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Objective: To evaluate the validity of 99mTc-methoxyisobutylisonitrile (MIBI) imaging in the detection of pathologic parathyroid glands causing hyperparathyroidism and its correlation with the parathyroid hormone (PTH) measurement.Methods: According to the clinical symptoms, laboratory examination or conventional imaging findings, seventy consecutive patients with suspected hyperparathyroidism underwent 99mTc-MIBI imaging and serum PTH measurement.There are 23 men and 47 women with age ranging from 12 to 79 years old.The interval between two examinations was less than two weeks.99mTc-MIBI parathyroid imaging was performed using Dual-phase 99mTc-MIBI scintigraphy, if the patient had elevated PTH level but no positive findings was acquired in the planar imaging, a tomography in corresponding areas was performed in the delayed phase.On 99mTc-MIBI imaging, any abnormal uptake lesion appeared at early phase and demonstrated more clearly at delayed phase, with image agent wash out of the thyroid gland, was considered as the pathologic parathyroid gland.A cut-off value of >88 ng/L for PTH was taken as the criteria for predicting hyperparathyroidism.According to the final clinical diagnosis, the efficacy of 99mTc-MIBI imaging for detecting pathologic glands was assessed in correlating with the serum PTH measurement.Within the patients documented with primary hyperparathyroidism, Pearson correlation coefficient between serum PTH and the gland volume was calculated.Results: Hyperparathyroidism was confirmed in 38 patients.Based on the imaging diagnostic criteria, the overall accuracy of 99mTc-MIBI imaging for detecting pathologic parathyroid glands was 90.0%(63/70), whereas, the accuracy was 80.0% (12/15)for the patients with normal serum PTH, and 92.7%(51/55)for the patients with elevated serum PTH.All of the false positive 99mTc-MIBI imaging were seen in the patients with normal serum PTH.If images were interpreted with referring the measurements of serum PTH, an accuracy of 94.3% (66/70) will be yielded for 99mTc-MIBI imaging in detection of pathologic parathyroid glands.Pearson linear correlation analysis show that there is a positive correlation between the serum PTH levels and the pathologic glands volumes(r=0.782, P<0.001), in the patients with primary hyperparathyroidism.Conclusion: For detecting pathologic parathyroid glands, 99mTc-MIBI imaging should be performed in the patients with elevated serum PTH.The correlation between the serum PTH levels and the glands volumes suggest us, that the level of serum PTH should be the reference for the image interpretation, as well as the technique procedure.