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Potential pitfall in parathyroid sestamibi imaging resulting from a cardiac pacemaker.
M P Granato1, M S Rodriguez, S M Elshazly
1University of Texas Medical School-Houston and Memorial Hermann Hospital, Department of Radiology, 77030, USA.
Clinical Nuclear Medicine
|January 4, 2001
Summary
Technetium-99m sestamibi imaging can reveal linear activity in the mediastinum due to cardiac pacemaker wires, not ectopic parathyroid tissue. This highlights the importance of correlating imaging findings with patient history.
Area of Science:
- Nuclear Medicine
- Radiopharmaceuticals
- Medical Imaging
Background:
- A patient with end-stage renal disease and hyperparathyroidism underwent technetium-99m sestamibi imaging to detect ectopic parathyroid tissue.
- Elevated calcium and parathyroid hormone levels prompted the investigation, despite a history of hypoparathyroidism and renal disease.
Observation:
- The imaging revealed persistent linear activity in the upper right mediastinum on delayed scans.
- This unusual finding persisted after thyroid tissue had cleared the radiotracer.
- The configuration of the uptake was atypical for parathyroid tissue.
Findings:
- The mediastinal activity was not attributed to hyperactive parathyroid tissue.
- The linear uptake was identified as being caused by central venous pacemaker wires.
- Cardiac pacemakers can cause increased radiotracer uptake in technetium-99m sestamibi imaging.
Implications:
- This case presents a potential imaging pitfall in parathyroid scintigraphy.
- Correlative imaging and thorough patient history are crucial for accurate interpretation.
- Understanding artifactual uptake is essential for avoiding misdiagnosis in nuclear medicine studies.