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El Mantani Ordoulidis S, Siampanopoulou M. The Role of [ 99mTc]Tc-Sestamibi in Functional Imaging of the Iodine-Loaded Thyroid Gland. J Nucl Med Technol 2023; 51:331-332. [PMID: 37433674 DOI: 10.2967/jnmt.123.265665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/10/2023] [Indexed: 07/13/2023] Open
Abstract
Due to high iodine loading from iodinated contrast media, the thyroid uptake of common radiopharmaceuticals ([99mTc]NaTcO4 and [123I]NaI) can be influenced up to 2 mo after administration. In such cases, and generally when differential diagnosis between productive and destructive thyrotoxicosis is necessary, [99mTc]Tc-sestamibi scintigraphy could be an option. This case highlights the role of [99mTc]Tc-sestamibi in the evaluation of thyrotoxicosis in a patient with a blocked thyroid gland as a result of stable iodine saturation.
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Chandra P, Nandy D, Saini S. 18 F-Fluorocholine PET-CT Outshines Sestamibi Scintigraphy in Detecting Parathyroid Adenomas in the Background of Hashimoto's Thyroiditis. World J Nucl Med 2023; 22:289-292. [PMID: 38152098 PMCID: PMC10751136 DOI: 10.1055/s-0043-1774732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Ultrasonography neck and dual-phase 99m Tc-sestamibi (MIBI) scan are standard imaging techniques for the detection of parathyroid adenomas in primary hyperparathyroidism. However, in presence of coexistent thyroid disease or small size of adenomas, the accuracy of these imaging modalities is low and leads to delayed diagnosis. We here present a report of two patients with primary hyperparathyroidism and with a nondiagnostic MIBI scan, who subsequently underwent successful surgery after positive localization of adenomas on 18 F-fluorocholine positron emission tomography-computed tomography.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine, Zydus Hospitals, Vadodara, Gujarat, India
| | - Dipayan Nandy
- Department of General Surgery, Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India
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Altmann H, Cui Y, Henrich M, Schaub S, Thiel C, Moritz A, Bauer R, Bauer N. 99m-Technetium-Pertechnetat- und 99m-Technetium-Sestamibi-Szintigrafie zur Darstellung von hypofunktionellem Schilddrüsengewebe und Staging bei einem Hund mit Schilddrüsenkarzinom. TIERÄRZTLICHE PRAXIS AUSGABE K: KLEINTIERE / HEIMTIERE 2022; 50:446-456. [DOI: 10.1055/a-1966-1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ZusammenfassungEine 10-jährige Mischlingshündin wurde aufgrund einer zervikalen Umfangsvermehrung zur Schilddrüsen-Szintigrafie vorgestellt.Aufgrund einer zusätzlichen Hypothyreose, die einen „kalten“ Knoten vermuten ließ, und zur Metastasensuche, erfolgte neben der 99m-Technetium-Pertechnetat (Tc-Pertechnetat)-Szintigrafie eine zweite Szintigrafie mit 99m-Technetium-Sestamibi (Tc-MIBI).Zwanzig Minuten nach intravenöser Gabe von 38 MBq Tc-Pertechnetat waren ein „heißer“ zervikaler und ein intrathorakaler Knoten mit einem „Uptake“ von 8,40 und 0,25 % sichtbar. In der zweiten Szintigrafie 20 Minuten nach intravenöser Gabe von 364 MBq Tc-MIBI und 70 Minuten nach der ersten Szintigrafie zeigten die Knoten nach Abzug der Pertechnetat-Aktivität und Zerfallskorrektur einen „Uptake“ von 0,99 und 0,03 %. Zudem stellten sich in der Schilddrüsenloge beide Schilddrüsenlappen mit einer geringen Tc-MIBI-Aufnahme dar. Das Verhältnis Tc-„Uptake“/Tc-MIBI-„Uptake“ betrug für beide Läsionen 8,48 bzw. 8,33.Nach Exstirpation des zervikalen Tumors ergab die histopathologische Untersuchung atrophisches Schilddrüsengewebe, das von einem expansiv wachsenden gut differenzierten follikulären Schilddrüsenkarzinom fast vollständig verdrängt wurde.Dieser Fallbericht beschreibt Durchführung, Nutzen und rechnerische Korrektur einer aufeinanderfolgenden Pertechnetat- und MIBI-Szintigrafie, die eine Darstellung von hypofunktionellem Schilddrüsengewebe ermöglichte. Die beiden heißen Knoten waren daher und aufgrund ihrer gleichen MIBI-Stoffwechselaktivität als dystopes Gewebe/Metastasen zu werten, wodurch die Hündin in das prognostisch ungünstigere WHO-Stadium IV klassifiziert werden musste. Anders als beim Menschen sollten beim Hund zur Vermeidung einer erneuten Narkose beide Szintigrafien kurz hintereinander durchgeführt werden. Eine qualitative/visuelle Beurteilung des MIBI-Szintigramms ist daher nicht sicher möglich, sodass eine quantitative Beurteilung über den „Uptake“ nach rechnerischer Korrektur der Pertechnetat-Aktivität erfolgen muss.
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Affiliation(s)
- Hannah Altmann
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, klinische Laboratoriumsdiagnostik und klinische Pathophysiologie, Justus-Liebig-Universität Gießen
| | - Yi Cui
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, klinische Laboratoriumsdiagnostik und klinische Pathophysiologie, Justus-Liebig-Universität Gießen
| | - Manfred Henrich
- Institut für Veterinär-Pathologie, Fachbereich Veterinärmedizin, Justus-Liebig-Universität Gießen
| | - Sebastian Schaub
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Chirurgie, Justus-Liebig-Universität Gießen
| | - Cetina Thiel
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Chirurgie, Justus-Liebig-Universität Gießen
| | - Andreas Moritz
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, klinische Laboratoriumsdiagnostik und klinische Pathophysiologie, Justus-Liebig-Universität Gießen
| | | | - Natali Bauer
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, klinische Laboratoriumsdiagnostik und klinische Pathophysiologie, Justus-Liebig-Universität Gießen
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Valenciaga A, Wittwer J, O'Donnell B, Lott Limbach A, Wright CL, Ing SW. A case of ectopic para-tracheal parathyroid adenoma identified with whole-body 99mTc-sestamibi scan. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.jecr.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Li P, Zhang A, Liu Y, Xu C, Tang L, Yuan H, Liu Q, Wang X, Feng D, Wang L, Huang G, Song S. Radioactive Iodine Therapy in Patients with Differentiated Thyroid Cancer: Study of External Dose Rate Attenuation Law and Individualized Patient Management. Thyroid 2019; 29:93-100. [PMID: 30351248 DOI: 10.1089/thy.2017.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Therapy with radioactive iodine (131I) is a well established treatment method for postsurgical differentiated thyroid carcinoma (DTC). A fixed discharge time is generally set, regardless of individual differences in residual body radioactivity (RBA). This study aimed to investigate the RBA of each patient to find the attenuation law and to identify underlying factors in order to predict the time point for a safe, scientifically sound discharge plan. METHODS A total of 231 DTC patients undergoing 131I treatment were all treated with 3.7 GBq (100 mCi) of 131I. RBA was estimated by measuring the external body dose rate (EDR) at a distance of 1 m from the body surface between 0 and 72 hours after oral administration of 131I. Data from each patient were used to establish a time-EDR value (h-μSv/h) curve. Software was developed to predict the time when a patient's dose equivalent meets the national safety standard by including six time points between 40 and 60 hours. Several factors that might affect that time were analyzed. RESULTS The EDR attenuation law in patients could be described with a double exponential decay model, and the cutoff value was set as 23.3 μSv/h, upon which the predictive software was developed. Student's t-test showed there was no statistical difference between predicted values and the actual measured values (p > 0.05). Correlation analysis found that serum thyroglobulin, total triiodothyronine, total thyroxine, free triiodothyronine, free thyroxine, thyrotropin, 2- and 24-hour iodine uptake rate of the thyroid, scores of 99mTc-pertechnetate thyroid scan, scores of 131I whole-body scan, scores of ultrasound scan, and gastrointestinal residues were associated with attenuation speed. A further multiple linear regression analysis found that 24-hour iodine uptake (X1), residual thyroid grading by 131I whole-body scan (X2), blood free triiodothyronine (X3) and free thyroxine (X4) predominantly influenced the decline of the EDR. The regression equation was Ŷ = 2.091X1 + 6.370X2 + 4.529X3 + 2.466X4 - 8.614 (F = 44.03, p < 0.01). CONCLUSIONS An effective and convenient method was created to measure and predict the individual safety time for discharge. This could play a significant role not only for scientific hospital discharge planning, rational use of medical resources, and better individualized management, but also in public radiation protection.
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Affiliation(s)
- Panli Li
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
| | - Aimi Zhang
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Ye Liu
- 4 Department of Automation; Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Chunyuan Xu
- 4 Department of Automation; Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Linglin Tang
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Hong Yuan
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Qiufang Liu
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
| | - Xiuying Wang
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
- 5 Biomedical and Multimedia Information Technology Research Group, School of Information Technologies, University of Sydney, Sydney, Australia
| | - Dagan Feng
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
- 5 Biomedical and Multimedia Information Technology Research Group, School of Information Technologies, University of Sydney, Sydney, Australia
| | - Lisheng Wang
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
- 4 Department of Automation; Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Gang Huang
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
- 6 Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, P.R. China
| | - Shaoli Song
- 1 Department of Nuclear Medicine; School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 2 Institute of Clinical Nuclear Medicine; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- 3 SJTU-USYD Joint Research Alliance for Translational Medicine; Shanghai, P.R. China
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Jovanovska A, Stoilovska B, Mileva M, Miladinova D, Majstorov V, Ugrinska A. Absent 99mTc-MIBI Uptake in the Thyroid Gland during Early Phase of Parathyroid Scintigraphy in Patients with Primary and Secondary Hyperparathyroidism. Open Access Maced J Med Sci 2018; 6:808-813. [PMID: 29875850 PMCID: PMC5985886 DOI: 10.3889/oamjms.2018.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/10/2018] [Accepted: 04/20/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Thyroid uptake of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) during parathyroid scintigraphy can be affected by various conditions. AIM To evaluate the frequency of absent 99mTc-MIBI uptake by the thyroid gland in the early phase of dual-phase parathyroid scintigraphy. METHODS The early planar images of dual phase Tc99m MIBI parathyroid scintigraphy from 217 patients performed between 2014 and 2017 were retrospectively analysed. Patients were divided into two groups. The first group included 147 patients with primary hyperparathyroidism and the second group included 70 patients with chronic renal failure. Patient records, laboratory and ultrasonographic data were analysed in all patients. Descriptive statistic was used for data analysis. RESULTS Out of all patients in the first group, 18 patients (12.24%) showed absent thyroid uptake. Thyroidectomy was performed in 44.4% of these patients, and the rest of them had some thyroid disease. Only one patient had no thyroid or another chronic disease. In the second group, 8 patients (11.42%) presented with absent thyroid uptake of MIBI. Among them, 5 patients had no history of thyroid disease and had been on hemodialysis programme, and 3 patients had hypothyroidism. CONCLUSION Absent 99mTc-MIBI uptake in the thyroid during the early phase of parathyroid scintigraphy is most frequently related to thyroid disease. A small proportion of patients with chronic renal failure can present with absent 99mTc-MIBI uptake in the thyroid as well. The mechanism for this alteration is still unclear and needs further investigation.
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Affiliation(s)
- Anamarija Jovanovska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Bojana Stoilovska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Magdalena Mileva
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Daniela Miladinova
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Venjamin Majstorov
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ana Ugrinska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Miyazaki Y, Kato Y, Imoto A, Fukuchi K. Imaging of the thyroid and parathyroid using a cardiac cadmium zinc telluride camera: Phantom studies. J Nucl Med Technol 2017; 46:jnmt.117.199042. [PMID: 29127244 DOI: 10.2967/jnmt.117.199042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/23/2017] [Indexed: 11/16/2022] Open
Abstract
Purpose: Cadmium zinc telluride (CZT) detectors have recently been introduced to the field of clinical nuclear cardiology. However, the feasibility of using them for organs other than the heart remains unclear. The aim of this study was to evaluate the potential of a cardiac CZT camera to acquire thyroid and parathyroid images. We used custom-made phantoms and the currently available standard protocols for CZT, instead of a sodium-iodine scintillation (NaI) camera. Materials and Methods: Thyroid phantoms with or without parathyroid adenomas were made from agar using radiopharmaceuticals (99mTc or 123I) and imaged using CZT and NaI cameras. Using the CZT camera data, we prepared maximum intensity projection (MIP) images and planar equivalent (PE) images. Image counts were compared to those from the NaI camera, and the radioactivity of the phantoms was measured. For parathyroid imaging, three different protocols with the NaI camera were tested using MIP images. Results: For thyroid imaging, MIP could provide images as clear as those obtained from the NaI camera. The radioactivity and image counts correlated better for the PE images than the MIP images, especially for 123I images. We succeeded in obtaining clear parathyroid adenoma images from MIP images using all three protocols. Conclusion: A cardiac CZT camera can effectively perform qualitative and quantitative assessments of the thyroid and parathyroid organs.
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Abstract
Amiodarone-induced thyrotoxicosis (AIT) type I describes inducement of clinical hyperthyroidism by excessive thyroidal iodine in the setting of latent Graves disease, and therapy differs from that used for AIT type II. A 65-year-old man previously on amiodarone for atrial fibrillation developed clinical hyperthyroidism. Diagnosis of AIT was made, but the type was not clear. Tc sestamibi thyroid scan showed diffusely increased uptake and retention in an enlarged thyroid gland, a pattern consistent with AIT type I. Methimazole was initiated and controlled the thyrotoxicosis. I iodide thyroid scan and uptake study performed later was consistent with Graves disease.
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Quantitative assessment of thyroid-to-background ratio improves the interobserver reliability of technetium-99m sestamibi thyroid scintigraphy for investigation of amiodarone-induced thyrotoxicosis. Nucl Med Commun 2015; 36:356-62. [PMID: 25569865 DOI: 10.1097/mnm.0000000000000260] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amiodarone-induced thyrotoxicosis (AIT) is caused by excessive hormone synthesis and release (AIT I), a destructive thyroiditis (AIT II), or a combination of both (AIT Ind). Although no gold-standard diagnostic test is available, technetium-99m sestamibi thyroid scintigraphy (99mTc-STS) has been previously reported to be an accurate tool for differentiating subtypes with important therapeutic implications. However, the information to guide reporting of 99mTc-STS is qualitative and highly subjective. This study aims to compare the interobserver reliability of 99mTc-STS before and after the use of quantitative thyroid-to-background ratios (TBRs) displayed on a time-activity curve for differentiation of AIT subtypes. METHODS A retrospective audit of Nuclear Medicine Departments at Royal Melbourne Hospital (Parkville, Victoria, Australia) and Cabrini Hospital (Malvern, Victoria, Australia) identified 15 consecutive 99mTc-STS studies performed for AIT. Four nuclear medicine physicians reported the studies according to previously established criteria (series 1). Quantitative TBR and estimated 'normal' range TBR were subsequently provided before the studies were reordered and reported again (series 2). Interobserver reliability was calculated using Fleiss' κ statistic for each assessment. RESULTS The overall percentage of agreement (PoA) and κ statistics for use of conventional 99mTc-STS for diagnosis of AIT improved from 47 to 80% and from 0.30 to 0.67 following the use of quantitative TBR displayed on a time-activity curve with reference to a normal population. Interobserver reliability improved substantially under all diagnostic comparisons, particularly for differentiation of either AIT I (PoA 80% to 94%, κ: 0.48 to 0.84) or AIT Ind (PoA 47% to 82%, κ: -0.05 to 0.51) from other types of AIT. CONCLUSION Use of quantitative TBR improves the interobserver reliability of reporting 99mTc-STS for investigation of different types of AIT. There is 'almost perfect' agreement upon differentiation of AIT I from AIT II and AIT Ind, with important implications for rationalizing the use of corticosteroid therapy. Prospective identification of AIT Ind is improved from 'poor' to a 'moderate' level of agreement to facilitate rational use of combination therapy at diagnosis.
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Oki GCR, Zantut-Wittmann DE, de Oliveira Santos A, Guariento MH, Tambascia MA, de Almeida EA, Amorim BJ, Lima MCL, Etchebehere ECSC, Camargo EE, Ramos CD. Tc-99m Sestamibi Thyroid Imaging in Patients on Chronic Amiodarone Treatment. Clin Nucl Med 2010; 35:223-7. [DOI: 10.1097/rlu.0b013e3181d18e8e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dual-Phase 99MTc-MIBI Parathyroid Imaging Reveals Synchronous Parathyroid Adenoma and Papillary Thyroid Carcinoma: A Case Report. Kaohsiung J Med Sci 2008; 24:542-7. [DOI: 10.1016/s1607-551x(09)70014-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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