Professor of Nuclear Medicine Cairo University, Egypt Parathyroid Scanning Prof. Dr. Hosna Moustafa Professor of Nuclear Medicine Cairo University, Egypt

Normal sites of Parathyroid glands

Parathyroid Scanning 99 Tc-MIBI is better and easier technique than 99Tl-201 TC subtraction technique for diagnosis of parathyroid adenoma with sensitivity of 90-95 %. It can diagnosis parathyroid lesions in the neckor other ectopic sites with supererior results compared to CT or MRI .

Parathyroid Scanning Normal parathyroid and 50% of hyperplasia not visualized. Majority of adenoma in lower aspects of thyroid lobes. Tertiary hyperpara ( C.R.F ) 50 % hyperplasia (not visualized ). Majority of parathyroid carcinoma are functional. Unreliable scan in presence or extensive multi nodular goiter .

Normal Tc- TL subtraction technique

Tc- TL subtraction technique Adenoma in left inferior parathyroid

Tc- MIBI technique Early Delayed Adenoma in right inferior parathyroid

Surgical removed adenoma Adenoma in left inferior parathyroid

Tc- MIBI technique Parathyroid hyperplasia

Tc- MIBI (Parathyroid hyperplasia) planner & SPECT/CT

Professor of Nuclear Medicine Cairo University, Egypt Adrenal Scanning Prof. Dr. Hosna Moustafa Professor of Nuclear Medicine Cairo University, Egypt

Adrenal scanning (Patient preparation) Day before injection: Instructs the patient to take 10 drops of Lugol’s solution to block iodine uptake in thyroid. beginning the day before radiotracer administration and continuing for 6 days. Instructs patients with hypersensitivity or allergy to medications such as iodine or steroids to be treated with oral antihistamine, 1 hour before injection. Day of injection: Ensure that the patient is not taking the following drugs: steroids, antihypertensive, reserpine, tricycle antidepressants, sympathomimetics for 2-3 weeks before the examination.

Adrenal scanning (Radiopharmaceutical ) 500 μCi of 131- I or 1 mCi of 123- I MIBG Injected IV slowly over 30 seconds. Equipment: High energy, parallel hole collimator, using 20% window centered at 364 or 159 keV.

Adrenal scanning (Procedure ) Ensure patient is off medications and has taken thyroid blocker the night before. Instruct patient to empty the bladder. Place the patient in supine position. Image neck, chest, abdomen, and pelvis (anteriorly and posteriorly) at 24, 48 and 72 hr using whole body images at 8 cm/min, to cover at least from head to pelvis. SPECT: using dual head camera 180º noncircular rotation, 64x64 matrix, 32 views each for 20 sec/stop.

MIBG Scanning Left renal hyperplaseia right renal hyperplaseia Left renal adenoma Left renal carcinoma

Whole body MIBG at 48,72hrs showing right pheochromocytoma Ant 48hr post 48hr Ant 72hr post 72hr

WB & SPECT/CT at 24&48 hrs of MIBG scan showing right pheochromocytoma

Metastatic neuroblastoma

MIBG Scan before & after therapy Good response to MIBG therapy with residual primary lesion First dose second dose