Objectives 99mTc-sestamibi is the current radiopharmaceutical of choice for the localization of hyperactive lesions of the parathyroid glands in patients with hyperparathyroidism. However, there are multiple factors that adversely affect the accumulation and retention 99mTc-sestamibi in the hyperfunctioning parathyroid tissue, resulting in a false-negative scan. The objective of this study was to investigate the possibility of an incremental diagnostic role of thallium-201 parathyroid scintigraphy in patients with presumably false-negative 99mTc-sestamibi scan results. Patients and methods The study comprised of 22 patients including 16 with primary hyperparathyroidism (PHPT) and 6 with secondary hyperparathyroidism where 99mTc-sestambi scan was initially negative, inconclusive or where additional lesions were suspected on the single-photon computed tomography/computed tomography (SPECT/CT) scan with the CT component identifying lesion(s) without significant 99mTc-sestamibi uptake. Results The results of our study show that in 22 patients (5 male, 17 female; age range 26–81; median age 53.4) further imaging with thallium-201 SPECT/CT scan showed 46.5% additional lesions in patients with hyperparathyroidism caused by an adenomatous or hyperplastic parathyroid lesion. In patients with PHPT caused by an adenomatous or hyperplastic parathyroid lesion, further imaging with thallium-201 showed 59% additional hyperactive parathyroid lesions. In patients with secondary hyperparathyroidism, further imaging with thallium-201 SPECT/CT showed additional 33.3% hyperplastic parathyroid lesions. Conclusion The results of this pilot study strongly advocate a role for thallium parathyroid SPECT/CT imaging in patients with primary and secondary hyperparathyroidism where the initial 99mTc-sestamibi scan is deemed to be false-negative in the presence of biochemical hyperparathyroidism.

Superior mesenteric artery syndrome is a rare cause of intestinal obstruction. The condition results from compression of the duodenum between the aorta and the superior mesenteric artery, which causes an impairment of gastric emptying and associated chronic symptoms. There is a need to objectively assess the severity of gastric-emptying disorder in these patients post-treatment to assess the efficacy of the conservative or surgical management. We report here a case of a patient where the radionuclide gastric-emptying study was crucial in monitoring the effectiveness of surgical management of this syndrome.

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Background: A 24-year-old male had a road traffic accident in which he sustained a crush injury to his right lower leg and a compound fracture of the right femur, which were respectively treated with below knee amputation and metallic nailing of the right femur. The patient presented to the outpatient clinic 7 years later with 1-month history of pain and swelling of the right thigh; however, he didn't report any fever. An FDG-PET scan was prescribed to rule out infection. Procedure:18

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