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Fig. 7B. —^99mTc sestamibi-¹²³I subtraction scintigraphy in 58-year-old man with recurrent hyperparathyroidism after cervical exploration. Planar scintigram after subtraction of ¹²³I portion of study. ¹²³I localizes in thyroid gland and not within hyperfunctioning parathyroid tissue; therefore, ¹²³I subtraction removes tracer activity in thyroid gland, increasing conspicuity of abnormal parathyroid tissue (arrow) cranial to superior aspect of left lobe of thyroid gland. Photopenic area in center of image represents subtracted thyroid tissue activity. Similar subtraction techniques may be performed using pertechnetate in place of ¹²³I. (Courtesy of Newberg A, Philadelphia, PA)

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