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Schouw HM, Noltes ME, Brouwers AH, Nilsson IL, Zedenius J, Kruijff S. How nuclear imaging changed parathyroid surgical strategies through time. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06707-9. [PMID: 38649491 DOI: 10.1007/s00259-024-06707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- H M Schouw
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - M E Noltes
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Surgery, Martini Hospital, Groningen, Netherlands
| | - A H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - J Zedenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - S Kruijff
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Romero-Velez G, Noureldine SI, Rahman M, Bena JF, Burneikis T, Jin J. Are 99mTC-Sestamibi Single Photon Emission Computed Tomography Scan Results Associated to the Parathyroid Cell Type in Primary Hyperparathyroidism? J Surg Res 2024; 293:517-524. [PMID: 37827030 DOI: 10.1016/j.jss.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION 99mTC-sestamibi scintigraphy (SPECT-CT) is a common imaging modality for parathyroid localization in primary hyperparathyroidism (PHPT). Prior studies have suggested that the cellular composition of parathyroid adenomas influences SPECT-CT imaging results. Other biochemical and anatomical factors may also play a role in false negative results. Therefore, after controlling for confounding variables, we sought to determine whether the histologic composition of parathyroid adenomas is associated to SPECT-CT results in patients with single gland disease causing PHPT. METHODS A retrospective review of patients with PHPT due to confirmed single gland disease was performed over a 2-y period. A 1:1 propensity score matching was done between patients with positive and negative SPECT-CT results with regard to demographical, biochemical, and anatomical characteristics followed by blinded pathologic examination of cell composition in the matched pairs. RESULTS Five hundred forty two patients underwent routine four gland exploration and 287 (53%) patients were found to have a single adenoma. Of those, 26% had a negative SPECT-CT result. There were significant differences between groups with regards to biochemical profile, gland location, and gland size. All of which became nonsignificant after propensity score matching. Adenomas were primarily composed of chief cells, with no difference between groups (95% versus 97%, P = 0.30). In the positive SPECT-CT group, chief cells were the dominant cell type in 68% of the cases, followed by mixed type (13%), oxyphil cells (12%), and clear cells (7%). This was similar to the negative SPECT-CT group (P = 0.22). CONCLUSIONS While certain patient's clinical characteristics are associated with SPECT-CT imaging results, histologic cell type is not significantly associated.
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Affiliation(s)
- Gustavo Romero-Velez
- Endocrinology and Metabolism Institute, Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Salem I Noureldine
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Mobeen Rahman
- Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - James F Bena
- Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Talia Burneikis
- Department of Endocrine and General Surgery, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Judy Jin
- Endocrinology and Metabolism Institute, Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
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Lalonde MN, Correia RD, Syktiotis GP, Schaefer N, Matter M, Prior JO. Parathyroid Imaging. Semin Nucl Med 2023; 53:490-502. [PMID: 36922339 DOI: 10.1053/j.semnuclmed.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/13/2023] [Indexed: 03/17/2023]
Abstract
Primary hyperparathyroidism (1° HPT) is a relatively common endocrine disorder usually caused by autonomous secretion of parathormone by one or several parathyroid adenomas. 1° HPT causing hypercalcemia, kidney stones and/or osteoporosis should be treated whenever possible by parathyroidectomy. Accurate preoperative location of parathyroid adenomas is crucial for surgery planning, mostly when performing minimally invasive surgery. Cervical ultrasonography (US) is usually performed to localize parathyroid adenomas as a first intention, followed by 99mTc- sestamibi scintigraphy with SPECT/CT whenever possible. 4D-CT is a possible alternative to 99mTc- sestamibi scintigraphy. Recently, 18F-fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) has made its way in the clinics as it is the most sensitive method for parathyroid adenoma detection. It can eventually be combined to 4D-CT to increase its diagnostic performance, although this results in higher dose exposure to the patient. Other forms of hyperparathyroidism consist in secondary (2° HPT) and tertiary hyperparathyroidism (3° HPT). As parathyroidectomy is not usually part of the management of patients with 2° HPT, parathyroid imaging is not routinely performed in these patients. In patients with 3° HPT, total or subtotal parathyroidectomy is often performed. Localization of hyperfunctional glands is an important aid to surgery planning. As 18F-FCH PET/CT is the most sensitive modality in multigland disease, it is the preferred imaging technic in 3° HPT patients, although its cost and availability may limit its widespread use in this setting.
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Affiliation(s)
- Marie Nicod Lalonde
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ricardo Dias Correia
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerasimos P Syktiotis
- Diabetology and Endocrinology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Niklaus Schaefer
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Maurice Matter
- Visceral Surgery Department, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland.
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Yuan Y, Li X, Bao X, Huangfu M, Zhang H. The magic mirror: a novel intraoperative monitoring method for parathyroid glands. Front Endocrinol (Lausanne) 2023; 14:1160902. [PMID: 37284221 PMCID: PMC10239973 DOI: 10.3389/fendo.2023.1160902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
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Park HS, Hong N, Jeong JJ, Yun M, Rhee Y. Update on Preoperative Parathyroid Localization in Primary Hyperparathyroidism. Endocrinol Metab (Seoul) 2022; 37:744-755. [PMID: 36327985 PMCID: PMC9633222 DOI: 10.3803/enm.2022.1589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 12/30/2022] Open
Abstract
Parathyroidectomy is the treatment of choice for primary hyperparathyroidism when the clinical criteria are met. Although bilateral neck exploration is traditionally the standard method for surgery, minimally invasive parathyroidectomy (MIP), or focused parathyroidectomy, has been widely accepted with comparable curative outcomes. For successful MIP, accurate preoperative localization of parathyroid lesions is essential. However, no consensus exists on the optimal approach for localization. Currently, ultrasonography and technetium-99m-sestamibi-single photon emission computed tomography/computed tomography are widely accepted in most cases. However, exact localization cannot always be achieved, especially in cases with multiglandular disease, ectopic glands, recurrent disease, and normocalcemic primary hyperparathyroidism. Therefore, new modalities for preoperative localization have been developed and evaluated. Positron emission tomography/computed tomography and parathyroid venous sampling have demonstrated improvements in sensitivity and accuracy. Both anatomical and functional information can be obtained by combining these methods. As each approach has its advantages and disadvantages, the localization study should be deliberately chosen based on each patient's clinical profile, costs, radiation exposure, and the availability of experienced experts. In this review, we summarize various methods for the localization of hyperfunctioning parathyroid tissues in primary hyperparathyroidism.
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Affiliation(s)
- Hye-Sun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Thyroid Cancer Clinic, Seoul, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Corresponding author: Yumie Rhee. Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1973, Fax: +82-2-393-6884, E-mail:
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Huglo PD. Functional imaging for hyperparathyroidism. Presse Med 2022; 51:104120. [PMID: 35321847 DOI: 10.1016/j.lpm.2022.104120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/06/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
Once hyperparathyroidism has been proven, the goal of parathyroid functional imaging is to identify one or more pathological glands in view of guiding a possibly targeted surgical procedure, while maximizing the chances for recovery. Currently, parathyroid radionuclide imaging is based on two techniques, parathyroid scintigraphy and 18F-fluorocholine - positron emission tomography (PET). The main radiopharmaceutical in scintigraphy is 99mTc-sestamibi, which can be used alone, in the dual-phase parathyroid scan, or in comparison with a thyroid radiotracer, pertechnetate (NaTcO4) or iodine 123 (dual-tracer method). The acquisitions can be planar and/or tomographic (SPECT). It is now recognized that the 99mTc-sestamibi - iodine 123 dual-tracer method is more efficient than the dual-phase scan, while SPECT-CT improves the sensitivity and specificity of the scintigraphy. This imaging and cervical ultrasonography are considered to be the two first-line reference techniques in preoperative assessment of hyperparathyroidism. More recently developed, 18F-fluorocholine detected by PET-CT has shown excellent performance, at least equal to that of scintigraphy. Initially considered as a second-line technique, its advantages over scintigraphy have prompted some authors to suggest it as the only examination to be performed in preoperative assessment of hyperparathyroidism. That said, due to a lack of specificity in 18F-fluorocholine uptake, which has been observed on inflammatory lesions and, particularly, in the mediastinal lymph nodes, and given the absence of simultaneous comparison of thyroid function, this strategy remains contested, and possibly reserved for patients without any associated thyroid pathology; large-scale evaluation would be justified.
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Affiliation(s)
- Pr Damien Huglo
- Univ Lille, Faculté de Médecine, 1 Place de Verdun, 5900 Lille, France; CHU Lille, Service de Médecine Nucléaire, Hôpital Huriez, rue Michel Polonovski, 59000 Lille, France; INSERM U1189 OncoTHAI, avenue Oscar Lambret, 59000 Lille, France.
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Morris MA, Saboury B, Ahlman M, Malayeri AA, Jones EC, Chen CC, Millo C. Parathyroid Imaging: Past, Present, and Future. Front Endocrinol (Lausanne) 2022; 12:760419. [PMID: 35283807 PMCID: PMC8914059 DOI: 10.3389/fendo.2021.760419] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022] Open
Abstract
The goal of parathyroid imaging is to identify all sources of excess parathyroid hormone secretion pre-operatively. A variety of imaging approaches have been evaluated and utilized over the years for this purpose. Ultrasound relies solely on structural features and is without radiation, however is limited to superficial evaluation. 4DCT and 4DMRI provide enhancement characteristics in addition to structural features and dynamic enhancement has been investigated as a way to better distinguish parathyroid from adjacent structures. It is important to recognize that 4DCT provides valuable information however results in much higher radiation dose to the thyroid gland than the other available examinations, and therefore the optimal number of phases is an area of controversy. Single-photon scintigraphy with 99mTc-Sestamibi, or dual tracer 99mTc-pertechnetate and 99mTc-sestamibi with or without SPECT or SPECT/CT is part of the standard of care in many centers with availability and expertise in nuclear medicine. This molecular imaging approach detects cellular physiology such as mitochondria content found in parathyroid adenomas. Combining structural imaging such as CT or MRI with molecular imaging in a hybrid approach allows the ability to obtain robust structural and functional information in one examination. Hybrid PET/CT is widely available and provides improved imaging and quantification over SPECT or SPECT/CT. Emerging PET imaging techniques, such as 18F-Fluorocholine, have the exciting potential to reinvent parathyroid imaging. PET/MRI may be particularly well suited to parathyroid imaging, where available, because of the ability to perform dynamic contrast-enhanced imaging and co-registered 18F-Fluorocholine PET imaging simultaneously with low radiation dose to the thyroid. A targeted agent specific for a parathyroid tissue biomarker remains to be identified.
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Affiliation(s)
| | | | | | | | | | - Clara C. Chen
- National Institutes of Health (NIH) Clinical Center, Department of Radiology and Imaging Sciences, Bethesda, MD, United States
| | - Corina Millo
- National Institutes of Health (NIH) Clinical Center, Department of Radiology and Imaging Sciences, Bethesda, MD, United States
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Yoshida A, Ueda D, Higashiyama S, Katayama Y, Matsumoto T, Yamanaga T, Miki Y, Kawabe J. Deep learning-based detection of parathyroid adenoma by 99mTc-MIBI scintigraphy in patients with primary hyperparathyroidism. Ann Nucl Med 2022; 36:468-478. [PMID: 35182328 DOI: 10.1007/s12149-022-01726-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/06/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE It is important to detect parathyroid adenomas by parathyroid scintigraphy with 99m-technetium sestamibi (99mTc-MIBI) before surgery. This study aimed to develop and validate deep learning (DL)-based models to detect parathyroid adenoma in patients with primary hyperparathyroidism, from parathyroid scintigrams with 99mTc-MIBI. METHODS DL-based models for detecting parathyroid adenoma in early- and late-phase parathyroid scintigrams were, respectively, developed and evaluated. The training dataset used to train the models was collected from 192 patients (165 adenoma cases, mean age: 64 years ± 13, 145 women) and the validation dataset used to tune the models was collected from 45 patients (30 adenoma cases, mean age: 67 years ± 12, 37 women). The images were collected from patients who were pathologically diagnosed with parathyroid adenomas or in whom no lesions could be detected by either parathyroid scintigraphy or ultrasonography at our institution from June 2010 to March 2019. The models were tested on a dataset collected from 44 patients (30 adenoma cases, mean age: 67 years ± 12, 38 women) who took scintigraphy from April 2019 to March 2020. The models' lesion-based sensitivity and mean false positive indications per image (mFPI) were assessed with the test dataset. RESULTS The sensitivity was 82% [95% confidence interval 72-92%] with mFPI of 0.44 for the scintigrams of the early-phase model and 83% [73-92%] with mFPI of 0.31 for the scintigrams of the delayed-phase model in the test dataset, respectively. CONCLUSIONS The DL-based models were able to detect parathyroid adenomas with a high sensitivity using parathyroid scintigraphy with 99m-technetium sestamibi.
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Affiliation(s)
- Atsushi Yoshida
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Shigeaki Higashiyama
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yutaka Katayama
- Department of Radiology, Osaka City University Hospital, 1-5-7, Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Toshimasa Matsumoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takashi Yamanaga
- Department of Radiology, Osaka City University Hospital, 1-5-7, Asahimachi, Abeno-ku, Osaka, 545-8586, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Joji Kawabe
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Guidoccio F, Valdés Olmos RA, Vidal-Sicart S, Orsini F, Giammarile F, Mariani G. Radioguided surgery for intraoperative detection of occult lesions. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shin M, Choi JY, Kim SW, Kim JH, Cho YS. Usefulness of 99mTc-SESTAMIBI Scintigraphy in Persistent Hyperparathyroidism after Kidney Transplant. Nucl Med Mol Imaging 2021; 55:285-292. [PMID: 34868377 DOI: 10.1007/s13139-021-00722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022] Open
Abstract
Purpose 99mTc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). The purpose of this study is to investigate the usefulness of 99mTc-sestamibi scintigraphy in persistent hyperparathyroidism after kidney transplant (KT). Methods Retrospectively evaluated 50 patients who received parathyroidectomy after KT at a single medical center. The parathyroid lesion with the highest sestamibi uptake intensity of a patient was graded from 0 to 3. Uptake intensity was analyzed in correlation with parathyroid hormone (PTH), calcium, ionized calcium, phosphorus, and vitamin D. Results Per-patient analysis, 43 patients had hyperplasia, 6 patients had adenomas, and 1 patient had a carcinoma. Only 3 patients with hyperplasia did not demonstrate any sestamibi uptake in the parathyroid scans. Out of the 148 pathologically confirmed parathyroid lesions, SPECT/CT images were able to identify 89 lesions (60%) and planar images of 71 lesions (48%). The average of sestamibi uptake intensity was mild at grade 1.6. Uptake intensity showed a positive correlation with parathyroid hormone (PTH) level but not with phosphorus, calcium, ionized calcium, or vitamin D levels. The largest lesion showed a high positive predictive value, especially in lesions with a diameter over 1.0 cm. Conclusions Regardless of relatively low and less discrete uptake in KT patients, it well depicts the largest and the most hyperfunctioning lesion.
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Affiliation(s)
- Muheon Shin
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Wook Kim
- Department of Endocrinology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Han Kim
- Department of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Dual-tracer radionuclide imaging in hyperparathyroidism: thallium-201 parathyroid scintigraphy revisited. Nucl Med Commun 2021; 42:32-42. [PMID: 32991396 DOI: 10.1097/mnm.0000000000001295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tc-sestamibi is the current radiopharmaceutical of choice for the localization of hyperactive lesions of the parathyroid glands in patients with hyperparathyroidism. However, there are multiple factors that adversely affect the accumulation and retention Tc-sestamibi in the hyperfunctioning parathyroid tissue, resulting in a false-negative scan. The objective of this study was to investigate the possibility of an incremental diagnostic role of thallium-201 parathyroid scintigraphy in patients with presumably false-negative Tc-sestamibi scan results. PATIENTS AND METHODS The study comprised of 22 patients including 16 with primary hyperparathyroidism (PHPT) and 6 with secondary hyperparathyroidism where Tc-sestambi scan was initially negative, inconclusive or where additional lesions were suspected on the single-photon computed tomography/computed tomography (SPECT/CT) scan with the CT component identifying lesion(s) without significant Tc-sestamibi uptake. RESULTS The results of our study show that in 22 patients (5 male, 17 female; age range 26-81; median age 53.4) further imaging with thallium-201 SPECT/CT scan showed 46.5% additional lesions in patients with hyperparathyroidism caused by an adenomatous or hyperplastic parathyroid lesion. In patients with PHPT caused by an adenomatous or hyperplastic parathyroid lesion, further imaging with thallium-201 showed 59% additional hyperactive parathyroid lesions. In patients with secondary hyperparathyroidism, further imaging with thallium-201 SPECT/CT showed additional 33.3% hyperplastic parathyroid lesions. CONCLUSION The results of this pilot study strongly advocate a role for thallium parathyroid SPECT/CT imaging in patients with primary and secondary hyperparathyroidism where the initial Tc-sestamibi scan is deemed to be false-negative in the presence of biochemical hyperparathyroidism.
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Petranović Ovčariček P, Giovanella L, Carrió Gasset I, Hindié E, Huellner MW, Luster M, Piccardo A, Weber T, Talbot JN, Verburg FA. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging 2021; 48:2801-2822. [PMID: 33839893 PMCID: PMC8263421 DOI: 10.1007/s00259-021-05334-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/23/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration. METHODS Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT. CONCLUSION These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.
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Affiliation(s)
- Petra Petranović Ovčariček
- EANM Thyroid Committee, Vienna, Austria
- Department of Oncology and Nuclear medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Luca Giovanella
- EANM Thyroid Committee, Vienna, Austria
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine and Interdisciplinary Thyroid Centre, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ignasi Carrió Gasset
- Department of Nuclear Medicine, Hospital Sant Pau and Autonomous University of Barcelona, Barcelona, Spain
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux Hospital and University, Bordeaux, France
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus Luster
- EANM Thyroid Committee, Vienna, Austria
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Genoa, Italy
| | - Theresia Weber
- Department of Endocrine Surgery, Katholisches Klinikum Mainz, Mainz, Germany
| | - Jean-Noël Talbot
- Nuclear Medicine, Hospital Tenon APHP and Sorbonne University, Paris, France
| | - Frederik Anton Verburg
- EANM Thyroid Committee, Vienna, Austria.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules? SURGERIES 2021. [DOI: 10.3390/surgeries2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases; one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules.
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Aksoy SÖ, Adiyaman SC, Çevlik AD, Güray Durak M, Seçil M, Sevinç Aİ. Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery. Am J Otolaryngol 2021; 42:102886. [PMID: 33460974 DOI: 10.1016/j.amjoto.2020.102886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE). OBJECTIVE The aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis. MATERIAL AND METHODS Data on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study. RESULTS The concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002). CONCLUSION IOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.
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Giovanella L, Bacigalupo L, Treglia G, Piccardo A. Will 18F-fluorocholine PET/CT replace other methods of preoperative parathyroid imaging? Endocrine 2021; 71:285-297. [PMID: 32892309 DOI: 10.1007/s12020-020-02487-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is a common endocrine disorder usually due to hyperfunctioning parathyroid glands (HPs). Surgical removal of the HPs is the main treatment for PHPT, making the correct detection and localization of HPs crucial to guiding targeted and minimally invasive surgical treatment in patients with PHPT. To date, different imaging methods have been used to detect and localize HPs, including radiology, nuclear medicine, and hybrid techniques. METHODS The present work discusses the role and value of different imaging methods in PHPT and, particularly, evaluates the potential role of 18F-fluorcholine PET/CT as a "one-stop-shop" method for preoperative parathyroid localization in patients with PHPT. DISCUSSION Cervical ultrasound (US) and parathyroid scintigraphy using 99mTc-MIBI are the most commonly employed methods in clinical practice. More recently, four-dimensional computed tomography (4D CT) and positron emission tomography (PET) with radiolabeled choline have emerged as useful alternatives in cases of negative or discordant findings from first-line imaging methods. CONCLUSIONS Due to the excellent diagnostic performance of radiolabeled choline PET/CT and the low radiation burden, this technique seems to be an ideal candidate to substitute current imaging procedures including US, MIBI scintigraphy, 4D CT and MRI and perform a fast and reliable "one-stop-shop" preoperative localization of HP in patients with PHPT, including challenging cases of postoperative persistent/recurrent disease.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Lorenzo Bacigalupo
- Department of Diagnostic Imaging, Radiology and Nuclear Medicine, Ente Ospedaliero Galliera, Genova, Italy
| | - Giorgio Treglia
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Research and Innovation Service, Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Diagnostic Imaging, Radiology and Nuclear Medicine, Ente Ospedaliero Galliera, Genova, Italy
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Jackson R, Chew D, McClean S, England J. Factors related to a non-localising technetium 99m sestamibi scan result during parathyroid adenoma imaging in primary hyperparathyroidism. Clin Otolaryngol 2020; 46:357-362. [PMID: 33259140 DOI: 10.1111/coa.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/12/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study is to investigate factors that are associated with having a non-localising 99m Tc-sestamibi scan. DESIGN A retrospective study was performed on patients that underwent parathyroid surgery performed within a single institution between 2001 and 2018. SETTING Single tertiary centre for parathyroid surgery. PARTICIPANTS 230 patients underwent surgery for primary hyperparathyroidism due to a solitary parathyroid adenoma and had preoperative 99m Tc-sestamibi imaging. MAIN OUTCOME MEASURES Variables including age, gender, intra-operative location of parathyroid adenoma, adenoma weight and pre- and postoperative calcium and parathyroid hormone levels were investigated through univariate and multivariate analysis to identify any association with having a non-localising (negative) 99m Tc-sestamibi scan result. RESULTS Multivariate analysis identified that right-sided adenomas (P = .038), superior adenomas (P = .042) and a lower preoperative PTH level (P = .034) were all individual factors associated with having a negative 99m Tc-sestamibi scan result. Although the weight of the adenoma was significant on univariate analysis (P = .029), this was not demonstrated on multivariate analysis (P = .422). CONCLUSION Factors that were associated with having non-localising 99m Tc-sestamibi scan were right-sided adenomas, superior adenomas and lower preoperative PTH level. Further large prospective multicentre studies are needed to further evaluate these initial findings.
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Affiliation(s)
| | - Dylan Chew
- Department of ENT, Royal Hallamshire Hospital, Sheffield, UK
| | - Simon McClean
- Department of ENT, Castlehill Hospital, Cottingham, UK
| | - James England
- Department of ENT, Castlehill Hospital, Cottingham, UK
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Suh HY, Na HY, Park SY, Choi JY, So Y, Lee WW. The Usefulness of Maximum Standardized Uptake Value at the Delayed Phase of Tc-99m sestamibi single-photon emission computed tomography/computed tomography for Identification of Parathyroid Adenoma and Hyperplasia. Medicine (Baltimore) 2020; 99:e21176. [PMID: 32664158 PMCID: PMC7360288 DOI: 10.1097/md.0000000000021176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tc-99m sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has been used to help surgeons explore the location of parathyroid diseases, but quantitative parameters have not been systemically investigated for this purpose. We aimed to establish objective criteria for adenoma and hyperplasia using the standardized uptake value (SUV) in patients with hyperparathyroidism.Thirty-nine hyperparathyroid patients (male/female: 17/22, age: 58.33 ± 11.69 years) with at least 1 uptake-positive lesion of any degree by visual assessment in preoperative Tc-99m sestamibi quantitative SPECT/CT were included from Oct 2015 to Oct 2017. Pathologically, 44 lesions (32 adenomas and 12 hyperplasia) were identified. All patients experienced normalized levels of intact parathyroid hormone immediately after surgery. Quantitative SPECT/CT was performed at 10 minute and 2 hour post injection of Tc-99m sestabmibi (dose = 740 MBq), and maximum SUV (SUVmax) was measured for the parathyroid lesions. Experienced pathologists evaluated the percentage cellular proportions of chief cells, oxyphil cells, and clear cells.SUVmax (g/mL) of adenomas, hyperplasia, and reference thyroid tissue were 12.92 ± 6.68, 7.90 ± 5.49, and 7.01 ± 2.62 at 10min (early phase), decreasing to 7.46 ± 5.66, 4.65 ± 3.14, and 2.21 ± 1.07 at 2 hour (delayed phase), respectively. The adenomas showed significantly higher SUVmax than both the hyperplasia (P = .0131) and reference thyroid tissue (P < .0001) along the early and delayed phases, but the SUVmax of the hyperplasia did not differ from that of the reference thyroid tissue (P = .4196). The adenomas and hyperplasia were discriminated from the reference thyroid tissue using a cutoff SUVmax of 3.26 at the delayed phase. The adenomas had lower %proportions of oxyphil cells than the hyperplasia (P = .0054), but its SUVmax at the delayed phase was positively correlated with the %proportions of mitochondria-abundant oxyphil cells (rho = 0.418, P = .0173). The hyperplasia showed no correlation between SUVmax and cellular proportions.SUVmax at the delayed phase in the Tc-99m sestamibi quantitative SPECT/CT was useful for the identification and differentiation of parathyroid lesions causing hyperparathyroidism.
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Affiliation(s)
- Hoon Young Suh
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University
| | | | | | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Young So
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Use of pinhole dual-phase Tc-99m sestamibi vs combined Tc-99m sestamibi and Tc-99m pertechnetate scintigraphy in patients with hyperparathyroidism where single-photon emission computed tomography/computed tomography is unavailable. Nucl Med Commun 2020; 41:87-95. [DOI: 10.1097/mnm.0000000000001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Thyroid and Parathyroid Imaging. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Aygün N, Uludağ M. Surgical Treatment of Primary Hyperparathyroidism: Which Therapy to Whom? SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:201-214. [PMID: 32377085 PMCID: PMC7192265 DOI: 10.14744/semb.2019.56873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022]
Abstract
Primary hyperparathyroidism (pHPT) is characterized by an increase in the levels of PTH and Ca, or one of these (Ca, PTH) as a result of a dysregulation of calcium (Ca) metabolism due to inappropriate excess parathyroid hormone (PTH) autonomously produced from one or more than one parathyroid glands. Ninety to 95% of pHPT is a sporadic type, which is not associated with the familial history and other endocrine organ tumors, and 5-10% of it is hereditary. While 80-85% of pHPT arises from a single parathyroid adenoma, 4-5% is caused by a double adenoma, 10-15% by multigland hyperplasia and less than 1% by parathyroid cancer. The diagnosis of pHPT is reached biochemically. The only curative treatment of pHPT is surgery. The choice of surgery in pHPT may vary depending on whether the patient has hereditary HPT or thyroid disease requiring surgical treatment, preoperative localization studies and the findings in these studies, the possibilities of using intraoperative PTH and the preference of the surgeon. The preoperatively determined surgical strategy can be revised according to intraoperative findings in case of need to achieve excellent results. The two main approaches in the surgical treatment of pHPT are BNE (bilateral neck exploration) and MIP (minimal invasive parathyroidectomy). Although BNE is a consistently valid option that has excellent results in the surgical treatment of pHPT and is considered the gold standard, MIP is the ideal approach in selected patients with clinically and radiologically considered a single-gland disease. Negative imaging is not a contraindication for parathyroid surgery and is not a criterion for the presence or absence of surgical indication. Although both methods are safe and effective in the surgical treatment of sporadic pHPT, there is still controversy regarding the effectiveness of both methods. Surgical intervention should establish the risk-benefit balance well, minimize the risk of persistent and recurrent disease and provide the highest cure rate without increasing the risk of complications. Complication rates are higher in the secondary surgery, thus in secondary procedures, selective surgery should be performed under guidance of an imaging modality. The surgical strategy should be determined to achieve maximum cure with minimum dissection and minimal morbidity. In this study, we aimed to determine the type of surgical treatment and pHPT patients suitable for the surgical treatment.
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Affiliation(s)
- Nurcihan Aygün
- Department of General Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Uludağ
- Department of General Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Abd Elhameed Elsayed W, Ali RA. Efficacy of Scintigraphy, Ultrasound and Both Scintigraphy and Ultrasonography in Preoperative Detection and Localization of Primary Hyperparathyroidism. Cureus 2019; 11:e4960. [PMID: 31453033 PMCID: PMC6701907 DOI: 10.7759/cureus.4960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The aim of our study was to evaluate the efficacy of preoperative dual-phase 99mTc-methoxyisobutylnitrile (MIBI) parathyroid scintigraphy (PS), and ultrasound (US) in primary hyperparathyroidism (pHPT) diagnosis and compare the results with the surgical findings. Methods: Forty-five patients were enrolled in this study. Preoperative serum parathyroid hormone (PTH) levels, calcium (Ca), phosphate (P), and alkaline phosphatase (AP) levels were measured. All parathyroid patients were evaluated by ultrasonography, dual phase 99mTc-MIBI. Surgical findings were used as a reference standard. Results: Of the 45 patients included in this study, 30 were females (66.7%) with an age range between 30 years and 70 years (mean age 41± 13). The sensitivity and specificity of 99mTc-MIBI scintigraphy was 97.4% and 71.4%, respectively, while the sensitivity of ultrasound was 94.4% and specificity 44.4%. The sensitivity, specificity, and accuracy of combined scintigraphy and ultrasound was higher-97.4%, 83.3%, and 95.6%, respectively. Conclusions: The combination of MIBI and US appears promising for localizing parathyroid pathology in patients with primary hyperparathyroidism. The concordance rate is high together with a lower chance of missing concomitant thyroid pathology, which might alter the surgical approach.
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Affiliation(s)
| | - Rasha A Ali
- Epidemiology and Public Health, Sohag University Hospital, Sohag, EGY
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22
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Kushchayeva YS, Tella SH, Kushchayev SV, Van Nostrand D, Kulkarni K. Comparison of hyperparathyroidism types and utility of dual radiopharmaceutical acquisition with Tc99m sestamibi and 123I for localization of rapid washout parathyroid adenomas. Osteoporos Int 2019; 30:1051-1057. [PMID: 30706095 DOI: 10.1007/s00198-019-04846-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/06/2019] [Indexed: 11/29/2022]
Abstract
UNLABELLED Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. We investigated the degree and causes of localization failure among different types of hyperparathyroidism. Pre-operative parathyroid hormone levels and size of the gland were major determinants of Tc99m-sestamibi positivity; 123I scan may be helpful in localization failures. INTRODUCTION Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. However, parathyroid adenomas/hyperplasia has been reported to washout as fast as normal thyroid tissue ("rapid washout") which may lead to diagnostic failure. We aimed to evaluate the determinants of rapid washout and to determine the role of subtraction imaging for detection of parathyroid adenomas/hyperplasia with rapid washout. METHODS Retrospective analysis of patients with hyperparathyroidism who have undergone Tc99m-sestamibi dual-time imaging and parathyroid surgery. Rapid washout was correlated to the type of hyperparathyroidism in surgically confirmed cases. Biochemical and pathological data were reviewed. RESULTS A total of 135 hyperparathyroidism patients met the inclusion criteria. Ninety-six (72%), 29 (21%), and 10 (7%) had primary, secondary, and tertiary hyperparathyroidisms, respectively. Rapid washout was identified in 28/87 glands (32%), 14/53 glands (26%), and 1/16 glands (6%) with primary, secondary, and tertiary hyperparathyroidisms, respectively. Glands that were positive on late-phase Tc99m-sestamibi scans were significantly large being 1.7 (IQR 1.4-2.3) vs. 1.45 (IQR 1-2) cm (p = 0.003). High parathyroid hormone levels (PTH) were associated with early-phase Tc99m-sestamibi positivity in both primary (p = 0.01) and secondary hyperparathyroidism (p = 0.03) but not with last phase (p = 0.11, p = 0.37, respectively). Correlative imaging with subtraction scintigraphy was positive in 14/16 (87.5%) parathyroid adenomas. CONCLUSION Pre-operative PTH levels and size of the gland were major determinants of Tc99m-sestamibi positivity on early-phase Tc99m-sestamibi scans, whereas size is an independent predictor of late-phase Tc99m-sestamibi positivity. Subtraction scintigraphy might be a useful tool in suspected cases of rapid washout adenomas/hyperplasia.
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Affiliation(s)
- Y S Kushchayeva
- Diabetes, Endocrinology, and Obesity Branch, NIDDK, NIH, Bethesda, MD, USA
| | - S H Tella
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - S V Kushchayev
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - D Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Suite GB1, Washington, DC, 20010, USA
| | - K Kulkarni
- Division of Nuclear Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Suite GB1, Washington, DC, 20010, USA.
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Zafereo M, Yu J, Angelos P, Brumund K, Chuang HH, Goldenberg D, Lango M, Perrier N, Randolph G, Shindo ML, Singer M, Smith R, Stack BC, Steward D, Terris DJ, Vu T, Yao M, Tufano RP. American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism. Head Neck 2019; 41:2398-2409. [PMID: 31002214 DOI: 10.1002/hed.25781] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Health care consumer organizations and insurance companies increasingly are scrutinizing value when considering reimbursement policies for medical interventions. Recently, members of several American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) committees worked closely with one insurance company to refine reimbursement policies for preoperative localization imaging in patients undergoing surgery for primary hyperparathyroidism. This endeavor led to an AAO-HNS parathyroid imaging consensus statement (https://www.entnet.org/content/parathyroid-imaging). The American Head and Neck Society Endocrine Surgery Section gathered an expert panel of authors to delineate imaging options for preoperative evaluation of surgical candidates with primary hyperparathyroidism. We review herein the current literature for preoperative parathyroid localization imaging, with discussion of efficacy, cost, and overall value. We recommend that planar sestamibi imaging, single photon emission computed tomography (SPECT), SPECT/CT, CT neck/mediastinum with contrast, MRI, and four dimensional CT (4D-CT) may be used in conjunction with high-resolution neck ultrasound to preoperatively localize pathologic parathyroid glands. PubMed literature on parathyroid imaging was reviewed through February 1, 2019.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Justin Yu
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Peter Angelos
- Section of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kevin Brumund
- Section of Head and Neck Surgery, UC San Diego Health System, San Diego, California
| | - Hubert H Chuang
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Texas
| | - David Goldenberg
- Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Miriam Lango
- Division of Head & Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nancy Perrier
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Russell Smith
- Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - David Steward
- Division of Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David J Terris
- Department of Otolaryngology, Medical College of Georgia, Augusta, Georgia
| | - Thinh Vu
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Mike Yao
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Update of the role of Nuclear Medicine techniques in the pre-surgical localization of primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Platz Batista da Silva N, Jung EM, Jung F, Schlitt HJ, Hornung M. VueBox® perfusion analysis of contrast-enhanced ultrasound (CEUS) examinations in patients with primary hyperparathyroidism for preoperative detection of parathyroid gland adenoma. Clin Hemorheol Microcirc 2019; 70:423-431. [DOI: 10.3233/ch-189307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | | | - Friedrich Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - Hans J. Schlitt
- Department of Surgery, University Hospital Regensburg, Germany
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Vaiman M, Cohenpur M, Halevy A, Volkov O, Gold R, Peer M, Golan H, Gavriel H. Low-radiation of technetium-99m-sestamibi and single-photon emission computed tomography/computed tomography to diagnose parathyroid lesions. World J Nucl Med 2019; 18:52-57. [PMID: 30774547 PMCID: PMC6357720 DOI: 10.4103/wjnm.wjnm_29_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We compared preoperative regular activity and low-activity radiology-based predictions with real surgical and pathological findings for parathyroidectomy surgery. The study retrospectively analyzed 54 consecutive cases (2009–2016) for benign tumor removal. Technetium-99m (Tc-99m)-sestamibi was used as a diagnostic radiopharmaceutical for diagnostic dual-phase parathyroid scintigraphy and single-photon emission computed tomography/computed tomography. We assessed images obtained with the radiation activity of 925 megabecquerel (MBq) and images obtained with the activity of 185 MBq. The study compared preoperative evaluation of tumor presence, multiplicity, location, and the type of pathology with actual data that were revealed during the operation and pathological investigation. The agreement between preoperative radiological prediction and actual location, number, and type of the parathyroid lesions was achieved in 98.4% (n = 61/62 lesions). The agreement between 925 MBq-based and 185-MBq based investigations was 100%. The agreement between radiological and pathological findings was 100% for both investigations. Our data suggest that the radioactivity of 185 MBq applied in the evaluation of the parathyroid glands provides results similar to the currently used 925–1110 MBq if used for diagnostic dual-phase parathyroid scintigraphy with Tc-99m-sestamibi. Such radioactivity may reduce the exposure to radiation of the patients and the staff without compromising results of the investigation.
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Affiliation(s)
- Michael Vaiman
- Department of Otorhinolaryngology - Head and Neck Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Mehrzad Cohenpur
- Department of Nuclear Medicine, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Halevy
- Division of Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Volkov
- Department of Nuclear Medicine, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Gold
- Division of Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Peer
- Department of Thoracic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Golan
- Department of Nuclear Medicine, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Gavriel
- Department of Otorhinolaryngology - Head and Neck Surgery, Tel Aviv University, Tel Aviv, Israel
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García-Talavera San Miguel P, Gómez-Caminero López F, Villanueva Curto JG, Tamayo Alonso MP, Martín Gómez ME. Update of the role of Nuclear Medicine techniques in the pre-surgical localization of primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2019; 38:123-135. [PMID: 30738915 DOI: 10.1016/j.remn.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Primary hyperparathyroidism is one of the most frequent endocrine disorders. Its diagnosis is biochemical. Imaging techniques are not useful for the diagnosis of this pathology; they are just tools for pre-surgical localization. In this continuing education, we will analyze the different imaging modalities used in this indication, focusing on Nuclear Medicine. The most commonly used imaging technique in this context is the parathyroid scintigraphy, nowadays double phase protocol with 99mTc-MIBI and the double tracer with 99mTc-MIBI/99mTc-pertechnetate, associated in the first case to SPECT or SPECT/CT, in an early or late phase. The PET/CT with different tracers is showing good results, especially applied to cases of failure in the pre-surgical scintigraphic localization. We expose the results of the morphological imaging techniques as well as the usefulness of combining techniques.
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Affiliation(s)
| | - F Gómez-Caminero López
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - J G Villanueva Curto
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - M P Tamayo Alonso
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - M E Martín Gómez
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
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Affiliation(s)
- Reema Mallick
- Department of Surgery, University of Alabama-Birmingham, 1808 7th Avenue South, Suite 502, Birmingham, AL 35233, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama-Birmingham, 1808 7th Avenue South, Suite 502, Birmingham, AL 35233, USA.
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Araz M, Cayir D, Ucan B, Dilli A, Çakal E. Clinical Significance of Incidental Pituitary TC-99m MIBI Uptake on Parathyroid Spect and Factors Affecting Uptake Intensity. Cancer Biother Radiopharm 2018; 33:295-299. [PMID: 29924654 DOI: 10.1089/cbr.2017.2433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE (1)To define a quantitative cutoff value for incidental pituitary Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) uptake above which is of clinical importance and (2) to investigate possible factors affecting the intensity of uptake in pituitary adenoma. MATERIALS AND METHODS A retrospective analysis of 55 patients with a simultaneous parathyroid single-photon emission computed tomography and pituitary magnetic resonance imaging were included. Twenty-four patients with pituitary adenoma were chosen as the study group and 31/55 patients who had no signs of a pituitary adenoma were included in the control group. Mean count values (count/pixel) for pituitary region of interest (ROI)/mean value for normal cortical region ROI (P/C) were calculated in both groups. Median P/C values were compared. A cutoff value for P/C was calculated as a quantitative parameter to indicate pituitary tumors. Possible contributing factors in intensity of pituitary Tc-99m MIBI uptake were investigated. RESULTS Median P/C ratios were significantly higher in the study group (p < 0.001). A cutoff value of 7.675 was found for P/C to have a sensitivity, spesificity, positive predictive value, and negative predictive value 100%, 96.8%, 96%, and 100%, respectively. There was no correlation between investigated factors and degree of pituitary Tc-99m MIBI uptake. CONCLUSIONS Incidental pituitary Tc-99m MIBI uptake values above 7.675 for P/C are suspicious for pituitary adenoma and can be further investigated clinically and radiologically. Tc-99m MIBI uptake is not affected from the biochemical nature of the adenoma, the therapies received, size, local invasion, or cystic necrotic component of the tumor.
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Affiliation(s)
- Mine Araz
- 1 Nuclear Medicine Department, UHS Diskapi Yildirim Beyazit Training and Research Hospital , Ankara, Turkey
| | - Derya Cayir
- 1 Nuclear Medicine Department, UHS Diskapi Yildirim Beyazit Training and Research Hospital , Ankara, Turkey
| | - Bekir Ucan
- 2 Endocrinology and Metabolism Department, UHS Diskapi Yildirim Beyazit Training and Research Hospital , Ankara, Turkey
| | - Alper Dilli
- 3 Radiology Department, UHS Diskapi Yildirim Beyazit Training and Research Hospital , Ankara, Turkey
| | - Erman Çakal
- 2 Endocrinology and Metabolism Department, UHS Diskapi Yildirim Beyazit Training and Research Hospital , Ankara, Turkey
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Kim D, Rhodes JA, Hashim JA, Rickabaugh L, Brams DM, Pinkus E, Dou Y. Highly specific preoperative selection of solitary parathyroid adenoma cases in primary hyperparathyroidism by quantitative image analysis of the early-phase Technetium-99m sestamibi scan. J Med Imaging Radiat Oncol 2018; 62:642-648. [PMID: 29877611 DOI: 10.1111/1754-9485.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/11/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Highly specific preoperative localizing test is required to select patients for minimally invasive parathyroidectomy (MIP) in lieu of traditional four-gland exploration. We hypothesized that Tc-99m sestamibi scan interpretation incorporating numerical measurements on the degree of asymmetrical activity from bilateral thyroid beds can be useful in localizing single adenoma for MIP. METHODS We devised a quantitative interpretation method for Tc-99m sestamibi scan based on the numerically graded asymmetrical activity on early phase. The numerical ratio value of each scan was obtained by dividing the number of counts from symmetrically drawn regions of interest (ROI) over bilateral thyroid beds. The final pathology and clinical outcome of 109 patients were used to perform receiver operating curve (ROC) analysis. RESULTS Receiver operating curve analysis revealed the area under the curve (AUC) was calculated to be 0.71 (P = 0.0032), validating this method as a diagnostic tool. The optimal cut-off point for the ratio value with maximal combined sensitivity and specificity was found with corresponding sensitivity of 67.9% (56.5-77.2%, 95% CI) and specificity of 75.0% (52.8-91.8%, 95% CI). An additional higher cut-off with higher specificity with minimal possible sacrifice on sensitivity was also selected, yielding sensitivity of 28.6% (18.8-38.6%, 95% CI) and specificity of 90.0% (69.6-98.8%, 95% CI). CONCLUSIONS Our results demonstrated that the more asymmetrical activity on the initial phase, the more successful it is to localize a single parathyroid adenoma on sestamibi scans. Using early-phase Tc-99m sestamibi scan only, we were able to select patients for minimally invasive parathyroidectomy with 90% specificity.
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Affiliation(s)
- DaeHee Kim
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jeffrey A Rhodes
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jeffrey A Hashim
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Lawrence Rickabaugh
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - David M Brams
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Edward Pinkus
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Yamin Dou
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Jovanovska A, Stoilovska B, Mileva M, Miladinova D, Majstorov V, Ugrinska A. Absent 99mTc-MIBI Uptake in the Thyroid Gland during Early Phase of Parathyroid Scintigraphy in Patients with Primary and Secondary Hyperparathyroidism. Open Access Maced J Med Sci 2018; 6:808-813. [PMID: 29875850 PMCID: PMC5985886 DOI: 10.3889/oamjms.2018.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/10/2018] [Accepted: 04/20/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Thyroid uptake of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) during parathyroid scintigraphy can be affected by various conditions. AIM To evaluate the frequency of absent 99mTc-MIBI uptake by the thyroid gland in the early phase of dual-phase parathyroid scintigraphy. METHODS The early planar images of dual phase Tc99m MIBI parathyroid scintigraphy from 217 patients performed between 2014 and 2017 were retrospectively analysed. Patients were divided into two groups. The first group included 147 patients with primary hyperparathyroidism and the second group included 70 patients with chronic renal failure. Patient records, laboratory and ultrasonographic data were analysed in all patients. Descriptive statistic was used for data analysis. RESULTS Out of all patients in the first group, 18 patients (12.24%) showed absent thyroid uptake. Thyroidectomy was performed in 44.4% of these patients, and the rest of them had some thyroid disease. Only one patient had no thyroid or another chronic disease. In the second group, 8 patients (11.42%) presented with absent thyroid uptake of MIBI. Among them, 5 patients had no history of thyroid disease and had been on hemodialysis programme, and 3 patients had hypothyroidism. CONCLUSION Absent 99mTc-MIBI uptake in the thyroid during the early phase of parathyroid scintigraphy is most frequently related to thyroid disease. A small proportion of patients with chronic renal failure can present with absent 99mTc-MIBI uptake in the thyroid as well. The mechanism for this alteration is still unclear and needs further investigation.
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Affiliation(s)
- Anamarija Jovanovska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Bojana Stoilovska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Magdalena Mileva
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Daniela Miladinova
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Venjamin Majstorov
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ana Ugrinska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Parathyroid radionuclide imaging: update. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Objective The aim of this study was to further elucidate the mechanisms of dual-phase technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) parathyroid imaging by exploring the association between early uptake results (EUR), delayed uptake results (DUR), and the retention index (RI) in dual-phase 99mTc-MIBI parathyroid imaging and P glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1), and glutathione S-transferase-π (GST-π) expression in hyperparathyroidism (HPT). Patients and methods Preoperative dual-phase (early and delayed) 99mTc-MIBI imaging was performed on 74 patients undergoing parathyroidectomy for HPT. EUR, DUR, and RI were calculated. P-gp, MRP1, and GST-π expressions were assessed using immunohistochemistry in resected tissue from HPT and control patients. The association between P-gp, MRP1, and GST-π expressions and EUR, DUR, and RI in HPT was evaluated. Results The positive rate of dual-phase 99mT c-MIBI imaging was 91.89% (68/74) and the false-negative rate was 8.11% (6/74). P-gp and GST-π expressions were higher in tissues resected from control compared with HPT patients (47.37 and 81.5%, P<0.05); there was no difference in MRP1. EUR were associated with P-gp and GST-π expressions, and DUR were associated with MRP1 expression. There was a significant difference in MRP1 expression between RI greater than or equal to 0 and RI less than 0. There was no relationship between the sensitivity of dual-phase 99mTc-MIBI imaging and P-gp, MRP1, and GST-π expressions in resected parathyroid tissue. The six false-negative HPT cases consisted of three P-gp (−)/MRP1 (−) tissues, three P-gp (−)/GST-π (−) tissues, and four MRP1 (−)/GST-π (−) tissues. Conclusion As P-gp and GST-π expressions were higher in tissues resected from control compared with HPT patients, 99mTc-MIBI may wash out faster from normal parathyroid tissue surrounding the lesion compared with the lesion itself, facilitating detection.
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Abstract
Hexakis (2-methoxyisobutylisonitrile) technetium-99m (99mTc-SestaMIBI) is a radiopharmaceutical used in nuclear medicine for myocardial perfusion imaging. In the literature different non-cardiac applications of 99mTc-SestaMIBI have been reported. Clinical studies have been performed also in non-oncologic diseases (such as thyroid adenoma, diabetic foot, osteomyelitis, pulmonary actinomycosis, aneurysmal bone cyst, Sudeck's atrophy). Several models for the uptake mechanism of this radiopharmaceutical have been proposed such as binding to an 8-10 kDa cytosolic protein, simple lipid partitioning, or a membrane translocation mechanism involving diffusion and passive transmembrane distribution. Most evidence points in the direction of the third hypothesis. Many studies have indicated that uptake of hexakis (alkylisonitrile) technetium complexes is dependent on mitochondrial and plasma membrane potentials like other lipophilic cations. This explains the initial biodistribution of 99mTc-SestaMIBI to tissues with negative plasma membrane potentials and with a relatively high mitochondrial content (like heart, liver, kidney and skeletal muscle tissue). Malignant tumours also possess these properties in order to maintain their increased metabolism. This behaviour encouraged the study of 99mTc-SestaMIBI as an interesting tracer imaging various tumour types: osteosarcoma, brain, lung, breast, nasopharyngeal, parathyroid, and thyroid cancer. Recent research on cell cellular physiology has further revealed an active transport of 99mTc-SestaMIBI out of the tumour cells, against the potential gradient. The same mechanism is also responsible for resistance to a structurally and functionally different group of cytotoxic agents, such as vinca alkaloids, epipodophyllotoxins, anthracyclins and actinomycin D. This peculiar type of resistance is due to amplification of the mammalian MDR1 gene, located on chromosome 7. For this reason the 99mTc- SestaMIBI uptake in vivo could permit the prediction of the response to the chemotherapy, when the decreased accumulation of 99mTc-SestaMlBI implies the presence of P-gp enriched tissues. In the next future a particular attention should be dedicated to this matter since one of the most important goals of the clinical trials is the demonstration of the usefulness of 99mTc-SestaMIBI for in vivo assessment of multidrug resistance.
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Affiliation(s)
- L Maffioli
- Divison of Nuclear Medicine, National Cancer Institute, Milan, Italy
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35
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The relationship between semiquantitative parameters derived from technetium-99m metoxyisobutylisonitrile dual-phase parathyroid single-photon emission computed tomography images and disease severity in primary hyperparathyroidism. Nucl Med Commun 2018; 39:304-311. [DOI: 10.1097/mnm.0000000000000803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Dual time-point quantitative SPECT-CT parathyroid imaging using a single computed tomography. Nucl Med Commun 2018; 39:3-9. [DOI: 10.1097/mnm.0000000000000761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ljungberg M, Pretorius PH. SPECT/CT: an update on technological developments and clinical applications. Br J Radiol 2018; 91:20160402. [PMID: 27845567 PMCID: PMC5966195 DOI: 10.1259/bjr.20160402] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 12/20/2022] Open
Abstract
Functional nuclear medicine imaging with single-photon emission CT (SPECT) in combination with anatomical CT has been commercially available since the beginning of this century. The combination of the two modalities has improved both the sensitivity and specificity of many clinical applications and CT in conjunction with SPECT that allows for spatial overlay of the SPECT data on good anatomy images. Introduction of diagnostic CT units as part of the SPECT/CT system has also potentially allowed for a more cost-efficient use of the equipment. Most of the SPECT systems available are based on the well-known Anger camera principle with NaI(Tl) as a scintillation material, parallel-hole collimators and multiple photomultiplier tubes, which, from the centroid of the scintillation light, determine the position of an event. Recently, solid-state detectors using cadmium-zinc-telluride became available and clinical SPECT cameras employing multiple pinhole collimators have been developed and introduced in the market. However, even if new systems become available with better hardware, the SPECT reconstruction will still be affected by photon attenuation and scatter and collimator response. Compensation for these effects is needed even for qualitative studies to avoid artefacts leading to false positives. This review highlights the recent progress for both new SPECT cameras systems as well as for various data-processing and compensation methods.
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Affiliation(s)
- Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - P Hendrik Pretorius
- Division of Nuclear Medicine, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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Toneto MG, Prill S, Debon LM, Furlan FZ, Steffen N. The history of the parathyroid surgery. Rev Col Bras Cir 2017; 43:214-22. [PMID: 27556546 DOI: 10.1590/0100-69912016003003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/03/2016] [Indexed: 11/22/2022] Open
Abstract
The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment. RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.
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Affiliation(s)
- Marcelo Garcia Toneto
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Shandi Prill
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Leticia Manoel Debon
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Fernando Zucuni Furlan
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Nedio Steffen
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
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Kim M, Yoo WJ, Lee B. Development of a fiber-optic gamma endoscope to measure both optical and gamma images in a confined space. OPTICS EXPRESS 2017; 25:20087-20097. [PMID: 29041693 DOI: 10.1364/oe.25.020087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
In nuclear medicine, obtaining information on the exact location, size, and dose of radiopharmaceuticals distributed on lesions is critically important. Therefore, we have fabricated a novel fiber-optic gamma endoscope (FOGE) to measure the shape and size of the radioisotope as well as the gamma-ray distribution simultaneously. To evaluate the performance of the novel FOGE, we obtained optical images and gamma images by using a USAF 1951 target and radioisotope sources, respectively. The experimental results demonstrated that the FOGE could be utilized to obtain both the location and the distribution of the radioactive isotope that emitted gamma-rays. Based on the results of this study, use of a flexible and thin FOGE would be valuable in nuclear medicine and nuclear safety technologies given the advantages of accurate dose-monitoring. Especially, improvements could be achieved in surgery technologies because the FOGE could be used in minimally invasive radioguided surgery owing to its thin form and flexibility.
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PAPEL DE LAS IMÁGENES EN EL ESTUDIO DE LOS SÍNDROMES NEOPLÁSICOS HEREDITARIOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sharma J, Halkar R, Weber CJ. Imaging of Parathyroid Glands in End Stage Renal Disease. Semin Dial 2017; 30:369-372. [PMID: 28558417 DOI: 10.1111/sdi.12608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Secondary hyperparathyroidism from chronic renal failure often requires a parathyroidectomy for correction. A successful parathyroidectomy often relies upon localization of all parathyroid tumors. Although most of the tumors are localized during a neck exploration, preoperative localization studies can help identify ectopic and supernumerary tumors. Three of the most common localization studies are radionuclide imaging, ultrasound, and CT scanning. Utility of these studies is strongly dependent on local institutional practice.
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Affiliation(s)
- Jyotirmay Sharma
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Raghuveer Halkar
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Collin J Weber
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Kobylecka M, Płazińska MT, Chudziński W, Fronczewska-Wieniawska K, Mączewska J, Bajera A, Karlińska M, Królicki L. Comparison of scintigraphy and ultrasound imaging in patients with primary, secondary and tertiary hyperparathyroidism - own experience. J Ultrason 2017; 17:17-22. [PMID: 28439424 PMCID: PMC5392549 DOI: 10.15557/jou.2017.0002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The imaging techniques most commonly used in the diagnosis of hyperparathyroidisms are ultrasound and scintigraphy. The diagnostic algorithms vary, depending mainly on the population, and experience of physicians. AIM Aim of the present research was to determine the usefulness of parathyroid scintigraphy and ultrasonography in patients diagnosed for hyperparathyroidism in own material. MATERIAL AND METHOD In the present research, 96 operated patients with documented primary, secondary and tertiary hyperparathyroidism were retrospectively analyzed. All patients underwent a 99mTc hexakis-2-methoxyisobutylisonitrile scintigraphy of the neck with the use of subtraction and two-phase examinations. Ultrasonography of the neck was performed in all the patients in B mode 2D presentation. A total number of 172 parathyroid glands were analyzed. RESULTS The sensitivity and specificity of scintigraphy was 68% and 60%, respectively. The sensitivity of ultrasound was 49% and specificity 85%. Both techniques allowed visualization of 76 parathyroid glands. Ultrasound revealed 19 glands that were not visible in scintigraphy. Scintigraphy showed 76 parathyroid glands that were not visualized on ultrasound. Having combined the results of scintigraphy and ultrasound, the sensitivity of 76% and specificity of 50% were obtained. Considering the ability to locate the parathyroid glands in both techniques as a positive result, the sensitivity decreased to 37% and specificity rose to 95%. CONCLUSIONS Scintigraphy showed greater sensitivity than ultrasound in the localization of enlarged parathyroid glands. Ultrasound, in turn, was characterized by a higher specificity. The combined use of scintigraphy and ultrasonography allowed to obtain the specificity of 95%. In the light of obtained results, scintigraphy and ultrasonography are complementary and should be used together.
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Affiliation(s)
| | | | - Witold Chudziński
- Department of General and Endocrinological Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Joanna Mączewska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Adam Bajera
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Maria Karlińska
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
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Uludag M. Preoperative Localization Studies in Primary Hyperparathyroidism. SISLI ETFAL HASTANESI TIP BULTENI 2017; 53:7-15. [PMID: 33536819 PMCID: PMC7847726 DOI: 10.14744/semb.2019.78476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 12/27/2022]
Abstract
Primary hyperparathyroidism (pHPT) is the third most frequently seen endocrine disease and it is the most common cause of hypercalcemia seen in ambulatory patients. PHPT is most often (80%-85%) caused by a single parathyroid adenoma, followed by double adenoma (4%-5%), multiple gland hyperplasia (10%-15%), and parathyroid carcinoma (<1%). The diagnosis of pHPT is biochemically established and the only curative treatment is surgery. Since the cause of pHPT is typically single-gland disease, it is possible to determine the majority of pathological glands with preoperative localization methods and use the minimally invasive parathyroidectomy (MIP) approach. MIP has become the standard treatment for pHPT in selected patients. There are both noninvasive and invasive preoperative localization methods. Noninvasive methods currently used include ultrasonography (US), parathyroid scintigraphy, 4-dimensional computed tomography (CT), magnetic resonance imaging, and positron emission tomography-CT with 18F-fluoroquinolone and 11C-methionine. Preoperative invasive localization methods include parathyroid hormone (PTH) measurement with fine-needle aspiration biopsy, lateralization with PTH measurement via bilateral jugular vein sampling, selective venous sampling, and parathyroid arteriography. The aim of this study was to evaluate preoperative localization studies used in cases of pHPT.
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Affiliation(s)
- Mehmet Uludag
- Department of General Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Factors affecting the sensitivity of Tc-99m methoxyisobutylisonitrile dual-phase parathyroid single photon emission computed tomography in primary hyperparathyroidism. Nucl Med Commun 2017; 38:117-123. [DOI: 10.1097/mnm.0000000000000621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Liddy S, Worsley D, Torreggiani W, Feeney J. Preoperative Imaging in Primary Hyperparathyroidism: Literature Review and Recommendations. Can Assoc Radiol J 2017; 68:47-55. [DOI: 10.1016/j.carj.2016.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/20/2016] [Accepted: 07/06/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stephen Liddy
- Department of Radiology, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - Daniel Worsley
- Division of Nuclear Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - John Feeney
- Department of Radiology, Tallaght Hospital, Tallaght, Dublin, Ireland
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Wesolowski CA, Wanasundara SN, Wesolowski MJ, Erbas B, Babyn PS. A gamma-distribution convolution model of 99mTc-MIBI thyroid time-activity curves. EJNMMI Phys 2016; 3:31. [PMID: 27987183 PMCID: PMC5161052 DOI: 10.1186/s40658-016-0166-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 11/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The convolution approach to thyroid time-activity curve (TAC) data fitting with a gamma distribution convolution (GDC) TAC model following bolus intravenous injection is presented and applied to 99mTc-MIBI data. The GDC model is a convolution of two gamma distribution functions that simultaneously models the distribution and washout kinetics of the radiotracer. The GDC model was fitted to thyroid region of interest (ROI) TAC data from 1 min per frame 99mTc-MIBI image series for 90 min; GDC models were generated for three patients having left and right thyroid lobe and total thyroid ROIs, and were contrasted with washout-only models, i.e., less complete models. GDC model accuracy was tested using 10 Monte Carlo simulations for each clinical ROI. RESULTS The nine clinical GDC models, obtained from least counting error of counting, exhibited corrected (for 6 parameters) fit errors ranging from 0.998% to 1.82%. The range of all thyroid mean residence times (MRTs) was 212 to 699 min, which from noise injected simulations of each case had an average coefficient of variation of 0.7% and a not statistically significant accuracy error of 0.5% (p = 0.5, 2-sample paired t test). The slowest MRT value (699 min) was from a single thyroid lobe with a tissue diagnosed parathyroid adenoma also seen on scanning as retained marker. The two total thyroid ROIs without substantial pathology had MRT values of 278 and 350 min overlapping a published 99mTc-MIBI thyroid MRT value. One combined value and four unrelated washout-only models were tested and exhibited R-squared values for MRT with the GDC, i.e., a more complete concentration model, ranging from 0.0183 to 0.9395. CONCLUSIONS The GDC models had a small enough TAC noise-image misregistration (0.8%) that they have a plausible use as simulations of thyroid activity for querying performance of other models such as washout models, for altered ROI size, noise, administered dose, and image framing rates. Indeed, of the four washout-only models tested, no single model approached the apparent accuracy of the GDC model using only 90 min of data. Ninety minutes is a long gamma-camera acquisition time for a patient, but a short a time for most kinetic models. Consequently, the results should be regarded as preliminary.
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Affiliation(s)
- Carl A Wesolowski
- Department of Medical Imaging, Royal University Hospital, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
- Nuclear Medicine, Department of Radiology, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3X7, Canada.
| | - Surajith N Wanasundara
- Department of Medical Imaging, Royal University Hospital, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Michal J Wesolowski
- Department of Medical Imaging, Royal University Hospital, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Belkis Erbas
- Department of Nuclear Medicine, Hacettepe University Medical School, Sıhhiye, Ankara, 06100, Turkey
| | - Paul S Babyn
- Department of Medical Imaging, Royal University Hospital, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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Ozkan ZG, Unal SN, Kuyumcu S, Sanli Y, Gecer MF, Ozcinar B, Giles YS, Erbil Y. Clinical Utility of Tc-99m MIBI SPECT/CT for Preoperative Localization of Parathyroid Lesions. Indian J Surg 2016; 79:312-318. [PMID: 28827905 DOI: 10.1007/s12262-016-1489-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/25/2016] [Indexed: 12/30/2022] Open
Abstract
We aimed to demonstrate the role of SPECT/CT in preoperative localization of parathyroid lesions in patients with hyperparathyroidism who had technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI) dual-phase parathyroid scintigraphy. We evaluated retrospectively the scintigraphic data of 103 patients who had parathyroidectomy after Tc-99m MIBI dual-phase parathyroid scintigraphy with SPECT/CT. The planar and SPECT/CT images were evaluated separately to determine their efficacy in localizing parathyroid lesions. These results were then compared with surgical data. There were 84 female and 19 male patients whose mean age was 54 ± 12 years. A total of 115 parathyroid lesions in 103 patients were resected during operations. In 87 patients, with both planar and SPECT/CT images, a total of 100 lesions could be detected correctly. In 11 patients, only SPECT/CT images could show 13 subcentimetric lesions. In three patients, three lesions were evaluated as parathyroid lesions both with planar and SPECT/CT images, but according to histopathologic evaluation, they came out to be nonparathyroidal lesions. In two patients, two parathyroid lesions could not be detected preoperatively neither with planar nor with SPECT/CT images. The lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87 %, 99 %, 97.1 %, 95.3 %, and 95.8 % for planar images and 98.3 %, 99 %, 97.4 %, 99.4 %, and 98.8 % for SPECT/CT images, respectively. Tc-99m MIBI parathyroid scintigraphy should be a diagnostic modality of choice in preoperative evaluation of patients with hyperparathyroidism. SPECT/CT has an incremental value both in demonstrating subcentimetric lesions and in accurately localizing lesions anatomically.
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Affiliation(s)
- Zeynep Gozde Ozkan
- Istanbul Medical Faculty, Nuclear Medicine Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Seher Nilgun Unal
- Istanbul Medical Faculty, Nuclear Medicine Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Serkan Kuyumcu
- Istanbul Medical Faculty, Nuclear Medicine Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Yasemin Sanli
- Istanbul Medical Faculty, Nuclear Medicine Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Mehmet Fatih Gecer
- Istanbul Medical Faculty, Nuclear Medicine Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Beyza Ozcinar
- Istanbul Medical Faculty, General Surgery Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Yasemin Senyurek Giles
- Istanbul Medical Faculty, General Surgery Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
| | - Yesim Erbil
- Istanbul Medical Faculty, General Surgery Department, Istanbul University, Millet Cad, 34390 Capa-Fatih, Istanbul Turkey
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Desiato V, Melis M, Amato B, Bianco T, Rocca A, Amato M, Quarto G, Benassai G. Minimally invasive radioguided parathyroid surgery: A literature review. Int J Surg 2016; 28 Suppl 1:S84-93. [DOI: 10.1016/j.ijsu.2015.12.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/10/2015] [Accepted: 05/10/2015] [Indexed: 01/08/2023]
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49
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A Multimodal Imaging Protocol, 123I/99Tc-Sestamibi, SPECT, and SPECT/CT, in Primary Hyperparathyroidism Adds Limited Benefit for Preoperative Localization. World J Surg 2016; 40:589-94. [DOI: 10.1007/s00268-015-3389-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Haghighatafshar M, Farhoudi F. Is Brown Adipose Tissue Visualization Reliable on 99mTc-Methoxyisobutylisonitrile Diagnostic SPECT Scintigraphy? Medicine (Baltimore) 2016; 95:e2498. [PMID: 26765463 PMCID: PMC4718289 DOI: 10.1097/md.0000000000002498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/18/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022] Open
Abstract
The 99mTc-MIBI has been used with great value as a diagnostic technique in patients with primary hyperparathyroidism. False-positive scans may occur due to misinterpretation of the physiologic distribution of the 99mTc-MIBI. Reviewing consecutive SPECT scans, we evaluated this possibility and assessed how frequently brown adipose tissue (BAT) is seen on 99mTc-MIBI scintigraphy. Here, we retrospectively reviewed scans of consecutive patients who were evaluated for parathyroid adenomas from March 2015 to June 2015, using dual-phase (early and delayed) planar imaging and SPECT. We identified 60 patients (48 female and 12 male; mean age, 52.25 ± 15.20 years; range, 22-86 years).We detected the presence of 99mTc-MIBI uptake in BAT in 20 of 60 patients (33.33%) in the neck. Although the patients with T99mc-MIBI uptake in BAT were younger (mean age, 48.85 ± 15.27 years, range, 26-73 years) than the patients with no 99mTc-MIBI uptake (mean age, 53.95 ± 15.07 years, range, 22-86 years), this difference was not statistically significant (P = 0.224). The percentage of female patients with BAT detection was higher (17/48 patients; 37.5%) than that of the male population (3/12 patients; 25%), this difference was not also statistically significant (P = 0.85).In patient population referred to 99mTc MIBI scintigraphy of the parathyroid glands, uptake of 99mTc-MIBI in BAT should not be misinterpreted with 99mTc-MIBI-avid-tumors. Fused SPECT/CT images (not SPECT-only) are necessary to distinguish BAT from bone, muscle, thyroid, myocardium, parathyroids, and other structures in the neck and chest.
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Affiliation(s)
- Mahdi Haghighatafshar
- From the Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MH, FF)
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