4D SPECT/CT with [99mTc]Tc-Sestamibi in Multiglandular Parathyroid Disease: A Case Report

Abstract Localizing hyperfunctioning parathyroid tissue requires reliably differentiating a solitary adenoma from multiglandular disease, since each subsequent cervical surgical intervention is associated with increasing complexity and risk. Radionuclide imaging is useful in identifying parathyroid glands, and single-photon emission computed tomography/computed tomography (SPECT/CT) has been associated with increased diagnostic sensitivity. This report discusses the case of a 70-year-old male with an incidental parathyroid hormone (PTH) level of 1,200 pg/mL who was diagnosed with a right parathyroid adenoma using planar parathyroid scintigraphy. After cervical resection and persistently elevated PTH levels, SPECT/CT with intravenous iodinated contrast provided additional anatomical and functional localization of parathyroid tissue, supporting the interpretation of multiglandular disease in the clinical evaluation.