Multiple brown tumors in a patient with parathyroid adenoma depicting affinity for both 99mTc -pertechnetate and 99mTc-MIBI: Evaluation with hybrid SPECT/CT

Document Type : Case Report

Author

Department of Nuclear Medicine, Amala Institute of Medical Sciences, Amalanagar, Thrissur, Kerala, India

Abstract

 Parathyroid adenoma involving a single parathyroid gland is the underlying cause of 80-85% of primary hyperparathyroidism (PHPT). Skeletal system is significantly affected by PHPT. Brown tumors are known to have affinity for 99mTc-MIBI. We report a rare case of PHPT presenting with diffuse bony pain, high calcium level and significantly elevated alkaline phosphatase level. 99mTc-pertechnetate/99mTc-MIBI subtraction, performed as a part of routine protocol, showed several brown tumors showing affinity for both 99mTc-pertechnetate and 99mTc-MIBI. They were further characterized using hybrid SPECT/CT. To the best of our knowledge, 99mTc-pertechnetate affinity in brown tumors has not been previously described.

Keywords

Main Subjects

References

Gayed IW, Elshazly SM, Vang RS, Barron BJ, Lamki LM. Technetium-99m sestamibi uptake in a maxillary brown tumor. Clin Nucl Med. 2001 Jan;26(1):65-7.
Ginsberg I, Federman A, Kim H, Freeman LM. Sestamibi uptake in brown tumor simulating a lung mass. Clin Nucl Med. 1997 Nov;22(11):798-9.
Dinauer PA, Balingit AG, Rivera JE. Tc-99m sestamibi imaging of brown tumors of primary hyperparathyroidism. Clin Nucl Med. 1996 Mar;21(3):192-6.
Miyakoshi M, Kamoi K, Takano T, Nishihara M, Kawashima T, Sudo N, Togashi K, Emura I, Williams D. Multiple brown tumors in primary hyperparathyroidism caused by an adenoma mimicking metastatic bone disease with false positive results on computed tomography and Tc-99m sestamibi imaging: MR findings. Endocr J. 2007 Apr;54(2):205-10.
 Kalambokis G, Economou G, Kamina S, Papachristou DJ, Bai M, Tsianos EV. Multiple brown tumors of the ribs simulating malignancy.  J Endocrinol Invest. 2005 Sep;28(8):738-40.
Treglia G, Dambra DP, Bruno I, Mulè A, Giordano A. Costal brown tumor detected by dual-phase parathyroid imaging and SPECT-CT in primary hyperparathyroidism. Clin Nucl Med. 2008 Mar;33(3):193-5.
Doppman JL, Marx S, Spiegel A, Brown E, Downs R, Brennan MF, Aurbach G. Differential diagnosis of brown tumor vs. cystic osteitis by arteriography and computed tomography. Radiology. 1979 May;131(2):339-40.
Yamamoto Y, Nishiyama Y, Ono Y, Satoh K, Ohkawa M, Kawasaki Y, Tanabe M. Accumulation of technetium-99m pertechnetate in a patient with metastases of thyroid carcinoma. Ann Nucl Med. 1999 Oct;13(5):357-9.
Iranian Journal of Nuclear Medicine
Volume 20, Issue 1 - Serial Number 37
Serial number: 37
December 2012
Pages 39-41

Files

Share

How to cite

Statistics