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Data are scarce in patients undergoing reoperative parathyroidectomy for persistent hyperparathyroidism. The aim of the present study was to determine the value of Tc99m\u2010MIBI\u2010SPECT in localizing residual hyperactive parathyroid tissue in patients with persistent primary hyperparathyroidism (PHPT) after initial excision of one or more pathological glands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We retrospectively evaluated the localizing accuracy of Tc99m\u2010MIBI\u2010SPECT scans in 19 consecutive patients with persistent PHPT who had a scan before reoperative parathyroidectomy. We used as controls 23 patients with sporadic PHPT who had a scan before initial surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In patients with persistent PHPT, Tc99m\u2010MIBI\u2010SPECT accurately localized a pathological parathyroid gland in 33% of cases before reoperative parathyroidectomy, compared to 61% before first PTx for sporadic PHPT. The Tc99m\u2010MIBI\u2010SPECT scan accurately localized intra\u2010thyroidal glands in 2 of 7 cases and a mediastinal gland in 1 of 3 cases either before initial or reoperative parathyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data suggest that the accuracy of Tc99m\u2010MIBI\u2010SPECT in localizing residual hyperactive glands is significantly lower before reoperative parathyroidectomy for persistent PHPT than before initial surgery for sporadic PHPT. These findings should be taken in consideration in the preoperative workup of patients with persistent primary hyperparathyroidism.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-010-0818-4","type":"journal-article","created":{"date-parts":[[2010,10,18]],"date-time":"2010-10-18T21:26:04Z","timestamp":1287437164000},"page":"128-139","source":"Crossref","is-referenced-by-count":35,"title":["Limitations of Tc99m\u2010MIBI\u2010SPECT Imaging Scans in Persistent Primary Hyperparathyroidism"],"prefix":"10.1002","volume":"35","author":[{"given":"Janneke E.","family":"Witteveen","sequence":"first","affiliation":[{"name":"Department of Endocrinology &amp; Metabolic Diseases Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job","family":"Kievit","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel P. 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