Incidental Finding of Extra Parathyroid and Cardiac Pathologies Detected on Parathyroid and Myocardial Perfusion Scans with Technetium-99m methoxyisobutylisonitrile: A Retrospective Study

Authors

Afnan M.F. Darwesh, Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah Saudi ArabiaFollow
Leen Albalbeesi, Nuclear Medicine Division, Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Adnan A.S. Alahmadi, Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah Saudi Arabia
Rawan Abdeen, Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah Saudi Arabia
Duaa Banaja, Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah Saudi Arabia
Hamzah H. Ahmed, Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah Saudi Arabia
Nadia Batawil, Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Abstract

Background: 99^mTc-MIBI is a lipophilic cation that can accumulate within the mitochondria of metabolically active tumor cells and is routinely used for parathyroid and myocardial perfusion imaging. Cases of incidental findings during parathyroid scintigraphy and myocardial perfusion scans using 99^mTc-MIBI have been reported previously. However, retrospective studies with more extensive sample data are lacking.

Objectives: This observational study retrospectively analyzed 99^mTc- MIBI parathyroid and myocardial perfusion images to describe incidental extra-parathyroid and cardiac uptake.

Methods: A retrospective review of 308 parathyroid and myocardial perfusion 99^mTc-MIBI scans was performed between January 2019 and December 2022. 99^mTc-pertechnetate with 99^mTc-MIBI was used in parathyroid cases to delineate thyroid-related abnormalities. The raw projection data, acquired images, and patients’ medical and laboratory records were assessed.

Results: Out of 308 scans, eight were identified with incidental extracardiac and parathyroid findings during data interpretation. Three incidental findings were noted in the parathyroid scans, specifically in the right parotid gland, right submandibular gland, and the fifth right rib. The use of 99^mTc-pertechnetate alongside 99^mTc-MIBI facilitated the visualization and comparison of incidental finding biodistribution in the parathyroid cases. Additionally, five incidental findings were detected in the cardiac stress raw projection data, located in the breast area, axillary lymph nodes, and lungs. All extracardiac incidental findings were observed in the stress data, attributed to the higher dose administered post-stress compared to the rest of the study.

Conclusion: Thorough screening of images and raw projection data is vital to prevent the progression of unknown abnormalities and ensure significant findings are not overlooked.

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Recommended Citation

Darwesh, Afnan M.F.; Albalbeesi, Leen; Alahmadi, Adnan A.S.; Abdeen, Rawan; Banaja, Duaa; Ahmed, Hamzah H.; and Batawil, Nadia (2025) "Incidental Finding of Extra Parathyroid and Cardiac Pathologies Detected on Parathyroid and Myocardial Perfusion Scans with Technetium-99m methoxyisobutylisonitrile: A Retrospective Study," Journal of King Abdulaziz University: Medical Sciences: Vol. 32: Iss. 1, Article 1.
DOI: https://doi.org/10.64064/1658-4279.1000

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