• Society of Nuclear Medicine. Procedure guideline for parathyroid scintigraphy. Version 3.0. Reston (VA): Society of Nuclear Medicine; 2004 Jun. 6 p.

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for parathyroid scintigraphy, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 19 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

Background Information and Definitions

Primary hyperparathyroidism is characterized by increased synthesis and release of parathyroid hormone, which produces an elevated serum calcium level and a decline in serum inorganic phosphates. Asymptomatic patients are frequently diagnosed as a result of screening by automatic multichemistry panels. The vast majority of cases of primary hyperparathyroidism (80 to 85%) are the result of single or multiple hyperfunctioning adenomas. Hyperplasia of several or all parathyroid glands accounts for approximately 12 to 15% of cases, whereas parathyroid carcinomas occur in only 1 to 3% of cases of hyperparathyroidism. In general, parathyroid adenomas larger than 500 mg can be detected scintigraphically. ^99mTc-sestamibi allows detection of hyperplastic glands, although with less sensitivity than adenomas.

Dual-phase or double-phase imaging refers to utilizing ^99mTc-sestamibi and acquiring early and delayed images. Dual-isotope or subtraction studies refer to protocols using 2 different radiopharmaceuticals for imaging acquisition.

Examples of Clinical or Research Applications

1. To localize hyperfunctioning parathyroid tissue (adenomas or hyperplasia) in primary hyperparathyroidism. This may be useful before surgery to help the surgeon find the lesion, thus shortening the time of the procedure.

   Although the use of preoperative localizing procedures, including parathyroid scintigraphy, has been controversial, sestamibi scans have been shown to be accurate and to reduce the time and, therefore, the cost of an initial operation for hyperparathyroidism. Selected high-surgical-risk patients and those with life-threatening adenomas are especially likely to benefit from parathyroid scintigraphy. An unequivocally positive study will aid the surgeon in streamlining the surgical procedure.

2. To localize hyperfunctioning parathyroid tissue (usually adenomas) in patients with persistent or recurrent disease. Many of these patients will already have had 1 or more surgical procedures, making reexploration much more technically difficult. Also, ectopic tissue is much more prevalent in this population, and preoperative localization will likely increase surgical success, in part by sometimes helping to direct the surgical approach.

Procedure

The detailed procedure recommendations in the guideline address the following areas: patient preparation; information pertinent to performing the procedure (i.e., important data that the physician should have about the patient at the time the exam is performed and interpreted); precautions; information regarding the radiopharmaceutical (i.e., ranges of administered activity, organ receiving the largest radiation dose, effective dose), image acquisition; interventions; processing; interpretation/reporting; quality control, and sources of error.

None provided

The type of evidence supporting the recommendations is not specifically stated.

• Society of Nuclear Medicine. Procedure guideline for parathyroid scintigraphy. Version 3.0. Reston (VA): Society of Nuclear Medicine; 2004 Jun. 6 p.

Not applicable: The guideline was not adapted from another source.

1999 Feb (revised 2004 Jun)

Society of Nuclear Medicine, Inc - Medical Specialty Society

Society of Nuclear Medicine (SNM)

Task Force

Authors: Bennett S. Greenspan, MD (University of Missouri Medical Center, Columbia, MO); Manuel L. Brown, MD (Henry Ford Hospital, Detroit, MI); Gary L. Dillehay, MD (Loyola University Medical Center, Maywood, IL); Mike McBiles, MD (Brooke Army Medical Center, San Antonio, TX); Martin P. Sandler, MD (Vanderbilt University Medical Center, Nashville, TN); James E. Seabold, MD (University of Iowa Hospitals and Clinics, Iowa City, IA); James C. Sisson, MD (University of Michigan Medical Center, Ann Arbor, MI)

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for parathyroid scintigraphy, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 19 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

None available

This summary was completed by ECRI on July 20, 1999. It was verified by the guideline developer as of August 5, 1999. This summary was updated by ECRI on May 18, 2005. The updated information was verified by the guideline developer on June 30, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.