Limits to parathyroid imaging with thallium-201 confirmed by tissue uptake and phantom studies

Correct location by 201TI imaging of 48 parathyroids in 35 patients was related to size; 25 out of 26 parathyroids of mass greater than 1.0 g were correctly located, none of ten parathyroids less than 0.3 g was correctly located. In seven patients previously imaged, 108 microCi (4.0 MBq) of 201TI was injected when the thyroid was first exposed surgically. Subsequently weighed and histologically confirmed samples of parathyroid, thyroid, and skeletal muscle were counted against a standard in a well counter. Thallium-201 uptake, as %/g, did not differ between hyperplastic and adenomatous parathyroids. Mean parathyroid uptake was 0.018%/g, thyroid 0.01%/g, muscle 0.0026%/g of administered dose. Lower limits for correct location lay between 0.006-0.0149% of administered dose and between 0.25-0.8 g. Studies using a 201TI phantom containing small aliquots of 201TI at higher concentrations suggested approximately 0.0075% of the usual patient imaging dose as a lower limit for correct location.