1
|
Vance-Daniel J, Curwen O, Stroud L, Gnanananthan V, Burney K, Jamal K. An Assessment of Enhancement Patterns in Abnormal Parathyroid Glands on Three-Phase CT Imaging. Cureus 2023; 15:e40166. [PMID: 37431348 PMCID: PMC10329771 DOI: 10.7759/cureus.40166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Background Four-dimensional computed tomography (4DCT) is increasingly used in the investigation of primary hyperparathyroidism. The objective of this study was to identify and analyse the usefulness of different enhancement patterns on 4DCT to improve its sensitivity. Methodology Retrospective data were collected on 100 glands. A consultant head and neck radiologist measured the Hounsfield units (HU) of the parathyroid gland and surrounding normal thyroid tissue in the pre-contrast, arterial and venous phases. Each gland was grouped according to the enhancement pattern, and the percentage change in HU was also calculated between the three phases. Results Thirty-five parathyroid glands demonstrated enhancement higher than the thyroid gland in the arterial phase and lower in the delayed phase and were placed into group A. Four parathyroid glands demonstrated enhancement higher than the thyroid gland in the arterial phase and also higher in the delayed phase and were placed into group B. Fifty-nine parathyroid glands demonstrated enhancement lower than the thyroid gland in the arterial phase and also lower in the delayed phase and were placed into group C. Two parathyroid glands demonstrated enhancement lower than the thyroid gland in the arterial phase and higher in the delayed phase and were placed into group D. Conclusions This study demonstrated that the classically described enhancement pattern of the parathyroid gland is not always present or the most frequent, thereby showing that the enhancement pattern cannot be relied upon in isolation. Instead, a thorough understanding of anatomy, embryology and possible ectopic gland locations is essential.
Collapse
Affiliation(s)
- Joseph Vance-Daniel
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London, GBR
| | - Oliver Curwen
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London, GBR
| | - Lauren Stroud
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London, GBR
| | - Visvalingham Gnanananthan
- Radiology, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London, GBR
| | - Kashif Burney
- Radiology, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London, GBR
| | - Karim Jamal
- General and Endocrine Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London, GBR
| |
Collapse
|
2
|
Karlas A, Pleitez MA, Aguirre J, Ntziachristos V. Optoacoustic imaging in endocrinology and metabolism. Nat Rev Endocrinol 2021; 17:323-335. [PMID: 33875856 DOI: 10.1038/s41574-021-00482-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 02/02/2023]
Abstract
Imaging is an essential tool in research, diagnostics and the management of endocrine disorders. Ultrasonography, nuclear medicine techniques, MRI, CT and optical methods are already used for applications in endocrinology. Optoacoustic imaging, also termed photoacoustic imaging, is emerging as a method for visualizing endocrine physiology and disease at different scales of detail: microscopic, mesoscopic and macroscopic. Optoacoustic contrast arises from endogenous light absorbers, such as oxygenated and deoxygenated haemoglobin, lipids and water, or exogenous contrast agents, and reveals tissue vasculature, perfusion, oxygenation, metabolic activity and inflammation. The development of high-performance optoacoustic scanners for use in humans has given rise to a variety of clinical investigations, which complement the use of the technology in preclinical research. Here, we review key progress with optoacoustic imaging technology as it relates to applications in endocrinology; for example, to visualize thyroid morphology and function, and the microvasculature in diabetes mellitus or adipose tissue metabolism, with particular focus on multispectral optoacoustic tomography and raster-scan optoacoustic mesoscopy. We explain the merits of optoacoustic microscopy and focus on mid-infrared optoacoustic microscopy, which enables label-free imaging of metabolites in cells and tissues. We showcase current optoacoustic applications within endocrinology and discuss the potential of these technologies to advance research and clinical practice.
Collapse
Affiliation(s)
- Angelos Karlas
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Partner Site, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Miguel A Pleitez
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Juan Aguirre
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany.
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
| |
Collapse
|
3
|
Jiang SQ, Yang T, Zou Q, Xu L, Ye T, Kang YQ, Li WR, Jiao J, Zhang Y. The role of 99mTc-MIBI SPECT/CT in patients with secondary hyperparathyroidism: comparison with 99mTc-MIBI planar scintigraphy and ultrasonography. BMC Med Imaging 2020; 20:115. [PMID: 33059621 PMCID: PMC7565325 DOI: 10.1186/s12880-020-00517-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study aimed to compare the sensitivity of 99mTc-MIBI SPECT/CT, 99mTc-MIBI planar scintigraphy and ultrasonography (US) in patients with secondary hyperparathyroidism (SHPT), and to explore the factors that affect the sensitivity of 99mTc-MIBI SPECT/CT. METHODS In this retrospective study, forty-six patients with SHPT who underwent 99mTc-MIBI planar scintigraphy, 99mTc-MIBI SPECT/CT and US were enrolled. They underwent surgery within 1 month. We compared the sensitivity of the different imaging methods based on the lesions according to the pathological results. The parathyroid lesions on 99mTc-MIBI SPECT/CT images were divided into missed diagnosis group (MDG) and non-missed diagnosis group (NMDG). We compared the lesion to background ratio (LBR), maximum diameter, volume, the mean CT Hounsfield unit values (CTmean) and location of lesions between MDG and NMDG. RESULTS The sensitivity of 99mTc-MIBI SPECT/CT, 99mTc-MIBI planar scintigraphy and US were 70.30% versus 48.48% versus 61.82%, respectively. The sensitivity of 99mTc-MIBI SPECT/CT combined US was 79.39%, which was higher than 99mTc-MIBI SPECT/CT with significant difference (P = 0.000). On 99mTc-MIBI SPECT/CT images, the LBR, maximum diameter and volume of lesions in MDG was smaller than those in NMDG with significant difference (P < 0.001). The average LBR, maximum diameter and volume of lesions in MDG and NMDG were 3.42 ± 1.28, 9.32 ± 2.69 mm, 208.51 ± 163.22 mm3 versus 6.75 ± 5.08, 15.03 ± 4.94 mm and 863.85 ± 1216.0 mm3, respectively. CONCLUSIONS 99mTc-MIBI SPECT/CT exhibited the highest sensitivity among the three methods. When 99mTc-MIBI SPECT/CT combined with US, the sensitivity can be further improved. Lesions with lower MIBI uptake and smaller lesions on 99mTc-MIBI SPECT/CT images were easily missed.
Collapse
Affiliation(s)
- Shu-Qin Jiang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Ting Yang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Qiong Zou
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Lei Xu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Ting Ye
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Yin-Qian Kang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Wan-Ru Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Ju Jiao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China
| | - Yong Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe Street, Guangzhou, 510630, Guangdong, China.
| |
Collapse
|
4
|
Current practice in the surgical management of parathyroid disorders: a United Kingdom survey. Eur Arch Otorhinolaryngol 2018; 275:2549-2553. [PMID: 30116879 DOI: 10.1007/s00405-018-5094-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Surgery for primary hyperparathyroidism is undertaken by many specialties but predominantly endocrine and ear, nose and throat (ENT) surgeons. There is currently no consensus on the peri-operative management of primary hyperparathyroidism. We sought to determine current surgical practice and identify any inter-specialty variation in the United Kingdom (UK). METHODS An online survey was disseminated to members of the British Association of Endocrine & Thyroid Surgeons (BAETS) in the UK. RESULTS 78 surgeons responded (40 Endocrine, 37 ENT and 1 maxillofacial). 90% of surgeons used ultrasound and sestamibi for pre-operative localisation. Intraoperative frozen section (31%) and parathyroid hormone monitoring (41%) were the most common adjuncts used intraoperatively. 68% of surgeons did not use any wound drains. Nearly two-thirds of surgeons (64%) discharged patients from the clinic within 3 months, There were some significant differences (p < 0.05) in particular areas of practice between endocrine and ENT surgeons (%, p): use of single-photon emission computed tomography (SPECT) (Endocrine 25% vs. ENT 5%), preoperative laryngeal assessment (endocrine 58% vs. ENT 95%), intraoperative laryngeal nerve monitoring (endocrine 35% vs. ENT 68%), use of monopolar diathermy (endocrine 58% vs. ENT 22%), bipolar diathermy (endocrine 60% vs. 89%) and surgical ties (endocrine 48% vs. ENT 19%). CONCLUSION Our study demonstrates some similarities as well as some notable differences in practice between endocrine and ENT surgeons, and therefore, highlights the need for national consensus with respect to some key areas in parathyroid surgery.
Collapse
|
5
|
Boury S. New methods for parathyroid imaging: Sonography, 4D CT, MRI. ANNALES D'ENDOCRINOLOGIE 2015; 76:148-52. [PMID: 25936463 DOI: 10.1016/j.ando.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Samuel Boury
- Service de radiologie, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France.
| |
Collapse
|