Tc-99m sestamibi before and during treatment in a patient with sarcoidosis and persistent hyperparathyroidism.

PURPOSE: Tc-99m sestamibi (MIBI) uptake in pulmonary sarcoidosis has been reported, but it has never been studied before and during treatment with glucocorticoids.

METHODS

The authors performed MIBI scintigraphy and somatostatin receptor scintigraphy in a patient with sarcoidosis of the mediastinum, lungs, and liver and who had persistent hyperparathyroidism after unsuccessful neck exploration.

RESULTS

Somatostatin receptor scintigraphy showed high mediastinal and pulmonary uptake in a pattern characteristic of sarcoidosis. Sustained MIBI uptake occurred in the same, although smaller, region. After the diagnosis was confirmed by liver biopsy, the patient was treated with glucocorticoids. Repeated MIBI scintigraphy showed that the uptake in the mediastinum had clearly decreased.

CONCLUSIONS

This decrease of MIBI uptake in the mediastinal lymph nodes with therapy may imply that MIBI can be used to assess the response to treatment in sarcoidosis. Perhaps a relation exists between MIBI uptake at the moment of diagnosis and prognosis. Further studies in more patients are needed to evaluate the role of MIBI in the management of sarcoidosis.