Clinical Presentation

A 37-year-old woman with a history of hypertensive renal failure and a renal transplant now presents with hyperparathyroidism. A surgical exploration of the neck shows four benign-appearing parathyroid glands. Three are removed, and a portion of the fourth is left behind. The patient remains hyperparathyroid, with parathyroid hormone (PTH) levels above 700 ng/L following surgery. A sestamibi study is done to search for additional parathyroid tissue.

Fig. 67.1

Fig. 67.2

Technique

• Approximately 20 mCi of ^99mTc-sestamibi injected intravenously

• High-resolution collimator

• Anterior view of the neck and chest done at 20 minutes and 2 hours after injection

• Pinhole view of the thyroid bed done at 20 minutes and 2 hours after injection

• SPECT/CT of the thyroid bed and mediastinum

Image Interpretation