multiple brown tumors in a patient with parathyroid adenoma depicting affinity for both 99mtc -pertechnetate and 99mtc-mibi: evaluation with hybrid spect/ct

parathyroid adenoma involving a single parathyroid gland is the underlying cause of 80-85% of primary hyperparathyroidism (phpt). skeletal system is significantly affected by phpt. brown tumors are known to have affinity for 99mtc-mibi. we report a rare case of phpt presenting with diffuse bony pain, high calcium level and significantly elevated alkaline phosphatase level. 99mtc-pertechnetate/99mtc-mibi subtraction, performed as a part of routine protocol, showed several brown tumors showing affinity for both 99mtc-pertechnetate and 99mtc-mibi. they were further characterized using hybrid spect/ct. to the best of our knowledge, 99mtc-pertechnetate affinity in brown tumors has not been previously described.