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Does skeletal uptake of MIBI indicate metabolic bone disease?

¹ Nuclear Medicine; ² Endocrinology, PGIMER, Chandigarh, U.T., India

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Objectives: Focal uptake of sestamibi in brown tumors is known, but not diffuse skeletal uptake. This study was performed (i) to identify uptake patterns of sestamibi in bone in different conditions and (ii) to see if this uptake predicts presence of metabolic bone.

Methods: We retrospectively reviewed 102 cases with clinical suspicion of primary hyperparathyroidism. 99mTc sestamibi scintigraphy was performed to identify the presence of hyperfunctioning parathyroid tissue. 99mTc MDP bone scan was performed in 14 patients.

Results: Of the 102 studies, 27 were reported positive for parathyroid adenoma on scintigraphy. Abnormal bone uptake of sestamibi was seen in 18 / 102 cases (15 with parathyroid adenoma, 2 with secondary hyperparathyroidism and 1 with osteogenesis imperfecta). Skeletal uptake of sestamibi was seen only in the early images, with washout in the delayed phase. Uptake was mostly seen in the sternum and ribs, followed by the clavicles and humeri. Skull uptake was difficult to comment upon due to physiological uptake of sestamibi in the scalp. Bone scan was suggestive of metabolic bone disease in 8/14 cases. Conversely, all patients with metabolic bone disease showed skeletal uptake of MIBI. All 18 patients with skeletal sestamibi uptake showed elevated parathyroid hormone and serum alkaline phosphatase levels. However, not all cases diagnosed as parathyroid adenoma showed skeletal uptake of sestamibi. Cases of parathyroid adenoma with normal alkaline phosphatase levels did not show skeletal uptake of sestamibi.

Conclusions: The findings of this study suggest that diffuse skeletal uptake of sestamibi is seen in cases of primary hyperparathyroidism, renal osteodystrophy and osteogenesis imperfecta and may be related to elevated levels of serum alkaline phosphatase.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kashyap, R. Articles by Singh, B. PubMed Articles by Kashyap, R. Articles by Singh, B.