检查,其中采用131I显像55例99mTcO4显像30例（两者联用2例）。并与临床病理检查结果比较。结果病理检查诊断为ETG11例。核素显像对11例ETG全部检出,诊断ETG的敏感性、特异性131I均为100％,99mTcO4亦均为100％;但99mTcO4较131I图像明显清晰。结论放射性核素显像对儿童ETG的诊断具有独特价值,宜常规选择99mTcO4^-显像。     

甲状旁腺四维CT在原发性甲状旁腺功能亢进症术前定位中的诊断价值

目的评估甲状旁腺四维CT(4-dimensional computed tomography,4D-CT)单独或联合其他定位手段对原发性甲状旁腺功能亢进症(甲旁亢)患者术前定位诊断的效能,为甲旁亢患者术前定位诊断提供更多的选择。方法共纳入57例术前完善甲状旁腺4D-CT、甲状旁腺99Tcm-甲氧基异丁基异腈甲状旁腺显像(MIBI)及甲状旁腺超声检查的原发性甲旁亢患者(共包含13例异常位置甲状旁腺病变),回顾性分析其临床及影像学资料。根据患者的术前血钙水平、肿瘤直径以及是否为异常位置甲状旁腺病变分为不同亚组。分别在总体及各亚组中分析4D-CT与其他检查手段单独或联合应用的敏感度、特异度、阳性预测值、阴性预测值,并绘制受试者工作特征(ROC)曲线,进行不同方案间曲线下面积(AUC)的比较。结果在57例患者中,4D-CT与99Tcm-MIBI诊断效能均高于超声,单独应用时AUC分别为0.943、0.927、0.847(超声与4D-CT、99Tcm-MIBI比较,P=0.01、0.04),任何两种方案联合的诊断效能均高于其中一种方案单独应用,但三者联合与两两联合相比差异均无统计学意义。当根据血...     

小剂量多巴酚丁胺超声心动图与硝酸甘油介入~(99m)Tc-MIBI的心肌灌注显像估测存活心肌

目的　探讨小剂量多巴酚丁胺超声心动图 (LDDE)与含服硝酸甘油 (NTG)介入99mTc 甲氧基异丁基异睛 (MIBI)的心肌灌注显像在心肌存活估测中的价值。方法　对 17例心肌梗死患者分别行静息 NTG介入99mTc MIBI和小剂量多巴酚丁胺超声心动图的检查 ,经皮冠状动脉腔内成形术或冠状动脉旁路移植术后一个月重复基础超声心动检查 ,并进行对比分析。结果　 17例患者于基础超声心动检查 ,共有 94个心肌节段运动异常 ,在其中 5 0个低动力心肌节段中 ,两种方法一致性节段 2 9个 (5 8% ,P >0 .0 5 ) ;在 44个无动力心肌节段中两种方法一致性节段 16个 (36 % ,P<0 .0 5 )。两种方法对低动力心肌节段功能恢复的预测差异无显著性意义 (P>0 .0 5 ) ;而对无动力心肌节段 ,LDDE较NTG介入 99m　Tc MIBI心肌灌注显像有较高的特异性 (90 .9%vs 6 4.7% ,P <0 .0 5 )和较低的敏感性 (6 3.6 %vs88.9% ,P <0 .0 5 )。对整个运动障碍节段功能恢复的预测 ,LDDE较NTG介入99mTc MIBI心肌灌注显像有较高的特异性 (87.2 %vs 6 8.2 % ,P <0 .0 5 )。结论　两种方法对低动力心肌节段的预测有良好的一致性 ,LDDE对整个运动障碍节段功能恢复的预测有较高的特异性。     

Technetium Tc 99m sestamibi myocardial perfusion imaging: current role for evaluation of prognosis.

Like 201Tl imaging, technetium Tc 99m sestamibi (MIBI) myocardial imaging can be used with exercise and pharmacologic testing to assess the presence of coronary artery disease. An increasing body of literature indicates that MIBI can also be used to assess risk of future cardiac events such as myocardial infarction or death. This article summarizes the current status of MIBI imaging for evaluating prognosis in patients with known or suspected coronary artery disease.     

运动与多巴酚丁胺负荷99m锝-焦磷酸盐心肌显像诊断冠心病价值的比较

目的　比较多巴酚丁胺和运动99m锝 焦磷酸盐心肌显像诊断冠心病的价值。方法　对12 0例拟诊为冠心病的患者分别进行药物和运动负荷99m锝 焦磷酸盐心肌显像 ,最后经冠状动脉造影确诊为冠心病。结果　多巴酚丁胺负荷诊断冠心病的敏感性为 94 .3 % ,特异性为 88% ,准确性91.7% ,显著高于运动负荷的 75 % ,61%和 68.4 % ,(P <0 .0 1)。结论　多巴酚丁胺对于诊断冠心病具有较高的敏感性和特异性。     

Detecting viable hibernating myocardium in chronic coronary artery disease--a comparison of resting 201Tl single photon emission computed tomography (SPECT), 99mTc-methoxy-isobutyl isonitrile SPECT after nitrate administration, and 201Tl SPECT after 201Tl-glucose-insulin infusion

To identify and quantify the amount of viable hibernating myocardium in patients with chronic coronary artery disease, resting 201Tl single photon emission computed tomography (SPECT) was compared with 99mTc-methoxy-isobutyl isonitrile (MIBI) SPECT after nitrate infusion (nitrate-99mTc-MIBI) and 201Tl SPECT after 201Tl with glucose-insulin-potassium infusion (201Tl-GIK) in 25 patients. Twenty-one patients also underwent completely left ventriculography beforehand and 5+/-4 months afterwards. SPECT images were divided into 9 segments and scored visually from 0 (normal uptake) to 3 (absent). The defect score was calculated as the summation of the total scores (TDS) in each patient. The TDS of nitrate-99mTc-MIBI images (6.3+/-4.3) and 201Tl-GIK images (5.8+/-4.2) were significantly lower than the 7.4+/-4.3 of resting 201Tl images (p<0.01). Based on the improvement of wall motion after coronary revascularization, the sensitivity of 201Tl-GIK imaging (85%) was significantly higher (p<0.05), and that of nitrate-99mTc-MIBI imaging (79%) also tended to be higher (p=0.08), than that of 201Tl imaging (62%) in detecting viable myocardium. The specificity of the 3 methods was almost the same. The nitrate-99mTc-MIBI and 201Tl-GIK methods were more useful than the resting 201Tl method for evaluating viable hibernating myocardium. Furthermore, the 201Tl-GIK method may provide a more accurate estimate of the amount of viable myocardium than the nitrate-99mTc-MIBI method.     

Quantitative rotational tomography with 201Tl and 99mTc 2-methoxy-isobutyl-isonitrile. A direct comparison in normal individuals and patients with coronary artery disease

We tested the hypothesis that 99mTc 2-methoxy-isobutyl-isonitrile (99mTc MIBI), a new radiopharmaceutical for myocardial perfusion imaging, provides accurate noninvasive detection of coronary artery disease (CAD). Imaging in patients after exercise and at rest with 99mTc MIBI was compared with imaging after exercise and redistribution with 201Tl in 12 normal subjects and 38 patients with angiographic documentation of CAD (greater than or equal to 50% diameter stenosis). We used single-photon emission computed tomography (SPECT) and computer quantitation of regional tracer distribution. The quality of reconstructed images with 99mTc MIBI judged visually was superior to that of 201Tl in 88% of all studies performed and was comparable in the others. With the limits of normal as 2.5 SD below the mean of gender-matched normal volunteers, 201Tl SPECT identified 32 and 99mTc MIBI identified 36 patients with CAD (p = 0.2). 201Tl SPECT identified 45 of 75 (60%) and 99mTc MIBI identified 59 of 75 (79%) stenosed coronary arteries (p less than 0.05). The quantitative severity of perfusion defects was similar for the two tracers. 201Tl SPECT identified 104 reversibly ischemic myocardial segments compared with 134 with 99mTc MIBI (p less than 0.05). Thus, SPECT myocardial perfusion imaging with 99mTc MIBI and computer quantitation provides an accurate method for the noninvasive detection of significant coronary artery disease. Furthermore, image quality is generally superior to 201Tl, and reversibly ischemic myocardial segments may be better identified with 99mTc MIBI.     

Detection of occult thymoma during exercise thallium 201, technetium 99m tetrofosmin imaging for coronary artery disease

Thallium (Tl) 201 and technetium (Tc) 99m tetrofosmin single-photon emission CT are routinely used in the evaluation of coronary artery disease. Mediastinal tumors demonstrate Tl 201 and Tc 99m tetrofosmin uptake. We report a 56-year-old man who developed chest pain after a previously successful angioplasty and stent of the left anterior descending coronary artery. He underwent a Tl 201, Tc 99m tetrofosmin exercise study. Abnormal mediastinal activity was visualized in both the Tl 201 and Tc 99m tetrofosmin images. Subsequently, the patient underwent resection of a stage II thymoma. Unanticipated focal extracardiac accumulation during myocardial scintiscanning should lead to further investigation to exclude mediastinal tumor.     

Comparison of histological findings and parathyroid scintigraphy in hemodialysis patients with secondary hyperparathyroid glands

To determine the usefulness of parathyroid scintigraphy in histological estimation for secondary hyperparathyroidism (2HPT) using Tc-99m sestamibi or Tc-99m tetrofosmin. Tc-99m sestamibi (MIBI) and Tc-99m tetrofosmin (Tetro) parathyroid imaging following double-phase study, magnetic resonance imaging (MRI), and ultrasound were performed on 14 patients with 2HPT. All patients underwent parathyroidectomy. The uptake of two tracers in parathyroid areas was compared with the histopathologic findings. Forty-nine parathyroid glands were surgically explored and histologically proven to be hyperplastic. Of these, 42 were diagnosed with nodular type (N-type) hyperplasia, and 7 with diffuse type (D-type) hyperplasia. MIBI and Tetro parathyroid imagings detected 34 and 35 parathyroid glands, respectively. The sensitivity of MIBI was determined to be 76.2% (32/42) for N-type, and 28.6% (2/7) for D-type. The sensitivity of Tetro was determined to be 78.6% (33/42) for N-type and 28.6% (2/7) for D-type. The sensitivity of both MIBI and Tetro was significantly higher for N-type than for D-type, 76.2% (32/42) vs. 28.6% (2/7) in MIBI, P = 0.022; 78.6% (33/42) vs. 28.6% (2/7) in Tetro, P = 0.015. The sensitivity of MRI was determined to be 76.2% (32/42) for N-type and 42.9% (3/7) for D-type, and the sensitivity of ultrasound was 71.4% (30/42) for N-type and 71.4% (5/7) for D-type. There was no significant difference in the sensitivity of MRI or ultrasound between N-type and D-type. The uptake ratios of MIBI and Tetro were also greater for N-type than for D-type. The detectability of both MIBI and Tetro was greater for N-type than for D-type. Tc-99m MIBI or Tc-99m Tetro parathyroid scintigraphy therefore may be used clinically to distinguish N-type from D-type parathyroid gland hyperplasia.     

Utility of 99mTc-sestamibi scintigraphy as a first-line imaging procedure in the preoperative evaluation of hyperparathyroidism

OBJECTIVE The use of preoperative imaging in patients with hyperparathyroidism remains controversial. Many of the available techniques are insufficiently sensitive and specific to justify their routine use. We have evaluated the Sensitivity and specificity of ^99mTc-sestamibi scintigraphy in the management of patients with different forms of hyperparathyroidism. DESIGN Preoperative imaging evaluation was carried out by sclntigraphic detection of pathological parathyroid glands using ^99mTc-sestamibi as a radiotracer; confirmation of scan findings was obtained surgically. PATIENTS A group of 25 patients with primary (n= 21) or secondary (n=4) hyperparathyroidism were studied. All were considered for surgical treatment. MEASUREMENTS In all cases parathyroid imaging was carried out by ^99mTc-sestamibi scintigraphy together with at least one other imaging technique which included CT-scan, ultrasonography, MRI or ²⁰¹TI/^99mTc subtraction scintigraphy. Blood tests included measurements of total calcium and PTH. RESULTS ^99mTc-sestamibi scintigraphy correctly localized 20 out of 21 adenomas, giving a sensitivity of 95.2%, markedly higher than that obtained with the other imaging techniques (ultrasonography 75%, ²⁰¹TI/^99mTc subtraction scintigraphy 57.1%, CT-scan 41.7% and MRI 33%). Of a total of 17 glands identified surgically as hyperplastic and confirmed by pathological examination, ^99mTc-sestamibi scintigraphy showed a positive image in 10, corresponding always to the larger abnormal glands (sensitivity 58.8%, higher than that observed with the other techniques). No false positive images were obtained with ^99mTc-sestamibi. All the ectopic adenomas (n= 3) were identified preoperatively, which contributed significantly to the surgical approach. CONCLUSION In patients with hyperparathyroidism, ^99mTc-sestamibi scintigraphy may be used as the single imaging technique as it shows a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands; the benefit of localizing parathyroid tissue prior to surgery in cases of ectopic adenomas clearly indicates that when an imaging procedure is required, this technique may be of great help in the management of hyperparathyroidism.     

Tc99m-sestaMIBI uptake in nonsecretory multiple myeloma

Staging and monitoring of multiple myeloma (MM) is mainly based on monoclonal component quantification; the absence of such a parameter renders difficult follow up of patients with nonsecretory MM (nsMM). In this study our aims were to determine the specificity and sensitivity of Tc99m-sestaMIBI scintigraphy at diagnosis and during follow up of nsMM patients. Nine nsMM patients were prospectively studied at diagnosis and during treatment for a mean time of 33 months (range: 12–65 +). Tc99m-sestaMIBI (MIBI) scintigraphy was compared to conventional imaging (CI: X ray with CAT or NMR details) at diagnosis and during follow up. At diagnosis, CI and MIBI were concordant in three patients; CI showed more focal lesions than MIBI in four patients, while MIBI revealed more focal lesions than CI in two patients. During the follow up, MIBI uptake was normal in the four patients who achieved remission. Five patients did not achieve remission: CI and MIBI were concordant in three, while MIBI was falsely negative in two patients. In conclusion, Tc99m-sestaMIBI scintigraphy has high sensitivity (no false positive cases) and 78% specificity (2/9 false negative cases) in tracing active nsMM lesions; it should be considered complementary to CI for monitoring this rare disease.     

Tc99m-sestaMIBI uptake in nonsecretory multiple myeloma

Staging and monitoring of multiple myeloma (MM) is mainly based on monoclonal component quantification; the absence of such a parameter renders difficult follow up of patients with nonsecretory MM (nsMM). In this study our aims were to determine the specificity and sensitivity of Tc99m-sestaMIBI scintigraphy at diagnosis and during follow up of nsMM patients. Nine nsMM patients were prospectively studied at diagnosis and during treatment for a mean time of 33 months (range: 12-65+). Tc99m-sestaMIBI (MIBI) scintigraphy was compared to conventional imaging (CI: X ray with CAT or NMR details) at diagnosis and during follow up. At diagnosis, CI and MIBI were concordant in three patients; CI showed more focal lesions than MIBI in four patients, while MIBI revealed more focal lesions than CI in two patients. During the follow up, MIBI uptake was normal in the four patients who achieved remission. Five patients did not achieve remission: CI and MIBI were concordant in three, while MIBI was falsely negative in two patients. In conclusion, Tc99m-sestaMIBI scintigraphy has high sensitivity (no false positive cases) and 78% specificity (2/9 false negative cases) in tracing active nsMM lesions; it should be considered complementary to CI for monitoring this rare disease.