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Deng E, Jiang T, Chai H, Weng N, He H, Zhang Z, Peng C, Yue W, Xu H. Ultrasound-Guided Radiofrequency Ablation in Tertiary Hyperparathyroidism: A Prospective Study. Korean J Radiol 2024; 25:289-300. [PMID: 38413113 PMCID: PMC10912492 DOI: 10.3348/kjr.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT). MATERIALS AND METHODS Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA. RESULTS A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05). CONCLUSION US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.
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Affiliation(s)
- Erya Deng
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Tingting Jiang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Huihui Chai
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Ning Weng
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Hongfeng He
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhengxian Zhang
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Chengzhong Peng
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
| | - Wenwen Yue
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.
| | - Huixiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Carsote M, Stanciu M, Popa FL, Sima OC, Petrova E, Cucu AP, Nistor C. Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue. Medicina (Kaunas) 2023; 60:15. [PMID: 38276049 PMCID: PMC10818294 DOI: 10.3390/medicina60010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95-99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.C.); (E.P.)
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania;
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | - Oana-Claudia Sima
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania;
- PhD Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Eugenia Petrova
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.C.); (E.P.)
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania;
| | - Anca-Pati Cucu
- PhD Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Claudiu Nistor
- Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Palot Manzil FF, Eichhorn J, Vattoth S. Synchronous Ectopic Thyroid Gland and Ectopic Parathyroid Adenoma on 99mTc-Sestamibi Scintigraphy and Correlative Imaging. J Nucl Med Technol 2023; 51:263-264. [PMID: 37316305 DOI: 10.2967/jnmt.122.265249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/31/2023] [Indexed: 06/16/2023] Open
Abstract
99mTc-sestamibi scintigraphy localizes parathyroid adenoma as a persistent focus of uptake on delayed images, whereas thyroid glands in normal or ectopic locations are seen on only early images and wash out on delayed images. We report a case of absence of eutopic neck thyroid activity and synchronous ectopic lingual thyroid and mediastinal parathyroid adenoma on scintigraphy confirmed with CT.
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Affiliation(s)
| | - Joshua Eichhorn
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Surjith Vattoth
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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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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Vilanilam GK, Nikpanah M, Vo CD, Kearns C. Osteitis Fibrosa Cystica: Brown Tumors of Hyperparathyroidism and End-Stage Renal Disease. Radiographics 2023; 43:e220211. [PMID: 37079460 PMCID: PMC10190131 DOI: 10.1148/rg.220211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 04/21/2023]
Affiliation(s)
- George K. Vilanilam
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
| | - Moozhan Nikpanah
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
| | - Chau D. Vo
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
| | - Ciléin Kearns
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
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Kołodziej M, Saracyn M, Lubas A, Dziuk M, Durma AD, Smoszna J, Zelichowski G, Niemczyk S, Kamiński G. Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism. Nutrients 2022; 15:nu15010188. [PMID: 36615844 PMCID: PMC9824283 DOI: 10.3390/nu15010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [11C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed.
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Affiliation(s)
- Maciej Kołodziej
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
- Correspondence:
| | - Marek Saracyn
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Arkadiusz Lubas
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Jerzy Smoszna
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | | | - Stanisław Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
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Maccora D, Fortini D, Moroni R, Sprecacenere G, Annunziata S, Bruno I. Comparison between MIBI-based radiopharmaceuticals for parathyroid scintigraphy: quantitative evaluation and correlation with clinical-laboratory parameters. J Endocrinol Invest 2022; 45:2139-2147. [PMID: 35792999 DOI: 10.1007/s40618-022-01847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Parathyroid scintigraphy is mandatory for the identification of hyperfunctioning parathyroid glands in hyperparathyroidism (HPT). The use of 99mTc-methoxy-isobutyl-isonitrile (MIBI) as radiopharmaceutical for parathyroid scintigraphy is considered the most valid and useful considering its uptake mechanism. Several MIBI-based radiopharmaceuticals are commercially available (i.e., MediMIBI, TechneMIBI, Stamicis). They seem to have similar physico-chemical characteristics and the choice between them is based on commercial criteria, even though some differences in qualitative scintigraphic results have been appreciated. Aims of the study were: first, to compare the scintigraphic quantitative data of MediMIBI, TechneMIBI, and Stamicis, particularly in the view of a personalized medicine approach; second, to investigate the potential effect of clinical-laboratory data on image quality using one of these radiopharmaceuticals. METHODS Patients with diagnosis of HPT, who underwent a parathyroid scintigraphy using one of the three MIBI-based radiopharmaceuticals between December 2018 and October 2020, have been retrospectively identified. Parameters derived from regions of interest (ROIs) drawn on three different sites were obtained: a reasonable parathyroid lesion detected, an area in the lateral neck considered as the background, and the hepatic dome as the site of MIBI physiological uptake. Laboratory and clinical data, such as serum calcium, PTH, vitamin D, and creatinine levels, as well as possible drug-mediated interferences were considered. RESULTS Among 250 patients included, 83 (33.2%) had the parathyroid scintigraphy using MediMIBI, 84 (33.6%) using TechneMIBI and 83 (33.2%) using Stamicis. The ROIs on the parathyroid uptake at early images, on the background, and on the hepatic dome were statistically different among the three groups (p < 0.05). No significant differences were found in the remaining semi-quantitative parameters among the three groups, not even considering clinical-laboratory data. CONCLUSIONS Some differences in semi-quantitative parameters emerged among MIBI-based radiopharmaceuticals for parathyroid scintigraphy. This might justify the different qualitative scintigraphic results obtained using one or another of the cited radiopharmaceuticals.
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Affiliation(s)
- D Maccora
- Institute of Nuclear Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
- Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144, Rome, Italy.
| | - D Fortini
- Nuclear Medicine Unit, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - R Moroni
- Scientific Management, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - G Sprecacenere
- Nuclear Medicine Unit, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - S Annunziata
- Nuclear Medicine Unit, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - I Bruno
- Nuclear Medicine Unit, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Nuclear Medicine Unit, Ospedale Generale Regionale F. Miulli, Strada Prov. 127 Acquaviva-Santeramo Km. 4, 70021, Acquaviva delle Fonti, BA, Italy
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Kawai Y, Iima M, Yamamoto H, Kawai M, Kishimoto AO, Koyasu S, Yamamoto A, Omori K, Kishimoto Y. The added value of non-contrast 3-Tesla MRI for the pre-operative localization of hyperparathyroidism. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S58-S64. [PMID: 34716111 DOI: 10.1016/j.bjorl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We investigated the efficacy of non-contrast 3-Tesla MR imaging added to the combination of sestamibi with99mTc (MIBI) scintigraphy and Ultrasonography (US) for the pre-operative localization of Primary Hyperparathyroidism (PHPT) lesions. METHODS A total of 34 parathyroid glands, including nine normal glands, were examined with MIBI, US, and non-contrast 3-Tesla MRI. MRI was performed with the acquisition of T1- and T2-weighted images and fat-suppressed T2-weighted images. We calculated the sensitivities of MIBI, US, and the 'additional' MRI, with knowledge of the former two modalities' results. RESULTS For the diagnosis of PHPT lesions, the sensitivity values of MIBI, US, and additional MRI were 88.0% (22/25), 84.0% (21/25), and 92.0% (23/25), respectively. Normal glands were not visualized with any modality (0/9). One lesion was detected neither with US nor MRI, but only with MIBI, with the limitation that MIBI represented no more than laterality. The two glands not identified in MRI were 4 mm and 6 mm in their size, which are within the range of normal gland's size. Two lesions were not detected with US or MIBI but were visualized with the additional MRI, which indicated that the MRI contributed an 8.0% (2/25) improvement of sensitivity, compared from that of US. Fat-suppressed T2-weighted images were useful in the identification of parathyroid lesions, as these images helped to differentiate between the lesion and the adjacent tissue. CONCLUSION Additional non-contrast 3-Tesla MRI was a useful adjunctive tool for localization of PHPT, which improved the sensitivity of the pre-operative localization of PHPT lesions. Fat-suppressed T2-weighted images contributed to their identification. LEVEL VI Evidence from a single descriptive or qualitative study.
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Affiliation(s)
- Yoshitaka Kawai
- Kyoto University, Graduate School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan
| | - Mami Iima
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan; Kyoto University Hospital, Institute for Advancement of Clinical and Translational Science (iACT), Department of Clinical Innovative Medicine, Kyoto, Japan
| | | | - Makiko Kawai
- Department of Radiology, Kyoto City Hospital, Kyoto, Japan
| | - Ayami Ohno Kishimoto
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan
| | - Sho Koyasu
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan
| | - Akira Yamamoto
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan
| | - Koichi Omori
- Kyoto University, Graduate School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan
| | - Yo Kishimoto
- Kyoto University, Graduate School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan.
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Onoda N, Hirokawa M, Miya A, Sasaki T, Fujishima M, Masuoka H, Higashiyama T, Kihara M, Miyauchi A. Lipoadenoma of the parathyroid: characteristics of a rare cause of hyperparathyroidism. Endocr J 2022; 69:1227-1232. [PMID: 35691821 DOI: 10.1507/endocrj.ej22-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parathyroid Lipoadenoma (PLA) contains abundant mature adipose tissue and is a rare cause of hyperparathyroidism. This study aimed to investigate the clinical features of PLA in nine patients with primary hyperparathyroidism, including two men and seven women, with ages ranging from 45-84 years (median 60 years). PLA accounted for 0.5% of all parathyroid tumors during the study period. One patient presented with anorexia due to hypercalcemia; however, the other eight patients were asymptomatic. The median preoperative serum intact-parathyroid hormone (iPTH) and calcium levels were 143 pg/mL (range, 102-378) and 10.8 mg/dL (range, 10.3-11.3), respectively. PLA was difficult to identify using ultrasonography (US) as it appears as a moderately hyperechoic nodule and is difficult to distinguish from the surrounding adipose tissues. Only 33% of the lesions (three out of nine lesions) were accurately identified. However, they could be distinctly differentiated from the surrounding tissue using computed tomography (CT). All PLAs were also detected using the sesta-methoxyisobutylisonitrile single-photon emission-computed tomography (SPECT). All the patients were treated by a single gland extirpation. The median size and weight of the PLA were 14 mm (range, 10-22) and 567 mg (range, 200-1,533), respectively. In conclusion, the clinical manifestations of PLA are similar to those of ordinal parathyroid adenomas, except for their unique US and CT images. PLA should be considered as a potential etiologic factor in cases of hyperparathyroidism when the lesions are demonstrated as hyperechoic nodules or unidentified by US but detected by CT or SPECT imaging.
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Affiliation(s)
- Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | | | - Hiroo Masuoka
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | - Minoru Kihara
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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10
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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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11
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Yin H, Shi H. Re: Hyperparathyroidism Due to Concurrent Parathyroid Carcinoma and Parathyroid Adenoma. Clin Nucl Med 2022; 47:e380. [PMID: 34593691 DOI: 10.1097/rlu.0000000000003926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hongyan Yin
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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12
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Hu G, Zhou W, Bai X. Increased 99mTc-Sestamibi Activity in Giant Cell Tumor of Bone. Clin Nucl Med 2022; 47:382-384. [PMID: 35175944 DOI: 10.1097/rlu.0000000000003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 99mTc-sestamibi parathyroid scintigraphy was performed in a 27-year-old woman to evaluate possible hyperparathyroidism. The images did not identify any parathyroid abnormality. However, an intense activity was noted in the proximal left upper extremity, which was confirmed as giant cell tumor of the proximal left humerus by pathological examination.
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Affiliation(s)
- Geng Hu
- From the Departments of Nuclear Medicine, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
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13
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Nazerani Hooshmand T, Pernthaler B, Szurian K, Pau M, Aigner RM. 18F-FDG PET/CT in the Hyperparathyroidism-Jaw-Tumor Syndrome. Clin Nucl Med 2021; 46:497-498. [PMID: 33826572 DOI: 10.1097/rlu.0000000000003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hyperparathyroidism-jaw-tumor syndrome (HPT-JTS) is a rare autosomal dominant disorder. A typical manifestation of HPT-JTS is the association of jaw-ossifying fibroma with primary hyperparathyroidism. Due to its rarity and diversity in its manifestations, it is a challenging diagnosis. A 33-year-old woman was referred due to painful swelling of the right maxilla suggestive of malignancy. The clinical presentations were not conclusive until she underwent F18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT). F18-FDG PET/CT proved to be a useful tool to assist the clinicians in visualizing the "bigger picture" and, therefore all manifestation as pieces of "one puzzle."
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Affiliation(s)
| | | | | | - Mauro Pau
- Division of Oral-, Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
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14
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Rivas-Prado L, Morales-Ortega A, Allodi-de la Hoz S, Bernal-Bello D. Hyperparathyroidism shows its hand: findings of osteitis fibrosa cystica. Lancet 2021; 397:1914. [PMID: 34022989 DOI: 10.1016/s0140-6736(21)00796-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Luis Rivas-Prado
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| | - Alejandro Morales-Ortega
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Sonia Allodi-de la Hoz
- Department of Radiology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - David Bernal-Bello
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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15
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Oliva AR, Lobos PA, Moldes JM, Liberto DH. Usefulness of combined ultrasonography and scintigraphy in the preoperative assessment of secondary or tertiary hyperparathyroidism. Cir Pediatr 2021; 34:63-66. [PMID: 33826257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine whether combined ultrasonography and parathyroid scintigraphy improves hyperplastic parathyroid gland detection in the pediatric population for parathyroidectomy planning in patients with secondary or tertiary hyperparathyroidism. MATERIAL AND METHODS An observational and analytical retrospective cohort study was carried out. Patients diagnosed with secondary or tertiary hyperparathyroidism from 2011 to 2018 undergoing total or subtotal parathyroidectomy were included - provided there was information available on pathological examination and surgical protocol. RESULTS N = 15 patients. A total of 53 parathyroid glands diagnosed with hyperplasia using either of the imaging methods were analyzed. For each method (ultrasonography and scintigraphy) and the combination of both, sensitivity and area under the curve were calculated, using pathological examination result as a reference. Ultrasonography and scintigraphy diagnostic match was 66%. DISCUSSION AND CONCLUSIONS The intraoperative difficulty of parathyroid gland identification as well as the anatomical variation that these present is well-known. Ultrasonography detected more glands than scintigraphy when diagnosing parathyroid hyperplasia. The combination of both methods allows patients with a first negative study to be detected.
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Affiliation(s)
- A R Oliva
- Pediatrics Department, Pediatric General Surgery Unit. Buenos Aires Italian Hospital. Buenos Aires, Argentina
| | - P A Lobos
- Pediatrics Department, Pediatric General Surgery Unit. Buenos Aires Italian Hospital. Buenos Aires, Argentina
| | - J M Moldes
- Pediatrics Department, Pediatric General Surgery Unit. Buenos Aires Italian Hospital. Buenos Aires, Argentina
| | - D H Liberto
- Pediatrics Department, Pediatric General Surgery Unit. Buenos Aires Italian Hospital. Buenos Aires, Argentina
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16
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Jacquet-Francillon N, Granjon D, Casteillo F, Prévot N, Habouzit V. Incidental Detection of a Small Cell Lung Cancer by 18F-Choline PET/CT Performed for Recurrent Hyperparathyroidism After Parathyroidectomy. Clin Nucl Med 2021; 46:e109-e111. [PMID: 32910058 DOI: 10.1097/rlu.0000000000003246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We report the case of a 64-year-old woman with musculoskeletal pain and elevated serum parathyroid hormone who had undergone parathyroidectomy for primary hyperparathyroidism 4 years earlier. An 18F-choline PET/CT scan was performed and incidentally showed an intense uptake in a right upper lobe pulmonary nodule and in the right hilar, mediastinal, and cervical lymph nodes. Histopathological analysis confirmed the diagnosis of a small cell lung cancer. Clinical symptoms and recurrent hyperparathyroidism were therefore consistent with a paraneoplastic syndrome. A complete metabolic response was achieved on 18F-FDG PET/CT scan after chemotherapy.
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17
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Abstract
INTRODUCTION Parathyroidectomy is the choice of treatment for patients with primary and tertiary hyperparathyroidism. Scintigraphic, preoperative localization of hyperfunctioning parathyroid tissue depends on either a delayed washout technique, a subtraction technique, or a combination of the two. The rationale for adopting a combination approach is its presumed superior sensitivity, but there is limited evidence to support this strategy at the cost of patient inconvenience and impact on departmental workflows. OBJECTIVE To determine whether a combined technique detects any additional lesions during scan interpretation compared to using subtraction-only technique in patients undergoing parathyroid scintigraphy before surgery. METHODS A retrospective analysis was performed of parathyroid scans at Tygerberg Hospital between January 2012 and April 2018. Scans were reinterpreted by consensus by three readers, blinded to the original interpretation. A McNemar discordant pairs analysis was then performed. RESULTS A total of 97 participant scans were reviewed (female: 71; mean age: 50.8 years). The number of patients with primary, secondary, and tertiary hyperparathyroidism were 63, 21, and 13, respectively. A total of 192 lesions were identified in this study. While both combined and subtraction-only approaches identified hyperfunctioning parathyroid lesions, only four lesions were identified using the combined technique that were missed by the subtraction technique. This result was not statistically significant (P = 0.125). CONCLUSION Based on our findings, the combined parathyroid scintigraphic technique does not improve lesion detection and may be dispensed with. Doing so will enhance patient convenience and comfort and improve departmental workflows without compromising lesion detection.
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Affiliation(s)
- Mugisha J Sebikali
- Division of Nuclear Medicine, Stellenbosch University and Tygerberg Hospital
| | - James M Warwick
- Division of Nuclear Medicine, Stellenbosch University and Tygerberg Hospital
| | - Alex G Doruyter
- Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Cape Town, South Africa
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Morland D, Lalire P, Deguelte S, Zalzali M, Richard C, Dejust S, Boulagnon C, Ly S, Papathanassiou D, Delemer B. Added value of 18F-fluorocholine positron emission tomography-computed tomography in presurgical localization of hyperfunctioning parathyroid glands after dual tracer subtraction scintigraphy failure: A retrospective study of 47 patients. Medicine (Baltimore) 2020; 99:e18681. [PMID: 31914064 PMCID: PMC6959899 DOI: 10.1097/md.0000000000018681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hyperparathyroidism is a common endocrine disorder. The precise localization of causal parathyroid gland is crucial to guide surgical treatment. Several studies report the added value of 18F-fluorocholine (FCH) positron emission tomography-computed tomography (PET/CT) as second line imaging but rely on suboptimal first-line imaging using 99mTc-sestaMIBI dual phase scintigraphy. The aim of this study is to evaluate the percentage of successful parathyroid localization with FCH PET/CT after failure of a more sensitive first-line detection protocol associating neck ultrasonography and 99mTc-Pertechnetate/99mTc-sestaMIBI dual tracer subtraction scintigraphy.We included retrospectively 47 patients who underwent a FCH PET/CT as second line imaging for biologically proven primary hyperparathyroidism from November 2016 to October 2018 in Godinot Institute (Reims, France). 99mTc-Pertechnetate/99mTc-sestaMIBI dual tracer subtraction scintigraphy and neck ultrasonography were used as first-line imaging and failed to localize the causal parathyroid lesion in all cases.FCH PET/CT demonstrated at least 1 parathyroid target lesion in 29 patients (62%). 21/29 patients underwent surgery. Target lesions corresponded histologically to hyperfunctioning parathyroid glands for all 21 patients and surgery was followed by hyperparathyroidism biological resolution. Calcium serum levels were associated to FCH PET/CT positivity (P = .002) and a trend toward significance was seen for Parathyroid hormone (PTH) levels (P = .09).FCH PET/CT is a promising tool in second-line parathyroid imaging. Large prospective studies and cost-effectiveness analyses are needed to precise its role.
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Affiliation(s)
- David Morland
- Médecine Nucléaire, Institut Jean Godinot
- Laboratoire de Biophysique, UFR de médecine, Université de Reims Champagne Ardenne
- CRESTIC EA 3804, Université de Reims Champagne Ardenne
| | | | - Sophie Deguelte
- Chirurgie digestive et endocrinienne, Hôpital Robert Debré, CHU de Reims
| | | | | | | | - Camille Boulagnon
- Laboratoire d’anatomie et de cytologie pathologique, Hôpital Robert Debré, CHU de Reims
| | - Sang Ly
- Endocrinologie, diabétologie, nutrition, Hôpital Robert Debré, CHU de Reims, Reims, France
| | - Dimitri Papathanassiou
- Médecine Nucléaire, Institut Jean Godinot
- Laboratoire de Biophysique, UFR de médecine, Université de Reims Champagne Ardenne
- CRESTIC EA 3804, Université de Reims Champagne Ardenne
| | - Brigitte Delemer
- Endocrinologie, diabétologie, nutrition, Hôpital Robert Debré, CHU de Reims, Reims, France
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20
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Sharma A, Kaushik P, Singh TP, Patel C. Focal pulmonary uptake on myocardial perfusion scintigraphy due to iatrogenic microembolism. J Nucl Cardiol 2019; 26:2133-2135. [PMID: 30515746 DOI: 10.1007/s12350-018-01553-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Anshul Sharma
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kaushik
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chetan Patel
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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21
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Bossert I, Chytiris S, Hodolic M, Croce L, Mansi L, Chiovato L, Mariani G, Trifirò G. PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism. J Endocrinol Invest 2019; 42:419-426. [PMID: 30094743 DOI: 10.1007/s40618-018-0931-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and/or 99mTc-Sestamibi scintigraphy, can be challenging. PET/CT with 18F-Fluorocholine (18F-FCH) might improve the detection of pathologic parathyroid glands. We aimed at comparing the diagnostic performance of 18F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US. METHODS Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism. All patients underwent high-resolution neck US, dual-phase dual-isotope 99mTc-Pertechnetate/99mTc-Sestamibi scintigraphy, and 18F-FCH-PET/CT. RESULTS In the whole patients' group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for 18F-FCH-PET/CT, and only 15% for 99mTc-Sestamibi scintigraphy. The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were 57 and 70% for neck US, 70 and 71% for 18F-FCH-PET/CT, and 0 and 18% for 99mTc-Sestamibi scintigraphy, respectively. In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology/biochemistry, the correct detection rate was 82% for neck US, 89% for 18F-FCH-PET/CT, and only 17% for 99mTc-Sestamibi scintigraphy. CONCLUSIONS 18F-FCH-PET/CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small.
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Affiliation(s)
- I Bossert
- Unit of Nuclear Medicine, ICS Maugeri, 27100, Pavia, Italy
| | - S Chytiris
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy
| | - M Hodolic
- Nuclear Medicine Research Department, Iason, Graz, Austria
- Nuclear Medicine Department, Iason, Graz, Austria
- Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
- Nuclear Medicine Department, Policlinico S. Orsola Malpighi, University of Bologna, Bologna, Italy
| | - L Croce
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy
| | - L Mansi
- Inter-Universitary Research Center for Sustainable Development (CIRPS), Naples, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy.
| | - G Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - G Trifirò
- Unit of Nuclear Medicine, ICS Maugeri, 27100, Pavia, Italy
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Miguel GA, Carranza FH, Rodríguez JCR, Ramos MA, Pablos DL, Herrero EF, Díaz-Guerra GM. Trabecular Bone Score, Bone Mineral Density and Bone Markers in Patients with Primary Hyperparathyroidism 2 Years After Parathyroidectomy. Horm Metab Res 2019; 51:186-190. [PMID: 30861565 DOI: 10.1055/a-0850-8679] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Following a parathyroidectomy there is a bone mineral density (BMD) improvement in patients with primary hyperparathyroidism. However, data of bone microarchitecture are scarce. Trabecular bone score (TBS) estimates bone microarchitecture and could provide valuable information in those patients. The aim of this study is to assess TBS changes 2 years after successful surgery in a group of patients with primary hyperparathyroidism and correlate these results with changes in BMD and bone turnover markers. This is a prospective study including 32 patients. In all participants BMD and TBS were measured, before and 24 months after surgery. Biochemical data: serum calcium, PTH, 25-OH-vitamin D, beta-crosslaps, bone alkaline phosphatase, and osteocalcin. 25 female and 7 male patients, mean age 64.6±12.4 years, were included in the study. At baseline, BMD was low at: lumbar spine (T-score -2.19±1.31), total hip (-1.33±1.12), femoral neck (-1.75±0.84), and distal one-third radius (-2.74±1.68). Baseline TBS showed partially degraded microarchitecture (1.180±0.130). After parathyroidectomy lumbar spine BMD increased significantly (5.3±13.0%, p<0.05), as well as total hip (3.8±8.8%, p<0.05). There was an increase in TBS, but this was not significant. There was a correlation between TBS and BAP at baseline (rs=0.73; p<0.01) and TBS and BAP 2 years after surgery (rs=0.57, p<0.05). Although bone density improves 2 years after surgery in patients with primary hyperparathyroidism and there is a restoration of bone turnover markers, TBS is not completely restored. These results remark the necessity of longer periods of study, to confirm if bone microarchitecture could be completely restored after surgery.
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Affiliation(s)
- Gonzalo Allo Miguel
- Endocrinology and Nutrition Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | - David Lora Pablos
- Clinical Research Unit, IMAS12-CIBERESP, Hospital Universitario 12 Octubre, Madrid, Spain
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23
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Sunny SA, Singh A, Adhikary AB. Ectopic Parathyroid Adenoma: Surgical Correction and its Complication Management. Mymensingh Med J 2019; 28:245-249. [PMID: 30755577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ectopic parathyroid are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland. Ectopic parathyroid glands are a major cause of persistent and recurrent Hyperparathyroidism. We report a case of 65-year-old female was referred from Surgical Endocrine department to the department of Cardiac Surgery on 20 September, 2017 in Bangabandhu Sheikh Mujib Medical University with parathyroid crisis due to an ectopic mediastinal parathyroid adenoma with her serum calcium and PTH markedly increased in short time. Computed tomography of the chest and lower neck showed an ovoid soft tissue density area measuring about 25×20×15mm in the anterior mediastinum. Technetium-99m-sestamibi (MIBI) scintigraphy scan showed positive and detected localized parathyroid adenoma/hyperplasia in superior mediastinum. Ectopic parathyroid adenoma resection was performed via median sternotomy approach. But after 4 hours patient developed the color change of the left arm due to acute left upper limb ischemia of unknown cause for which the patient was rushed to operation theatre suspecting it to be embolic occlusion and managed by both surgical and medical therapy.
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Affiliation(s)
- S A Sunny
- Dr Mohammad Samir Azam Sunny, Medical Officer, Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
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Bae WK, Chung IJ. Full-blown hyperparathyroidism. Korean J Intern Med 2018; 33:1258-1259. [PMID: 29166761 PMCID: PMC6234395 DOI: 10.3904/kjim.2012.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/18/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Woo Kyun Bae
- Correspondence to Woo Kyun Bae, M.D. Tel: +82-61-379-7623 Fax: +82-61-379-8019 E-mail:
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Abstract
Hypercalcemia due to primary hyperparathyroidism during pregnancy is a rare condition and associated with increased morbidity and mortality for the mother and the unborn child. Whereas parathyroidectomy is favored during the second trimester, no clear recommendations exist for its management during the third trimenon. We here report the case of a 26-year-old woman in the 29th week of her first pregnancy, who was admitted to our clinic with hypertension, intra-uterine growth retardation and polyhydramnios. Severe hypercalcemia due to primary hyperparathyroidism was diagnosed (total calcium 3.34 mmol/l; PTH 216 pg/ml), but no enlarged parathyroid gland could be localized by ultrasound. Treatment with calcitonin and cinacalcet could not control hypercalcemia. Therefore explorative surgery was performed and a single parathyroid adenoma was resected, resulting in normalization of serum calcium levels. The surgical procedure was tolerated well by the mother and fetus. Hypercalcemia-induced hypertension and polyhydramnios ameliorated before C-section was performed two weeks later and unrelated to the intervention. This case report underlines the importance of early diagnosis and treatment of primary hyperparathyroidism during pregnancy. If diagnosed in the third trimenon, an interdisciplinary approach is crucial. If medical treatment fails to sufficiently control hypercalcemia, surgical parathyroid exploration should be considered even in cases of unsuccessful localization of adenomatous parathyroid glands.
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Affiliation(s)
- Julie Refardt
- a Division of Endocrinology, Diabetes and Metabolism , University Hospital Basel , Switzerland
| | - Patricia Farina
- b Department of Obstetrics and Gynecology , University Hospital Basel , Switzerland
| | - Irene Hoesli
- b Department of Obstetrics and Gynecology , University Hospital Basel , Switzerland
| | - Christian Meier
- a Division of Endocrinology, Diabetes and Metabolism , University Hospital Basel , Switzerland
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Bombil I, Louw L, Mitchell C, Mahlobo F, Muganza RA, Madima NR. Sonar guided focused parathyroidectomy under cervical block. S AFR J SURG 2018; 56:30-33. [PMID: 30010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Presentation of hyperparathyroidism varies and is highly non-specific. The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging. METHOD A two-year review of parathyroidectomies performed between January 2013 and December 2014. OBJECTIVE To reflect on the result of sonar-guided focused parathyroidectomy under SCB. RESULTS There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. CONCLUSION The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings.
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Affiliation(s)
- I Bombil
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - L Louw
- Department of Nuclear Medicine, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - C Mitchell
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - F Mahlobo
- Department of Radiology, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - R A Muganza
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - N R Madima
- Department of Anesthesiology, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
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27
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Rubello D, Casara D, Saladini G, Piotto A, Pagetta C, Pelizzo MR. 99MTc-mibi Radio-guided Surgery in Primary Hyperparathyroidism: A Prospective Study of 128 Patients. Tumori 2018; 88:S63-5. [PMID: 12369561 DOI: 10.1177/030089160208800352] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and study design We investigated the role of an intraoperative gamma probe (IGP) technique in 128 patients with primary hyperparathyroidism (HPT). The patients were evaluated before surgery by 99mTcO4/MIBI scintigraphy and neck ultrasound and then operated on by the same surgical team. The IGP technique consisted of the injection of a low dose (37 MBq) of 99mTc-MIBI in the operating room shortly before the start of surgery. Quick parathyroid hormone (QPTH) was routinely measured during the operation. Results In 94/97 patients (96.9%) with a preoperative diagnosis of solitary parathyroid adenoma (PA) minimally invasive radioguided surgery (MIRS) was successfully performed; in the other 3/97 patients (3.1%) conversion to bilateral neck exploration (BNE) was required because of the intraoperative diagnosis of parathyroid carcinoma in two cases and multiglandular disease (MGD) in one. MIRS was successfully performed also in 23 patients who had undergone previous thyroid or parathyroid surgery. In 31 patients with a preoperative diagnosis of MGD (n = 5) or concomitant nodular goiter (n = 26) the IGP technique was used during a bilateral neck exploration. Among these patients IGP was useful in localizing an ectopic parathyroid gland in the thymus in one case of MGD and a PA located deep in the neck (n = 2) or ectopic at the carotid bifurcation (n = 1) in three cases with nodular goiter. However, in several other patients with nodular goiter it was difficult for the probe to distinguish intraoperatively between thyroid nodules and PA located close to the thyroid gland. Conclusions It can be concluded that a) in primary HPT patients with a high likelihood (according to scintigraphic and ultrasound findings) of being affected by a single PA and with a normal thyroid gland, the IGP technique appears useful in MIRS; b) a 99mTc-MIBI dose as low as 37 MBq appears to be adequate to perform MIRS; c) the measurement of QPTH is strongly recommended in HPT patients selected for MIRS to confirm the radicality of parathyroidectomy; d) MIRS can be useful also in HPT patients who underwent previous parathyroid or thyroid surgery to limit the surgical trauma of reoperation and minimize complications; e) with the exception of PAs located at ectopic sites or deep in the neck, the IGP technique does not seem to be recommendable in HPT patients with concomitant nodular goiter.
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Affiliation(s)
- D Rubello
- Nuclear Medicine Service II, Radiotherapy Department, Azienda Ospedaliera of Padua, Italy
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Jenkins BJ, Newell MS, Goode AW, Boucher BJ, Monson JP, Brown CL. Impact of Conventional and Three-Dimensional Thallium-Technetium Scans on Surgery for Primary Hyperparathyroidism. J R Soc Med 2018; 83:427-9. [PMID: 2168488 PMCID: PMC1292729 DOI: 10.1177/014107689008300705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Twenty-nine patients with primary hyperparathyroidism underwent double-tracer subtraction scanning after injection of 201Tl as thallous chloride for thyroid and parathyroid images followed by 99mtechnetium as sodium pertechnetate for thyroid images prior to surgical exploration of the neck. The operative findings were correlated with the scans. All 23 adenomas (100%) and 13 of 18 (72%) hyperplastic glands were correctly localized. The ability of the scan to identify abnormal parathyroids was determined by the gland mass rather than whether the tissue was adenomatous or hyperplastic as all 32 (100%) abnormal glands weighing more than 180 mg were successfully localized in contrast to four of nine (44%) glands weighing less than 180 mg. An additional technique, in which emission tomography was carried out after subtraction scintigraphy, was used on 11 patients in the series. In all 11, the site of a single abnormal gland was predicted by the conventional subtraction scan: in nine of these patients, emission tomography provided additional localization of the gland in the anteroposterior plane.
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Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania.
| | - Ashwag Aloyouny
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Martin S Greenberg
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Boutzios G, Sarlanis H, Kolindou A, Velidaki A, Karatzas T. Primary hyperparathyroidism caused by enormous unilateral water-clear cell parathyroid hyperplasia. BMC Endocr Disord 2017; 17:57. [PMID: 28888222 PMCID: PMC5591518 DOI: 10.1186/s12902-017-0207-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/31/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Parathyroid water-clear cell hyperplasia (WCCH) and water-clear cell adenoma (WCCA) are rare causes of primary hyperparathyroidism. The frequency of WCCH seems to be less than 1% of all primary hyperplasia. CASE PRESENTATION We report a 53-year-old woman with a large unilateral water clear cell parathyroid hyperplasia associated with primary hyperparathyroidism and severe osteoporosis. Ultrasonography showed a 5.4 cm multilobulated hypoechoic well defined mass localized in the lower half of the left thyroid lobe. Technetium sestamibi scanning showed a persistent very large area of increased activity possibly corresponding to a left inferior double parathyroid adenoma. At surgery, two large merged lobulated parathyroid glands were removed from the left superior and inferior aspects of the adjacent thyroid extending to the sub-clavicular area. Histopathology showed polygonal hyperplastic vacuolated cells with abundant water clear cytoplasm. The lesion had lack of capsule or rim of parathyroid tissue and immunohistochemistry was positive for PTH staining. These findings were consistent with diffused water clear cell hyperplasia. After parathyroidectomy, iPTH and calcium levels dropped immediately. CONCLUSION The clinical presentation of the patients with water clear cells parathyroid content and hyperparathyroidism is indistinguishable from that of the more common causes of primary hyperparathyroidism of adenoma or hyperplasia and the diagnosis is made only on pathological examination. In conclusion, the distinction of water clear cell hyperplasia from water clear cell adenoma can be challenging in many cases, although clinically significant as far as treatment and follow-up.
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Affiliation(s)
- Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Mikras Asias 75, 115 27 Athens, Greece
| | - Helen Sarlanis
- Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anna Kolindou
- Department of Nuclear Medicine, Laiko General Hospital, Athens, Greece
| | - Antigoni Velidaki
- Department of Nuclear Medicine, Laiko General Hospital, Athens, Greece
| | - Theodore Karatzas
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece
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Mazokopakis E, Papadomanolaki M, Skarakis SNN, Tsekouras K. Primary and secondary hyperparathyroidism among vitamin D deficient Hashimoto's thyroiditis patients and the need for a parathyroid scan. Hell J Nucl Med 2017; 20:258-259. [PMID: 29177267 DOI: 10.1967/s002449910613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The patients with Hashimoto thyroiditis must be investigated mainly for secondary hyperparathyroidism due to vitamin D deficiency/insufficiency. Parathyroid scintigraphy has no place in the diagnosis of primary, secondary or tertiary hyperparathyroidism or in the decision for surgical treatment. Parathyroid scintigraphy is a useful preoperative technique for the localization of the pathological parathyroid glands.
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Affiliation(s)
- Elias Mazokopakis
- Department of Internal Medicine, Naval Hospital of Crete, Souda 73 200, Chania, Crete, Greece.
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32
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Isidori AM, Cantisani V, Giannetta E, Diacinti D, David E, Forte V, Elia D, De Vito C, Sbardella E, Gianfrilli D, Monteleone F, Pepe J, Minisola S, Ascenti G, D'Andrea V, Catalano C, D'Ambrosio F. Multiparametric ultrasonography and ultrasound elastography in the differentiation of parathyroid lesions from ectopic thyroid lesions or lymphadenopathies. Endocrine 2017; 57:335-343. [PMID: 27709473 DOI: 10.1007/s12020-016-1116-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/07/2016] [Indexed: 12/16/2022]
Abstract
To evaluate the accuracy of ultrasound elastography with ElastoscanTM Core Index in the differential diagnosis of parathyroid lesions from ectopic thyroid nodules and lymph nodes. Seventy nine patients with repeatedly high levels of circulating intact parathyroid hormone, normal vitamin D and renal function tests, with an ultrasound scan showing a neck lesion, sharply demarcated from the thyroid lobules, were consecutively enrolled. Ultrasound with and without Color Doppler and ultrasound elastography were performed before histological examination. All ultrasound features, vascularization and ultrasound elastography diagnostic performance were assessed using ROC curves. Histological examination confirmed 47 parathyroid lesions, 18 thyroid ectopic nodules and 14 reactive lymph nodes. In distinguishing parathyroid from thyroid nodules, shape had a 100 % sensitivity (95 % CI 92.4-100) and 50 % specificity (95 % CI 37.2-64.7), cleavage had a 85.1 % sensitivity (95 % CI 72.3-92.6) and 77.8 % specificity (95 % CI 65.1-88) while peripheral vascularization had a sensitivity of 91.5 (95 % CI 79.6-97.6) and specificity of 72.2 (95 % CI 46.5-90.3). An ElastoscanTM Core Indexof 1.28 was 46 % sensitive (95 % CI 33.4-58.7) and 77 % specific (95 % CI 66.2-89.1) in discriminating parathyroid lesions from thyroid nodules. An ElastoscanTM Core Index of 1.0 was 78 % sensitive (95 % CI 65.1-88) and 71 % specific (95 % CI 56-81.3) in discriminating parathyroid lesions from lymph nodes (p = 0.045). An ElastoscanTM Core Index greater than 2.58 had a 100 % sensitivity (95 % CI 43.8-100) and 95.4 % specificity (95 % CI 38.3-99.7) in discriminating malignant from benign parathyroid nodules. ElastoscanTM Core Index was significantly higher in thyroid nodules than in reactive lymph nodes (1.18 ± 0.62, p = 0.008). The ultrasound features of cleavage and peripheral vascularization help to differentiate parathyroid from thyroid nodules. ElastoscanTM Core Index can improve ultrasound discrimination of parathyroid lesions from lymph nodes. The ElastoscanTM Core Index is significantly higher in malignant than in benign parathyroid lesions.
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Affiliation(s)
- Andrea M Isidori
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy.
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele David
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Valerio Forte
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Elia
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Emilia Sbardella
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Francesco Monteleone
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines Sapienza University of Rome, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines Sapienza University of Rome, Rome, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
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Abstract
BACKGROUND Spontaneous haemorrhage into a parathyroid adenoma is a rare and potentially life-threatening presentation. CASE PRESENTATION We report the case of a 45 year old female recently diagnosed with primary hyperparathyroidism who presented with chest discomfort and acute airway compromise due to spontaneous extracapsular haemorrhage into a parathyroid adenoma. Computed tomography (CT) imaging showed a hypopharyngeal haematoma extending 10 cm into the superior mediastinum. Surgical decompression of the cyst followed by enbloc resection of the parathyroid tumour was performed after elective intubation. Calcium and parathyroid hormone (PTH) levels had fallen prior to surgery and remain normal post-operatively. CONCLUSION Spontaneous parathyroid haemorrhage should be considered in any patient with unexplained spontaneous cervical haemorrhage, particularly if there is a history of hyperparathyroidism. Initial evaluation of such patients should include serum calcium and PTH as well as imaging.
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Affiliation(s)
- Aoife Garrahy
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - David Hogan
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - James Paul O’Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Amar Agha
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
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Panarese A, D'Andrea V, Pontone S, Favoriti P, Pironi D, Arcieri S, Filippini A, Sorrenti S. Management of concomitant hyperparathyroidism and thyroid diseases in the elderly patients: a retrospective cohort study. Aging Clin Exp Res 2017; 29:29-33. [PMID: 27832469 DOI: 10.1007/s40520-016-0665-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thyroid disease and hyperparathyroidism are the most common endocrine disorders. The incidence of thyroid disease in patients with hyperparathyroidism ranges in the different series from 17 to 84%, and thyroid cancer occurs with an incidence ranging from 2 to 15%. AIM The aim of our study was to analyze the management of elderly patients with concomitant thyroid and parathyroid disease in order to define the best surgical therapeutic strategy and avoid reoperations associated with a higher risk of complications. METHODS All consecutive patients (64 patients, age range 60-75 years), undergoing surgery for hyperparathyroidism, from January 2011 to June 2014, were retrospectively evaluated. Enrolled patients were divided into two study groups of patients affected by hyperparathyroidism with or without a concomitant thyroid disease. RESULTS Out of 64 patients enrolled in our study (24 men, age range 60-75 years), affected by hyperparathyroidism, 34 had an associated thyroid disease and were treated with total thyroidectomy and parathyroidectomy. The group, who underwent parathyroidectomy associated with thyroidectomy, had no greater complications than the group receiving only parathyroidectomy. CONCLUSIONS Thyroid disease must be excluded in patients affected by hyperparathyroidism. It is difficult to determine whether hyperparathyroidism can be considered a risk factor for thyroid disease, but an accurate preoperative study is essential for a surgery able to treat both thyroid and parathyroid disease. In this way, we avoid the elderly patient, with associated morbidity and increased surgical risk, to undergo a reoperation for thyroid disease, burdened with major complications.
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Affiliation(s)
- Alessandra Panarese
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy.
| | - Vito D'Andrea
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Stefano Pontone
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Pasqualino Favoriti
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Stefano Arcieri
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
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35
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Jasim S, Kennel K. Persistent hyperparathyroidism due to ectopic parathyroid gland. Endocrine 2017; 55:322-323. [PMID: 27738885 DOI: 10.1007/s12020-016-1143-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA.
| | - Kurt Kennel
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
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Di Monaco M, Castiglioni C, Tappero R. Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip-fracture. Hormones (Athens) 2016; 15:527-533. [PMID: 28222407 DOI: 10.14310/horm.2002.1709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hip-fracture patients with vitamin D deficiency can have either secondary hyperparathyroidism or normal levels of parathyroid hormone (PTH). We hypothesized that bone mineral density (BMD) could be lower in patients with high PTH levels than in those with normal levels of PTH, irrespectively of the severity of vitamin D depletion. DESIGN In this cross-sectional study, we examined 405 women who had serum 25-hydroxyvitamin D below 12ng/ml 20.0 ± 5.9 (mean ± SD) days after a hip-fracture. PTH was assessed by a chemiluminescent immunometric assay and BMD by dual-energy x-ray absorptiometry at the unfractured femoral neck. RESULTS BMD was significantly lower in the 148 women with secondary hyperparathyroidism than in the 257 with normal PTH levels: the mean T-score (SD) was -2.88 (0.93) and -2.65 (0.83), respectively, in the two groups (mean difference 0.23; 95% CI 0.05 - 0.41; P = 0.010). The association between PTH status and BMD persisted after adjustment for age, body mass index, phosphate, albumin-adjusted total calcium, 25-hydroxyvitamin D, estimated glomerular filtration rate, and magnesium (P=0.01). The presence of secondary hyperparathyroidism was significantly associated with a femoral neck T-score lower than -2.5. The adjusted odds ratio was 1.81 (95% CI 1.11 - 2.95; P=0.017). CONCLUSIONS Our results show that PTH levels in the presence of severe vitamin D deficiency were significantly associated with femoral BMD in women with hip-fracture. Prevention and treatment of vitamin D deficiency may be particularly relevant in women who develop secondary hyperparathyroidism.
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Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center and Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Strada Santa Margherita 136, 10131, Torino, Italy.
| | - Carlotta Castiglioni
- Osteoporosis Research Center and Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Strada Santa Margherita 136, 10131, Torino, Italy
| | - Rosa Tappero
- Osteoporosis Research Center and Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Strada Santa Margherita 136, 10131, Torino, Italy
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Abstract
Major complications of thyroid and parathyroid surgery are recurrent laryngeal nerve injuries and definitive hypoparathyroidism. The use of intra-operative Indocyanine Green Angiography for confirmation of vascular status of the parathyroid gland is reported here.
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Affiliation(s)
- Jordi Vidal Fortuny
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, 1211, Geneva, Switzerland
| | - Wolfram Karenovics
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, 1211, Geneva, Switzerland
| | - Frederic Triponez
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, 1211, Geneva, Switzerland
| | - Samira M Sadowski
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, 1211, Geneva, Switzerland.
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38
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Zakharova NM, Vetchinnikova ON, Ivantsova LP. [The cytomorphologic characteristics of parathyroid gland under various forms of hyperparathyroidism]. Klin Lab Diagn 2016; 61:697-700. [PMID: 30615328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The study was organized to establish criteria of cytological diagnostic of pathology of parathyroid glands under various forms of hyperparathyroidism. The ultrasound examination of pathology of parathyroid glands was applied to 74 patients with hyperparathyroidism aged 24-66 years (20 males and 54 females). The examination was applied to 11 patients with primary hyperparathyroidism (bone visceral form), 51 patients with secondary hyperparathyroidism of severe course and 12 patients with tertiary hyperparathyroidism (post-transplantation). The 109 samples of expanded parathyroid glands were visualized and subjected to fine-needle aspiration biopsy. The cytologic material was colored with azure-eosin according Pappenheim method and analyzed using light microscopy technique. The cytological material was informative in 105 (96%) findings. The elements of tissue of parathyroid glands were detected in 99 (90.8%) samples. The main cytomorphologic indications of adenoma of parathyroid gland were follicle-like and papillary structures of main parathyrocites detected in all patients with primary hyperparathyroidism; main parathyrocites at various stages of secretory cycle - in 64% of patients and macrophages - in 50% of patients. The characteristic cytomorphologic indications of hyperplasia of parathyroid gland turned out to be situated in groups, papillary and branching structures with expressed intercellular contacts, main dark parathyrocytes detected in 88% of patients with secondary hyperparathyroidism, parathyrocytes at various stages of secretory cycle (53% of patients) and small basophilic granules of secretion of parathyrocites in cytoplasm and/or extracellular space (31% of patients). The distinctive cytological indications of tissue of parathyroid gland under tertiary hyperparathyroidism included prevalence of main light parathyrocites situated in small clusters and groups with ill-defined intercellular contacts and presence of large basophilic secretory granules in cytoplasm of parathyrocites, extracellular space and colloid-like substance (92% of patients). The comparative analysis detected similar cytological indications in tissue of parathyroid gland and strictly definite criteria characteristic for primary, secondary and tertiary hyperparathyroidism. The relationship between structural functional condition of tissue of parathyroid gland and development of either form of hyperparathyroidism is discussed. The cytomorphologic characteristics of tissue of parathyroid gland under primary, secondary and tertiary hyperparathyroidism can be included in algorithm of pre-surgery diagnostic.
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Nilsen FS, Haug E, Heidemann M, Karlsen SJ. Does Rapid Intraoperative Parathyroid Hormone Analysis Predict Cure in Patients Undergoing Surgery for Primary Hyperparathyroidism? Scand J Surg 2016; 95:28-32. [PMID: 16579252 DOI: 10.1177/145749690609500106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: Preoperative 99mTc-sestamibi scintigraphy is used by many surgeons to identify the anatomical location of pathological parathyroid glands in patients undergoing surgical treatment for hyperparathyroidism. However, false negative results do occur. It has been suggested that intraoperative parathyroid hormone (PTH) analysis may enhance the possibility of performing successful focused, unilateral neck surgery in these patients. This study aimed to evaluate whether an adequate fall in intraoperative parathyroid hormone values predicts the removal of all hyperfunctioning parathyroid tissue and postoperative normocalcemia. Material and Methods: One hundred consecutive patients undergoing surgery for hyperparathyroidism had preoperative 99mTc-sestamibi scintigraphy and intraoperative parathyroid hormone (PTH) analysis. A fall in intraoperative PTH value by more than 50% of baseline value ended the procedure. This prospective study presents the clinical and biochemical results. Results: The overall sensitivity of the 99mTc-sestamib scintigraphy was 88% and for single adenomas 95%. The scintigraphy failed to detect the correct pathology in all cases with multiglandular disease (7 patients). A fall in intraoperative PTH value by more than 50% of baseline value was achieved in all patients. The combination of intraoperative PTH analysis and 99mTc-sestamibi scintigraphy enabled us to limit the operation to a focused, unilateral operation in 87 of the 100 patients. All patients were normocalcemic postoperatively. Conclusions: A fall in intraoperative PTH value more than 50 % of baseline value seems to predict postoperative normocalcemia and the removal of all hyperfunctioning parathyroid tissue. Bilateral neck exploration is avoided in the majority of patients.
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Affiliation(s)
- F S Nilsen
- Oslo Urological University Clinic, Aker University Hospital, University of Oslo/Faculty Division Aker, Norway.
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Kawabe J, Higashiyama S, Yoshida A, Kotani K, Shiomi S. [Imaging of hyperparathyroidism-Ultrasonography and 99mTc-MIBI scintigraphy-]. Clin Calcium 2016; 26:867-874. [PMID: 27230842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Treatments for primary hyperparathyroidism due to adenoma, hyperplasia and carcinoma and secondary hyperparathyroidism are mainly surgical resections of them. Accurate imaging diagnoses of the existences and the regions are very important for reductions of invasiveness. We describe ultrasonography and (99m)Tc-MIBI scintigraphy of hyperparathyroidism. We explain an advantage, a disadvantage and diagnosability of these modalities. We mention utilities of SPECT/CT, too. We show echogram and (99m)Tc-MIBI scintigraphy images about 3 cases of hyperparathyroidism.
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Affiliation(s)
- Joji Kawabe
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Shigeaki Higashiyama
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Atsushi Yoshida
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Kohei Kotani
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Susumu Shiomi
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Japan
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Lastoria S, Marciello F, Faggiano A, Aloj L, Caracò C, Aurilio M, D'Ambrosio L, Di Gennaro F, Ramundo V, Camera L, De Luca L, Fonti R, Napolitano V, Colao A. Role of (68)Ga-DOTATATE PET/CT in patients with multiple endocrine neoplasia type 1 (MEN1). Endocrine 2016; 52:488-94. [PMID: 26242621 DOI: 10.1007/s12020-015-0702-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a hereditary syndrome predisposing to many endocrine and neuroendocrine tumors (NET). Conventional imaging (CI) cannot provide satisfactory results for all the different types of MEN1-related tumors. Objective of this prospective observational study was to evaluate the role of (68)Ga-DOTATATE PET/CT in MEN1 compared to CI. Diagnostic performance of (68)Ga-DOTATATE PET/CT for the detection of NET was evaluated as well as the prognostic role of SUVmax. Eighteen patients with genetically confirmed MEN1 were evaluated by (68)Ga-DOTATATE PET/CT, endoscopic ultrasounds, multidetector-row computed tomography, magnetic resonance imaging, and hormone/markers serum measurements. Four MEN1-related tumor sites (pancreas, pituitary, parathyroids, adrenals) were considered. Sensitivity and specificity of (68)Ga-DOTATATE PET/CT for the detection of NET were calculated. There was (68)Ga-DOTATATE PET/CT uptake in 11/11 patients with pancreatic lesions, in 9/12 with pituitary adenoma, in 5/15 with parathyroid enlargements, and in 5/7 with adrenal lesions. (68)Ga-DOTATATE PET/CT showed sensitivity and specificity of 100 and 100 % in pancreas, 75 and 83 % in pituitary, 28 and 100 % in parathyroids, and 62.5 and 100 % in adrenals, respectively. Compared with CI, no significant difference in sensitivity for pancreas, pituitary, and adrenals was found, while CI had a better sensitivity for parathyroids (p = 0.002). On the ROC analysis, progression of pancreatic lesions was significantly associated to SUVmax <12.3 (p < 0.05). (68)Ga-DOTATATE PET/CT is greatly helpful in the work-up of MEN1 providing a panoramic view of MEN1-related lesions. There is also a prognostic role of (68)Ga-PET in patients with MEN1-pancreatic lesions.
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Affiliation(s)
- Secondo Lastoria
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy.
| | - Francesca Marciello
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Antongiulio Faggiano
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Aloj
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Corradina Caracò
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Michela Aurilio
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Laura D'Ambrosio
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Francesca Di Gennaro
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Valeria Ramundo
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Camera
- Department of Biomorphological and Functional Sciences, "Federico II" University of Napoli, Naples, Italy
| | | | - Rosa Fonti
- Istitute of Biostructures and Bioimages (IBB), National Research Council, Naples, Italy
| | - Vincenzo Napolitano
- Department of General and Specialistic Surgery, Second University of Napoli, Caserta, Italy
| | - Annamaria Colao
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
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Bann DV, Goldenberg D. Four cystic parathyroid adenomas in a 71-year-old man. Ear Nose Throat J 2016; 95:21-22. [PMID: 26829681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Darrin V Bann
- Division of Otolaryngology-Head and Neck Surgery, Penn State University College of Medicine, Hershey, PA, USA
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Elegino-Steffens DU, Coppit GL, Mai VQ, Clyde PW, Shakir MKM. Visual Vignette. Endocr Pract 2015; 22:281. [PMID: 26523623 DOI: 10.4158/ep15908.vv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Olsen J, Sealey C. Brown tumour of the mandible in primary hyperparathyroidism; a case report. N Z Dent J 2015; 111:116-118. [PMID: 26502600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present an uncommon diagnosis in a 34-year-old female with a non-healing extraction socket. Incisional biopsy revealed multi-nucleated giant cells suggestive of central giant cell granuloma (CGCG). The computed tomography (CT) report made incidental note of a parathyroid mass. The parathyroid hormone (PTH) level was checked and found to be abnormally high. A diagnosis of brown tumour of the mandible was made. The patient was referred to a head and neck surgeon and the parathyroid mass was removed. The mandibular lesion was managed conservatively and continues to regress post-normalisation of PTH levels. The inclusion of the parathyroid region on the CT scan in this case was fortuitous. There are a range of pathologies containing multinucleated giant cells that can arise from the maxillofacial region; PTH level should, nevertheless, be checked in all such jaw lesions. This allows the clinician to exclude brown tumour from the diagnostic sieve.
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Sommerauer M, Graf C, Schäfer N, Huber G, Schneider P, Wüthrich R, Schmid C, Steinert H. Sensitivity and Specificity of Dual-Isotope 99mTc-Tetrofosmin and 123I Sodium Iodide Single Photon Emission Computed Tomography (SPECT) in Hyperparathyroidism. PLoS One 2015; 10:e0129194. [PMID: 26079132 PMCID: PMC4469677 DOI: 10.1371/journal.pone.0129194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose Despite recommendations for 99mTc-tetrofosmin dual tracer imaging for hyperparathyroidism in current guidelines, no report was published on dual-isotope 99mTc-tetrofosmin and 123I sodium iodide single-photon-emission-computed-tomography (SPECT). We evaluated diagnostic accuracy and the impact of preoperative SPECT on the surgical procedures and disease outcomes. Methods Analysis of 70 consecutive patients with primary hyperparathyroidism and 20 consecutive patients with tertiary hyperparathyroidism. Imaging findings were correlated with surgical results. Concomitant thyroid disease, pre- and postoperative laboratory measurements, histopathological results, type and duration of surgery were assessed. Results In primary hyperparathyroidism, SPECT had a sensitivity of 80% and a positive predictive value of 93% in patient-based analysis. Specificity was 99% in lesion-based analysis. Patients with positive SPECT elicit higher levels of parathyroid hormone and higher weight of resected parathyroids than SPECT-negative patients. Duration of parathyroid surgery was on average, approximately 40 minutes shorter in SPECT-positive than in SPECT-negative patients (89±46 vs. 129±41 minutes, p=0.006); 86% of SPECT-positive and 50% of SPECT-negative patients had minimal invasive surgery (p = 0.021). SPECT had lower sensitivity (60%) in patients with tertiary hyperparathyroidism; however, 90% of these patients had multiple lesions and all of these patients had bilateral lesions. Conclusion Dual-isotope SPECT with 99mTc-tetrofosmin and 123I sodium iodide has a high diagnostic value in patients with primary hyperparathyroidism and allows for saving of operation time. Higher levels of parathyroid hormone and higher glandular weight facilitated detection of parathyroid lesion. Diagnostic accuracy of preoperative imaging was lower in patients with tertiary hyperparathyroidism.
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Affiliation(s)
- Michael Sommerauer
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- * E-mail:
| | - Carmen Graf
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Niklaus Schäfer
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Gerhard Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Paul Schneider
- Department of General, Visceral and Transplant Surgery, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Rudolf Wüthrich
- Division of Nephrology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Schmid
- Division of Endocrinology and Diabetology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Hans Steinert
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Abstract
This section gives an overview of radiological findings in bony fragility states, with a special focus on osteogenesis imperfecta (OI) and rickets. Conventional radiological assessment of bone density is inaccurate and imprecise and only reliably detects severe osteopaenia. However, other aspects of bone structure and morphology can be assessed, and it is possible to distinguish between osteopaenic and osteomalacic states. OI is a heterogeneous group of disorders of type 1 collagen formation and processing that are characterised by varying degrees of bony fragility, with presentations varying from perinatal lethality to asymptomatic. Radiological diagnosis of severe forms is usually straightforward, but that of milder disease may be challenging because specific features are often absent. However, a multidisciplinary approach is usually successful. Features of OI, including Wormian bones, skull base deformities, vertebral involvement and long bone fractures and deformities, are reviewed in this section. Rickets is best defined as a disorder of the growth plate characterised by the impaired apoptosis of hypertrophied chondrocytes. Vitamin D deficiency is a common cause of rickets. The patho-anatomical basis of radiological findings in rickets is reviewed and illustrated. Rickets is frequently accompanied by hyperparathyroidism and osteomalacia. Rickets used to be classified as calciopaenic or phosphopaenic but is now referred to as parathyroid hormone or fibroblast growth factor 23 mediated, respectively [1]. The radiological features of the two forms are reviewed.
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Affiliation(s)
- Alistair D Calder
- Radiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Vasilev V, Daly AF, Thiry A, Petrossians P, Fina F, Rostomyan L, Silvy M, Enjalbert A, Barlier A, Beckers A. McCune-Albright syndrome: a detailed pathological and genetic analysis of disease effects in an adult patient. J Clin Endocrinol Metab 2014; 99:E2029-38. [PMID: 25062453 DOI: 10.1210/jc.2014-1291] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT McCune Albright syndrome (MAS) is a clinical association of endocrine and nonendocrine anomalies caused by postzygotic mutation of the GNAS1 gene, leading to somatic activation of the stimulatory α-subunit of G protein (Gsα). Important advances have been made recently in describing pathological characteristics of many MAS-affected tissues, particularly pituitary, testicular, and adrenal disease. Other rarer disease related features are emerging. OBJECTIVE The objective of the investigation was to study the pathological and genetic findings of MAS on a tissue-by-tissue basis in classically and nonclassically affected tissues. DESIGN This was a comprehensive autopsy and genetic analysis. SETTING The study was conducted at a tertiary referral university hospital. PATIENTS An adult male patient with MAS and severe disease burden including gigantism was the subject of the study. INTERVENTION(S) Interventions included clinical, hormonal, and radiographic studies and gross and microscopic pathology analyses, conventional PCR, and droplet digital PCR analyses of affected and nonaffected tissues. MAIN OUTCOME MEASURE Pathological findings and the presence of GNAS1 mutations were measured. RESULTS The patient was diagnosed with MAS syndrome at 6 years of age based on the association of café-au-lait spots and radiological signs of polyostotic fibrous dysplasia. Gigantism developed and hyperprolactinemia, hypogonadotropic hypogonadism, and hyperparathyroidism were diagnosed throughout the adult period. The patient died at the age of 39 years from a pulmonary embolism. A detailed study revealed mosaiscism for the p.R201C GNAS1 mutation distributed across many endocrine and nonendocrine tissues. These genetically implicated tissues included rare or previously undescribed disease associations including primary hyperparathyroidism and hyperplasia of the thymus and endocrine pancreas. CONCLUSIONS This comprehensive pathological study of a single patient highlights the complex clinical profile of MAS and illustrates important advances in understanding the characteristics of somatic GNAS1-related pathology across a wide range of affected organs.
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Affiliation(s)
- Vladimir Vasilev
- Departments of Endocrinology (V.V., A.F.D., P.P., L.R., A.Be.) and Pathological Anatomy (A.T.), Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium; Department of Biological Oncology Transfer (F.F.), Laboratory of Medical Biology, Assistance Publique-Hôpitaux de Marseille, 13354 Marseille, France; and Laboratory of Biochemistry and Molecular Biology (M.S., A.E., A.Ba.), Centre Hospitalier Universitaire Conception, University of the Mediterranean, 13007 Marseille, France
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Candell L, Campbell MJ, Shen WT, Gosnell JE, Clark OH, Duh QY. Ultrasound-guided methylene blue dye injection for parathyroid localization in the reoperative neck. World J Surg 2014; 38:88-91. [PMID: 24132819 DOI: 10.1007/s00268-013-2234-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to review a single institution's experience using intraoperative ultrasound-guided (ioUSG) methylene blue dye injection for the localization and removal of enlarged parathyroid glands in patients with primary hyperparathyroidism and a history of previous neck surgery. METHODS We performed a retrospective review of nine consecutive patients who underwent reoperative parathyroidectomy using ioUSG methylene blue dye injection. RESULTS All patients had successful resolution of their hyperparathyroidism, with at least a 50 % decrease in intraoperative parathyroid hormone level after resection. One patient had transient recurrent laryngeal nerve paresis. There were no permanent recurrent laryngeal nerve injuries or cases of permanent hypoparathyroidism. CONCLUSIONS Blue dye injection is a safe and effective method of localizing diseased parathyroid glands in the reoperative neck.
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Affiliation(s)
- Leah Candell
- General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA
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Bisogni C, Meurisse M, Withofs N, Betea D, Hustinx R. [Ectopic parathyroid gland]. Rev Med Liege 2014; 69:473-475. [PMID: 25796754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Chicklore S, Schulte KM, Talat N, Hubbard JG, O'Doherty M, Cook GJR. 18F-FDG PET rarely provides additional information to 11C-methionine PET imaging in hyperparathyroidism. Clin Nucl Med 2014; 39:237-42. [PMID: 24445273 DOI: 10.1097/rlu.0000000000000340] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to assess the utility of combined C-methionine and F-FDG PET/CT imaging in hyperparathyroidism. PATIENTS AND METHODS We reviewed all scans performed for hyperparathyroidism with both C-methionine and F-FDG PET/CT or PET in our institution since 1993. Forty-three patients (47 pairs of scans) were included (13 men and 30 women) with a mean age of 63 years. C-methionine and F-FDG PET/CT scans were classified as positive or negative for localization of abnormal parathyroid tissue, and the site of uptake was noted in the positive scans. Other concurrent imaging (Tc-MIBI scintigraphy, ultrasonography, CT, or MRI) findings were also noted when performed. Clinical follow-up information was available in 27 patients (30 episodes). RESULTS Of the 47 PET scan episodes, 23 (49%) were positive. Twenty-two C-methionine scans showed abnormal focal localization of which 10 also showed concordant abnormal F-FDG uptake. One patient was positive with F-FDG and negative with C-methionine.Of the 16 patients who underwent subsequent surgery, 6 had concordant C-methionine, F-FDG, and surgical findings; 6 had concordant C-methionine and surgical findings; 1 had concordant F-FDG and surgical findings; and 3 had both PET scans negative but had adenomas excised during surgery.Of the 3 with both PET scans negative and discordant surgical findings, 1 had mediastinal parathyroid lipoadenoma excised and 2 had normally sited parathyroid adenoma excised. CONCLUSIONS F-FDG PET/CT rarely provides additional information and could be saved for patients in whom C-methionine PET/CT is negative.
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Affiliation(s)
- Sugama Chicklore
- From the *Clinical PET Centre, Division of Imaging Sciences, King's College London; †Department of Endocrine Surgery, King's College Hospital; and ‡Department of Endocrine Surgery, Guy's & St Thomas' Hospital, London, United Kingdom
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