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Comparison between MR Imaging and ^99mTc MIBI Scintigraphy in the Evaluation of Recurrent or Persistent Hyperparathyroidism¹

¹ From the Thoracic Imaging Section, Department of Radiology, University of California, San Francisco General Hospital, 1001 Potrero Ave, Rm 1X 55A, Box 1325, San Francisco, CA 94110 (M.B.G.); the Department of Radiology, University of California, San Francisco (M.B.G., G.P.R., W.R.W., E.T.M., C.B.H.); and the Department of Surgery, University of California, Mt Zion Medical Center, San Francisco (O.H.C.). Received April 28, 2000; revision requested June 17; revision received July 14; accepted July 25. Address correspondence to M.B.G. (e-mail: michael.gotway@radiology.ucsf.edu).

PURPOSE: To compare the sensitivity and positive predictive value of magnetic resonance (MR) imaging and technetium 99m 2-methoxyisobutyl-isonitrile (MIBI) scintigraphy for the detection of hyperfunctioning parathyroid tissue when used alone and in combination in a large patient population with recurrent or persistent hyperparathyroidism (HPT).

MATERIALS AND METHODS: In 98 consecutive patients with biochemically proved recurrent or persistent HPT after surgery, MR imaging and ^99mTc MIBI study findings were retrospectively reviewed and compared with surgical and histopathologic findings. The sensitivity and positive predictive value of MR imaging and ^99mTc MIBI scintigraphy were compared with each other and in combination.

RESULTS: In these patients, 130 abnormal parathyroid glands were identified at surgery. The sensitivity and positive predictive value of MR imaging were 82% (95% CI: 75%, 89%) and 89%, respectively; those for ^99mTc MIBI scintigraphy were 85% (95% CI: 79%, 91%) and 89%. No significant difference was found between MR imaging and ^99mTc MIBI scintigraphy for sensitivity (P = .7). The sensitivity and positive predictive value for the detection of abnormal parathyroid tissue on a per-gland basis increased to 94% (95% CI: 90%, 98%) and 98%, respectively, when only one of the two tests was required to be positive.

CONCLUSION: MR imaging and ^99mTc MIBI scintigraphy have similarly good sensitivity and positive predictive value for the detection of hyperfunctioning parathyroid tissue in patients after surgery. The combination of the two tests provided a substantial increase in sensitivity and positive predictive value.

Index terms: Parathyroid, hyperparathyroidism, 274.531 • Parathyroid, MR, 274.121411, 274.121415 • Parathyroid, neoplasms, 274.363 • Parathyroid, radionuclide studies, 274.12175 • Parathyroid, SPECT, 274.12162

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