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Aktaş A, Gençoğlu EA, Çolak T, Haberal KM, Özdemir BH, Sayin CB, Haberal M. Evaluation of Imaging Findings in Patients with Pretransplant and Posttransplant Tertiary Hyperparathyroidism. EXP CLIN TRANSPLANT 2024; 22:96-101. [PMID: 38385382 DOI: 10.6002/ect.mesot2023.o16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Tertiary hyperparathyroidism, characterized by autonomous overproduction of parathyroid hormone, can be seen in patients with long-standing secondary hyperparathyroidism (pretransplant) or after renal transplant (posttransplant). Parathyroid scintigraphy and ultrasonography are the most commonly used imaging procedures for the preoperative localization of abnormal parathyroid glands. We aimed to evaluate imaging findings in pretransplant and posttransplant tertiary hyperparathyroidism. MATERIALS AND METHODS This study included 32 patients with pretransplant tertiary hyperparathyroidism and 20 patients with posttransplant tertiary hyperparathyroidism. On parathyroid scintigraphy with technetium-99m sestamibi, early-phase and latephase images were acquired. Images were evaluated for the presence and the number of active foci and the degree of uptake on the late-phase image. The existence of an autonomous gland was based on latephase retention and was scored from 0 to 2 (retention score). On ultrasonography, the criteria threshold for autonomy was the maximum length of the largest gland ≥10 mm (ultrasonography score). RESULTS On parathyroid scintigraphy, the most commonly observed pattern in the pretransplant group was positivity in ≥3 glands, and in the posttransplant group the most commonly observed pattern was positivity in 1 to 2 glands. In pretransplant and posttransplant groups, the criteria threshold for the presence of an autonomous parathyroid gland on parathyroid scintigraphy (grade 2 retention) was met in 26 (81%) and 9 (45%) patients and on ultrasonography in 25 (78%) and 10 (50%) patients, respectively. In the whole group of patients (n = 52), correlation existed between ultrasonography score and retention score. Glandular weight was correlated with both retention score and ultrasonography score. CONCLUSIONS Higher numbers of detectable glands and the presence of parathyroid autonomy were more common in the pretransplant group. This might be explained by parathyroid gland involution after transplant. The results may also suggest that factors other than autonomy are responsible for posttransplant tertiary hyperparathyroidism.
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Affiliation(s)
- Ayşe Aktaş
- From the Department of Nuclear Medicine, Baskent University Faculty of Medicine, Ankara, Turkey
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Zhao B, Chen S, Dai X, Gao F, Xie P, Wang S, Sui X. Secondary hyperparathyroidism combined with thyroid disease. Medicine (Baltimore) 2023; 102:e36514. [PMID: 38115353 PMCID: PMC10727630 DOI: 10.1097/md.0000000000036514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
To retrospectively analyze the diagnosis and treatment of secondary hyperparathyroidism (SHPT) combined with thyroid disease, and to investigate the correlation between SHPT and papillary thyroid carcinoma (PTC), SHPT and thyroid disease, and the importance of preoperative localization diagnosis in patients with SHPT. Clinical data of 101 patients who underwent surgical treatment for SHPT at the Third Hospital of Hebei Medical University were collected from August 2014 to May 2023, and patients were divided into SHPT without PTC group (n = 94) and SHPT with PTC group (n = 7) according to their postoperative pathology. Patients were divided into SHPT without thyroid disease group (n = 32) and SHPT with thyroid disease group (n = 69) according to their preoperative ultrasound diagnosis and postoperative pathology. The differences between the 2 groups were compared to explore the association between SHPT and PTC and between SHPT and thyroid disease. Of the 101 patients with SHPT, 65 were male and 36 were female with a mean age of (44.26 ± 11.16) years. There were 69 patients (68.32%) with concomitant thyroid disease and 32 patients (31.68%) without concomitant thyroid disease, including 7 patients (6.93%) with PTC. The results of univariate analysis showed that the differences in age and preoperative PTH levels between the SHPT without PTC group and the SHPT with PTC group were statistically significant (P < 0. 05),There were no significant differences in age, gender, preoperative PTH, preoperative alkaline phosphatase, preoperative serum calcium, preoperative serum phosphorus, preoperative serum creatinine, duration of dialysis disease, and whether they were accompanied by hypertension or not between the SHPT without thyroid disease group and the SHPT with thyroid disease group (P > 0. 05), logistic regression analysis showed that there was a correlation between the age of patients with SHPT and the level of preoperative PTH with PTC. In patients with SHPT, concomitant thyroid disease is more common, so patients with SHPT should be screened for thyroid disease at the same time as routine preoperative ultrasonography combined with nuclear scan for localized diagnosis, and surgical resection is preferred if concomitant PTC is present.
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Affiliation(s)
- Bingxin Zhao
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Simei Chen
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Xinpeng Dai
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Feng Gao
- Department of Pathology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Peng Xie
- Department of Nuclear Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Shuchang Wang
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Xin Sui
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1175237. [PMID: 37396185 PMCID: PMC10311438 DOI: 10.3389/fendo.2023.1175237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Following total parathyroidectomy (PTx), transcervical thymectomy, and forearm autograft for secondary hyperparathyroidism (SHPT), recurrent SHPT can occur in the autografted forearm. However, few studies have investigated the factors contributing to re-PTx due to autograft-dependent recurrent SHPT before the completion of the initial PTx. Methods A total of 770 patients who had autografted parathyroid fragments derived from only one of the resected parathyroid glands (PTGs) and who had undergone successful initial total PTx and transcervical thymectomy-defined by serum intact parathyroid hormone level < 60 pg/mL on postoperative day 1-between January 2001 and December 2022 were included in this retrospective cohort study. Factors contributing to re-PTx due to graft-dependent recurrent SHPT before the completion of the initial PTx were investigated using multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimal maximum diameter of PTG for autograft. Results Univariate analysis showed that dialysis vintage and maximum diameter and weight of the PTG for autograft were significant factors contributing to graft-dependent recurrent SHPT. However, multivariate analysis revealed that dialysis vintage (P=0.010; hazard ratio [HR], 0.995; 95% confidence interval [CI], 0.992-0.999) and the maximum diameter of the PTG for autograft (P=0.046; HR, 1.107; 95% CI, 1.002-1.224) significantly contributed to graft-dependent recurrent SHPT. ROC curve analysis showed that < 14 mm was the optimal maximum diameter of PTG for autograft (area under the curve, 0.628; 95% CI, 0.551-0.705). Conclusions The dialysis vintage and maximum diameter of PTG for autograft may contribute to re-PTx due to autograft-dependent recurrent SHPT, which can be prevented by using PTGs with a maximum diameter of < 14 mm for autograft.
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Treatment for secondary hyperparathyroidism focusing on parathyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1169793. [PMID: 37152972 PMCID: PMC10159274 DOI: 10.3389/fendo.2023.1169793] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and 99mTc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients' need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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Mi J, Fang Y, Xian J, Wang G, Guo Y, Hong H, Chi M, Li YF, He P, Gao J, Liao W. Comparative Effectiveness of MRI, 4D-CT and Ultrasonography in Patients with Secondary Hyperparathyroidism. Ther Clin Risk Manag 2023; 19:369-381. [PMID: 37159605 PMCID: PMC10163888 DOI: 10.2147/tcrm.s379814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 02/13/2023] [Indexed: 05/11/2023] Open
Abstract
Objective Accurate preoperative localization of abnormal parathyroid glands is crucial for successful surgical management of secondary hyperparathyroidism (SHPT). This study was conducted to compare the effectiveness of preoperative MRI, 4D-CT, and ultrasonography (US) in localizing parathyroid lesions in patients with SHPT. Methods We performed a retrospective review of prospectively collected data from a tertiary-care hospital and identified 52 patients who received preoperative MRI and/or 4D-CT and/or US and/or 99mTc-MIBI and subsequently underwent surgery for SHPT between May 2013 and March 2020. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each imaging modality to accurately detect enlarged parathyroid glands were determined using histopathology as the criterion standard with confirmation using the postoperative biochemical response. Results A total of 198 lesions were identified intraoperatively among the 52 patients included in this investigation. MRI outperformed 4D-CT and US in terms of sensitivity (P < 0.01), specificity (P = 0.455), PPV (P = 0.753), and NPV (P = 0.185). The sensitivity and specificity for MRI, 4D-CT, and US were 90.91%, 88.95%, and 66.23% and 58.33%, 63.64%, and 50.00%, respectively. The PPV of combined MRI and 4D-CT (96.52%) was the highest among the combined 2 modalities. The smallest diameter of the parathyroid gland precisely localized by MRI was 8×3 mm, 5×5 mm by 4D-CT, and 5×3 mm by US. Conclusion MRI has superior diagnostic performance compared with other modalities as a first-line imaging study for patients undergoing renal hyperparathyroidism, especially for ectopic or small parathyroid lesions. We suggest performing US first for diagnosis and then MRI to make a precise localization, and MRI proved to be very helpful in achieving a high success rate in the surgical treatment of renal hyperparathyroidism in our own experience.
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Affiliation(s)
- Jiaoping Mi
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Yijie Fang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Jianzhong Xian
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Guojie Wang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Yuanqing Guo
- Department of Spinal Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Haiyu Hong
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Mengshi Chi
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Yong-Fang Li
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Peng He
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Jiebing Gao
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
- Jiebing Gao, Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China, Email
| | - Wei Liao
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
- Correspondence: Wei Liao, Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519020, People’s Republic of China, Email
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Intraoperative intact parathyroid hormone monitoring and frozen section diagnosis are essential for successful parathyroidectomy in secondary hyperparathyroidism. Front Med (Lausanne) 2022; 9:1007887. [PMID: 36419788 PMCID: PMC9676982 DOI: 10.3389/fmed.2022.1007887] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/25/2022] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Total parathyroidectomy (PTx) is often performed to treat secondary hyperparathyroidism (SHPT). Successful PTx is essential to prevent recurrent and persistent SHPT because remnant parathyroid glands (PTGs) in the neck can be stimulated and may secrete excessive parathyroid hormone (PTH) in end-stage renal disease. However, to date, few studies have investigated factors contributing to successful PTx before the completion of surgery. MATERIALS AND METHODS Between August 2010 and February 2020, 344 patients underwent total PTx, transcervical thymectomy, and forearm autograft for SHPT at our institute. Factors contributing to successful PTx before the completion of surgery were investigated. Preoperative imaging diagnoses, including computed tomography, ultrasonography, technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy, intraoperative intact PTH (IOIPTH) monitoring, and frozen section histologic diagnosis, were performed. Successful PTx was defined as intact PTH level < 60 pg/mL on postoperative day 1. A sufficient decrease in IOIPTH level was defined as > 70% decrease in intact PTH levels measured 10 min after total PTx and transcervical thymectomy compared to intact PTH levels measured before skin incision. Logistic regression analysis was conducted to investigate factors contributing to PTx success. RESULTS Univariate analysis showed that the number of all PTGs identified preoperatively by imaging modalities and the specimens submitted for frozen section diagnosis, which surgeon presumed to be PTGs, were not significant factors contributing to successful PTx. However, multivariate analysis revealed that the number of PTGs identified by frozen section diagnosis (P < 0.001, odds ratio [OR] 4.356, 95% confidence interval [CI] 2.499-7.592) and sufficient decrease in IOIPTH levels (P = 0.001, OR 7.847, 95% CI 2.443-25.204) significantly contributed to successful PTx. CONCLUSION Sufficient intact PTH level decrease observed on IOIPTH monitoring and the number of PTGs identified by frozen section diagnosis contributed to successful PTx for SHPT. IOIPTH monitoring and frozen section diagnosis are essential for achieving successful PTx for SHPT.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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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] [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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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg 2022; 276:e141-e176. [PMID: 35848728 DOI: 10.1097/sla.0000000000005522] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. BACKGROUND Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. METHODS Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.
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Imaging of parathyroid adenomas by gamma camera. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Zander D, Bunch PM, Policeni B, Juliano AF, Carneiro-Pla D, Dubey P, Gule-Monroe MK, Hagiwara M, Hoang JK, Jain V, Kim LT, Moonis G, Parsons MS, Rath TJ, Solórzano CC, Subramaniam RM, Taheri MR, DuChene Thoma K, Trout AT, Zafereo ME, Corey AS. ACR Appropriateness Criteria® Parathyroid Adenoma. J Am Coll Radiol 2021; 18:S406-S422. [PMID: 34794597 DOI: 10.1016/j.jacr.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 12/20/2022]
Abstract
Hyperparathyroidism is defined as excessive parathyroid hormone production. The diagnosis is made through biochemical testing, in which imaging has no role. However, imaging is appropriate for preoperative parathyroid gland localization with the intent of surgical cure. Imaging is particularly useful in the setting of primary hyperparathyroidism whereby accurate localization of a single parathyroid adenoma can facilitate minimally invasive parathyroidectomy. Imaging can also be useful to localize ectopic or supernumerary parathyroid glands and detail anatomy, which may impact surgery. This document summarizes the literature and provides imaging recommendations for hyperparathyroidism including primary hyperparathyroidism, recurrent or persistent primary hyperparathyroidism after parathyroid surgery, secondary hyperparathyroidism, and tertiary hyperparathyroidism. Recommendations include ultrasound, CT neck without and with contrast, and nuclear medicine parathyroid scans. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- David Zander
- Chief, Head and Neck Radiology, University of Colorado Denver, Denver, Colorado.
| | - Paul M Bunch
- Research Author, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Bruno Policeni
- Panel Chair; and Director, Research and Academic Affairs, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and ACR Chair, NI-RADS Committee
| | - Denise Carneiro-Pla
- Medical University of South Carolina, Charleston, South Carolina; American Thyroid Association
| | | | - Maria K Gule-Monroe
- Medical Director, Division of Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York; and Secretary, Eastern Neuroradiological Society
| | | | - Vikas Jain
- Associate Radiology Residency Program Director, MetroHealth Medical Center, Cleveland, Ohio
| | - Lawrence T Kim
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; American College of Surgeons
| | - Gul Moonis
- Columbia University Medical Center, New York, New York
| | | | - Tanya J Rath
- Director, Neuroradiology Division Education, Mayo Clinic Arizona, Phoenix, Arizona; and President, Eastern Neuroradiological Society
| | - Carmen C Solórzano
- Vanderbilt University Medical Center, Nashville, Tennessee; Society of Surgical Oncology
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; and PET Center of Excellence, Society of Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Andrew T Trout
- Director, Radiology Clinical Research, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; JRCNMT, Board Member and Vice-Chair; and ACR representative
| | - Mark E Zafereo
- Associate Medical Director, Head & Neck Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; American Academy of Otolaryngology-Head and Neck Surgery
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Kimura B, Nagelberg J, Koo SJ, Bykowski J, Brumund KT, McCowen KC. Inappropriate requesting of parathyroid scintigraphy at an academic medical center. Head Neck 2021; 43:3404-3407. [PMID: 34378837 DOI: 10.1002/hed.26839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/29/2021] [Accepted: 07/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism is a biochemical, not radiologic diagnosis. Parathyroid scintigraphy should only be requested for surgical planning, not to confirm diagnosis. Here we determined reasons for inappropriately ordered parathyroid scintigraphy. METHODS We generated a database of patients undergoing parathyroid scintigraphy over 5 years, who did not undergo parathyroidectomy. RESULTS Over 5 years 129 parathyroid scintigraphies (of 308 total scans) were performed in patients who did not undergo parathyroidectomy. We determined that only 58 (45%) had true primary hyperparathyroidism. The most common reason for the scan was to "confirm the diagnosis." Only 20% were ordered for adenoma localization, although surgery was not performed. Physicians requesting parathyroid scintigraphies specialized in a variety of disciplines. CONCLUSION Forty-two percent of parathyroid scintigraphies were requested inappropriately to "confirm" a diagnosis of primary hyperparathyroidism. We propose to change the ordering system to clarify that parathyroid scintigraphy is a functional tool to optimize surgery when the diagnosis is secure.
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Affiliation(s)
- Brad Kimura
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Jodi Nagelberg
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Sonya J Koo
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Julie Bykowski
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Kevin T Brumund
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Karen C McCowen
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
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Pediatric hyperparathyroidism: review and imaging update. Pediatr Radiol 2021; 51:1106-1120. [PMID: 33904951 DOI: 10.1007/s00247-021-05050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Hyperparathyroidism, due to increased secretion of parathyroid hormones, may be primary, secondary or tertiary. Most pediatric patients with sporadic primary hyperparathyroidism will be symptomatic, presenting with either end-organ damage or nonspecific symptoms. In younger patients with primary hyperparathyroidism, there is a higher prevalence of familial hyperparathyroidism including germline inactivating mutations of the calcium-sensing receptor genes that result in either neonatal severe hyperparathyroidism or familial hypocalciuric hypercalcemia. Parathyroid scintigraphy and ultrasound are complementary, first-line imaging modalities for localizing hyperfunctioning parathyroid glands. Second-line imaging modalities are multiphase computed tomography (CT) and magnetic resonance imaging. In pediatrics, multiphase CT protocols should be adjusted to optimize radiation dose. Although, the role of these imaging modalities is better established in preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism, the same principles apply in secondary and tertiary hyperparathyroidism. In this manuscript, we will review the embryology, anatomy, pathophysiology and preoperative localization of parathyroid glands as well as several subtypes of primary familial hyperparathyroidism. While most of the recent imaging literature centers on adults, we will focus on the issues that are pertinent and applicable to pediatrics.
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Maccora D, Caldarella C, Calcagni ML. 11C-Methionine PET/CT in patients with primary hyperparathyroidism and inconclusive pre-operative imaging work-up: diagnostic accuracy and role of semi-quantitative analysis. Ann Nucl Med 2021; 35:469-478. [PMID: 33491131 DOI: 10.1007/s12149-021-01584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE 11C-Methionine PET/CT (C-MET) is a promising method in detecting abnormal parathyroid glands in patients with primary hyperparathyroidism (PHPT). The first aim of the study was to evaluate which is the diagnostic role of C-MET in patients with PHPT and inconclusive pre-operative imaging. Second, we aimed to investigate whether C-MET semi-quantitative parameters may reflect biochemical and histological characteristics of involved glands. METHODS Patients with PHPT, undergoing C-MET after an inconclusive pre-operative imaging and having a parathyroid surgery, were retrospectively included. C-MET visual and semi-quantitative assessment was performed. Parameters, as SUVmax, SUVpeak, SUVmean, functional lesion volume (FLV) and total lesion activity (TLA), were measured for each detected lesion; SUVmean, FLV and TLA were calculated on 40-90% thresholds of SUVmax to define SUVmean40-90, FLV40-90 and TLA40-90, respectively. Results were correlated with patients' clinical-laboratory (calcium and PTH values) and histological data (size and weight of excised glands). Mann-Whitney test was used and P value < 0.05 was considered significant. RESULTS Thirty-eight patients (36 female, age: 57.69 ± 15.13 years) were included. Pre-operative median calcium and PTH values were 11.1 mg/dl [interquartile range (IQR) 10.6-11.5] and 154.6 pg/ml (IQR 101.8-227.0), respectively. C-MET showed a parathyroid uptake in 30 out of thirty-eight patients (78.9%). Among 42 nodules excised, C-MET correctly detected the side of the neck (right/left) in 30/42 with sensitivity, specificity and accuracy of 79, 75 and 79%, respectively. C-MET correctly identified the exact position (superior/inferior) in 27/42 with sensitivity, specificity and accuracy of 75, 50 and 71%, respectively. SUVpeak, FLV50-70 and TLA40-70 were significantly (P < 0.05) higher in patients with higher PTH results. The histological size resulted significantly (P < 0.05) higher in abnormal glands with higher SUVmax, SUVpeak, FLV40-80 and TLA40-90, the weight was higher in glands with higher SUVpeak, SUVmean40-50, FLV40-80 and TLA40-90. CONCLUSIONS C-MET showed a good performance in detecting hyperfunctioning parathyroid glands in PHPT patients with inconclusive pre-operative imaging. Semi-quantitative PET-derived parameters closely correlated with PTH as well as with size and weight of the excised gland, thus reflecting some biochemical and histological characteristics of involved glands.
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Affiliation(s)
- Daria Maccora
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Caldarella
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
| | - Maria Lucia Calcagni
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
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Li X, Li J, Li Y, Wang H, Yang J, Mou S, Zhou M, Jiang C, Ning C. The role of preoperative ultrasound, contrast-enhanced ultrasound, and 99mTc-MIBI scanning with single-photon emission computed tomography/X-ray computed tomography localization in refractory secondary hyperparathyroidism. Clin Hemorheol Microcirc 2020; 75:35-46. [PMID: 31868660 DOI: 10.3233/ch-190723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the role of preoperative US, CEUS, and 99mTc-MIBI scanning with SPECT/CT in localizing diseased parathyroid glands in cases of refractory secondary hyperparathyroidism (SHPT). MATERIAL AND METHODS Using pathological results as the gold standard, we compared the operative findings with the preoperative localization of each modality in 73 nodules and evaluated the accuracy, and sensitivity of each modality and combinations of the four modalities. RESULTS The sensitivity of US, CEUS, 99mTc-MIBI and SPECT/CT was 98.59%, 94.37%, 50.70% and 78.87%, respectively. US had the highest sensitivity of the four imaging methods and the diagnostic sensitivity of US and CEUS was superior to that of 99mTc-MIBI (p < 0.001 and p < 0.001) and SPECT/CT (p = 0.001 and p = 0.012). In addition, we found that the sensitivity of the combination of US with CEUS, US with 99mTc-MIBI and/or SPECT/CT, CEUS with 99mTc-MIBI and/or SPECT/CT, US with CEUS and two other imaging modalities (99mTc-MIBI and/or SPECT/CT) was 98.59%, 100%, 95.77%, and 100%, respectively. CONCLUSIONS The combination of US with SPECT/CT is the best choice for the comprehensive preoperative localization of glands in refractory SHPT. CEUS can elevate the accuracy of US in differential diagnosis via the interpretation of dynamic microvascular features.
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Affiliation(s)
- XiuMei Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jun Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yong Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - HongQiao Wang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - JingRu Yang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Mou
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - MaoPing Zhou
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - CaiYun Jiang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - ChunPing Ning
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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15
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Zhang R, Zhang Z, Huang P, Li Z, Hu R, Zhang J, Qiu W, Hu P. Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism. BMC Med Imaging 2020; 20:91. [PMID: 32746794 PMCID: PMC7398336 DOI: 10.1186/s12880-020-00490-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT. METHODS Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH). RESULTS A total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US, early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99mTc-MIBI scintigraphy (P < 0.001). Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P < 0.05). The Spearman correlation results showed a significant albeit weak association between calcification and both serum PTH and ALP (P = 0.002). CONCLUSION The ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.
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Affiliation(s)
- Rongqin Zhang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Zhanwen Zhang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Pinbo Huang
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Zhi Li
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Rui Hu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Jie Zhang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Wanglin Qiu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Ping Hu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
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Zeng M, Liu W, Zha X, Tang S, Liu J, Yang G, Mao H, Yu X, Sun B, Zhang B, Ouyang C, Zhang L, Guo J, Wang J, Huang Y, Purrunsing Y, Qian H, Wang N, Xing C. 99mTc-MIBI SPECT/CT imaging had high sensitivity in accurate localization of parathyroids before parathyroidectomy for patients with secondary hyperparathyroidism. Ren Fail 2020; 41:885-892. [PMID: 31537128 PMCID: PMC6758704 DOI: 10.1080/0886022x.2019.1662804] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: Accurate preoperative parathyroid localization is important for successful parathyroidectomy (PTX). The aim of our study was to investigate whether SPECT/CT has enhanced effect in preoperative localization of parathyroids. Methods: In our retrospective cohort study, we evaluated the effects of technetium-99m methoxyisobutylisonitrile-single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) on preoperative parathyroid localization for 645 secondary hyperparathyroidism (SHPT) patients. Among them, 569 successful PTX patients were divided into group A (received 99mTc-MIBI scintigraphy, n = 175) and group B (received 99mTc-MIBI scintigraphy and SPECT/CT imaging, n = 394). Sensitivity, specificity, and consistency of two imaging methods in preoperative localization of parathyroids were compared. Results: Overall sensitivity and consistency were higher in group B, while there was no difference in specificity between the two groups. In group A, the sensitivity of 99mTc-MIBI was 50.00%, 77.11%, 61.76%, and 76.54% in the right upper gland (RU), right lower gland (RL), left upper gland (LU), and left lower gland (LL) subgroups, while the consistency was 52.00%, 76.57%, 61.71%, and 75.43%, respectively. In group B, the sensitivity of 99mTc-MIBI with SPECT/CT was 69.39%, 90.03%, 78.07%, and 84.27%, and the consistency was 69.54%, 88.32%, 78.43%, and 84.26%, respectively. The sensitivity and consistency in lower glands were higher than in upper glands in both groups. Sensitivity for eutopic parathyroid was higher in group B, while there was no difference for ectopic parathyroid. Conclusions: 99mTc-MIBI SPECT/CT can increase the sensitivity and consistency of preoperative localization of eutopic parathyroid glands, and it can accurately locate ectopic parathyroid without sensitivity improvement.
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Affiliation(s)
- Ming Zeng
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Wei Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Xiaoming Zha
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Shaowen Tang
- Department of Epidemiology and Biostatistics, School of Public Health , Nanjing Medical University , Nanjing , China
| | - Jin Liu
- Clinical Medicine Research Institution, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Guang Yang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Huijuan Mao
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Xiangbao Yu
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Bin Sun
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Bo Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Chun Ouyang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Lina Zhang
- Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University , Zhengzhou , China
| | - Jing Guo
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Jing Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Yaoyu Huang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Yogendranath Purrunsing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Hanyang Qian
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Ningning Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Nanjing , China
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Purrunsing Y, Zhang J, Cui Y, Liu W, Xu Y, Hong X, Xing C, Zha X, Wang N. Sixty-Two-Year-Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism. JBMR Plus 2018; 2:240-245. [PMID: 30283905 PMCID: PMC6124177 DOI: 10.1002/jbm4.10038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/01/2018] [Accepted: 01/30/2018] [Indexed: 01/02/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is a long‐term complication of chronic kidney disease–mineral and bone disorder (CKD‐MBD). SHPT is characterized by hyperplasia of the parathyroid glands and abnormal secretion of parathyroid hormones (PTH), calcium and phosphorous metabolic disorders, renal osteodystrophy, vascular and soft tissue calcification, malnutrition, and other multiple system complications, which can seriously affect the quality of life of the patient and increase the risk of cardiovascular disease and mortality rate. Uremic leontiasis ossea (ULO) is a medical condition only rarely encountered clinically. SHPT causes craniofacial bone deformity accompanied by lesions of the nerve, cardiovascular, respiratory, bone, or other systems within the body. The case discussed here is related to severe SHPT. A 62‐year‐old male patient was suffering from leontiasis ossea, pectus excavatum, vascular calcification, spontaneous bone fractures, and lower limb deformities. He was undergoing hemodialysis and given total parathyroidectomy (TPTX) with autotransplantation (AT). We further analyzed the multivariate therapeutic effects of TPTX on this patient in order to provide clinical data for standardized treatment of individuals with CKD‐MBD. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Yogendranath Purrunsing
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Jingjing Zhang
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Ying Cui
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Wei Liu
- Department of Nuclear Medicine First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Yi Xu
- Department of Radiology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Xunning Hong
- Department of Radiology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Changying Xing
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Xiaoming Zha
- Department of General Surgery First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Ningning Wang
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
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Zhu M, Zhang Z, Lin F, Miao J, Wang P, Zhang C, Yu H, Deng H, Liu Z, Liu L, Wan B, Yang H, Song M, Zhao Y, Jiang N, Zhang Z, Zhang Z, Pan L. Therapeutic experience of severe and recurrent secondary hyperparathyroidism in a patient on hemodialysis for 18 years: A case report. Medicine (Baltimore) 2018; 97:e10816. [PMID: 29768384 PMCID: PMC5976323 DOI: 10.1097/md.0000000000010816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION For patients with refractory secondary hyperparathyroidism (SHPT), parathyroidectomy (PTX) has received increasing attention. However, evidence-based medicine shows that there is still controversy regarding surgical methods, efficacy, and safety. We retrospectively analyzed the process of diagnosis and treatment in one patient with severe SHPT and long-term chronic renal failure (CRF), so as to further improve the therapeutic effect. CASE PRESENTATION A 61-year-old female with SHPT and CRF manifested as no urine for 18 years, underwent PTX 4 times since September 2010, with satisfactory final recovery. The first operation involved resection of 3 parathyroid glands in the normal position; the second operation involved removal of an ectopic parathyroid gland, combined with parathyroid gland autotransplantation; the third operation was performed to resect suspected recurrent parathyroid gland; the fourth operation involved partial excision of the autotransplanted parathyroid glands. CONCLUSION Accurate preoperative localized diagnosis and optimal surgical approach play key roles in the prevention and treatment of SHPT; postoperative recurrence of SHPT caused by ectopic or autotransplanted parathyroid gland should receive more attention.
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Affiliation(s)
| | | | | | | | - Pei Wang
- Department of Nuclear Medicine, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University
| | | | | | | | | | | | | | | | | | | | - Nan Jiang
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Tsinghua University, Beijing, China
| | - Zichao Zhang
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Tsinghua University, Beijing, China
| | - Zhenya Zhang
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Tsinghua University, Beijing, China
| | - Lijie Pan
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Tsinghua University, Beijing, China
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Cunha-Bezerra P, Vieira R, Amaral F, Cartaxo H, Lima T, Montarroyos U, Bandeira F. Better performance of four-dimension computed tomography as a localization procedure in normocalcemic primary hyperparathyroidism. J Med Imaging Radiat Oncol 2018; 62:493-498. [PMID: 29656552 DOI: 10.1111/1754-9485.12728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/24/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The multi-phase or four-dimensional computed tomography (4D CT) has emerged as a promising technique for preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism (PHPT), but little is known about its accuracy in patients with normocalcemic primary hyperparathyroidism (NPHPT). METHODS A total of 18 patients diagnosed with PHPT underwent three methods of preoperative localization (4D CT, TC-99-Sestamibi scintigraphy and ultrasonography). After surgery, the results of imaging were compared with operative findings, pathological and biochemical data to evaluate the sensitivity and of each localization procedure. RESULTS In NPHPT the sensitivity for identifying the parathyroid lesion, according to presentation of PHPT (hypercalcemic or normocalcemic), was better with 4DCT in comparison to USG and scintigraphy. In these patients, the sensitivity for lateralization was as follows: USG: 22% (95% CI 0-44.9), scintigraphy: 11.1% (95% CI 0-31.6), 4DCT: 55.6% (95% CI 23.1-88). In hypercalcemic patients the results were as follows: USG: 58.3% (95% CI 30.4-86.2), scintigraphy: 75% (95% CI 50.5-99.5), 4DCT: 75% (95% CI 50.5-99.5). There was a poor agreement between the three procedures in the identification of the parathyroid lesions, with Kappa coeficients of 0.292 and 0.01 for scintigraphy and 4DCT, respectively, in comparison to USG. CONCLUSION Our data showed that 4DCT had a better performance as a preoperative localization procedure of the parathyroid lesion in patients with NPHPT.
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Affiliation(s)
- Phelipe Cunha-Bezerra
- Head and Neck Unit, Department of Surgery, Oswaldo Cruz Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Ricardo Vieira
- Head and Neck Unit, Department of Surgery, Oswaldo Cruz Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Fernando Amaral
- Radiology Department, Hospital Barão de Lucena (SUS/PE), Recife, Brazil
| | | | - Túlio Lima
- Pathology Division, Instituto de Medicina Integral Prof. Fernando Figueira (Imip), Recife, Brazil
| | | | - Francisco Bandeira
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Hospital Agamenon Magalhães, University of Pernambuco Medical School, Recife, Brazil
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Karipineni F, Sahli Z, Somervell H, Mathur A, Prescott JD, Tufano RP, Zeiger MA. Are preoperative sestamibi scans useful for identifying ectopic parathyroid glands in patients with expected multigland parathyroid disease? Surgery 2018; 163:35-41. [DOI: 10.1016/j.surg.2017.07.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 12/16/2022]
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Li P, Liu Q, Tang D, Zhu Y, Xu L, Sun X, Song S. Lesion based diagnostic performance of dual phase 99mTc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism. BMC Med Imaging 2017; 17:60. [PMID: 29233127 PMCID: PMC5727828 DOI: 10.1186/s12880-017-0235-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/05/2017] [Indexed: 12/23/2022] Open
Abstract
Background We aimed to evaluate the diagnostic performance of 99mTc-MIBI SPECT/CT and ultrasonography in patients with secondary hyperparathyroidism (SHPT), and explored the factors that affect the diagnostic performance. Methods 99mTc-MIBI SPECT/CT and ultrasonography were performed in 50 patients with SHPT within 1 month before they underwent surgery. Imaging results were confirmed by the pathology. Pearson correlation analysis was used to determine the correlation of PTH level with clinical data. The optimal cutoff value for predicting positive 99mTc-MIBI results was evaluated by ROC analysis in lesions diameter. Results Forty-nine patients had a positive 99mTc-MIBI imaging results and 39 patients had positive ultrasonography results. The sensitivities of 99mTc-MIBI and ultrasonography were 98.00% and 78.00%, respectively. A total of 199 lesions were resected in 50 patients. Among them, 183 lesions were proved to be parathyroid hyperplasia. On per-lesion basis analysis, the sensitivity and specificity of 99mTc-MIBI and ultrasonography were 59.34% and 75.00% vs 46.24% and 80.00%, respectively. The Pearson correlation analysis showed that the serum AKP and PTH level had a significant linear association (r = 0.699, P < 0.001). The lesion diameter was a statistically significant predictive factor in predicting positive 99mTc-MIBI SPECT/CT. The optimal cutoff value for predicting positive 99mTc-MIBI results evaluated by ROC analysis in lesions diameter was 8.05 mm. Conclusion Dual phase 99mTc-MIBI SPECT/CT imaging had a higher sensitivity in patients with SHPT than ultrasonography. Therefore, using 99mTc-MIBI positioning the lesion could be an effective method pre-surgical in patients with SHPT.
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Affiliation(s)
- Panli Li
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China.,SJTU-USYD Joint Research Alliance for Translational Medicine, Shanghai, 200240, China
| | - Qiufang Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China.,SJTU-USYD Joint Research Alliance for Translational Medicine, Shanghai, 200240, China
| | - Daoqiang Tang
- Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yinyan Zhu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China
| | - Lian Xu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China
| | - Xiaoguang Sun
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China
| | - Shaoli Song
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong District, Shanghai, 200127, China.
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Zhang L, Xing C, Shen C, Zeng M, Yang G, Mao H, Zhang B, Yu X, Cui Y, Sun B, Ouyang C, Ge Y, Jiang Y, Yin C, Zha X, Wang N. Diagnostic Accuracy Study of Intraoperative and Perioperative Serum Intact PTH Level for Successful Parathyroidectomy in 501 Secondary Hyperparathyroidism Patients. Sci Rep 2016; 6:26841. [PMID: 27231027 PMCID: PMC4882599 DOI: 10.1038/srep26841] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022] Open
Abstract
Parathyroidectomy (PTX) is an effective treatment for severe secondary hyperparathyroidism (SHPT); however, persistent SHPT may occur because of supernumerary and ectopic parathyroids. Here a diagnostic accuracy study of intraoperative and perioperative serum intact parathyroid hormone (iPTH) was performed to predict successful surgery in 501 patients, who received total PTX + autotransplantation without thymectomy. Serum iPTH values before incision (io-iPTH0), 10 and 20 min after removing the last parathyroid (io-iPTH10, io-iPTH20), and the first and fourth day after PTX (D1-iPTH, D4-iPTH) were recoded. Patients whose serum iPTH was >50 pg/mL at the first postoperative week were followed up within six months. Successful PTX was defined if iPTH was <300 pg/mL, on the contrary, persistent SHPT was regarded. There were 86.4% patients underwent successful PTX, 9.8% remained as persistent SHPT and 3.8% were undetermined. Intraoperative serum iPTH demonstrated no significant differences in two subgroups with or without chronic hepatitis. Receiver operating characteristic (ROC) curves showed that >88.9% of io-iPTH20% could predict successful PTX (area under the curve [AUC] 0.909, sensitivity 78.6%, specificity 88.5%), thereby avoiding unnecessary exploration to reduce operative complications. D4-iPTH >147.4 pg/mL could predict persistent SHPT (AUC 0.998, sensitivity 100%, specificity 99.5%), so that medical intervention or reoperation start timely.
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Affiliation(s)
- Lina Zhang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Changying Xing
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, People's Republic of China
| | - Ming Zeng
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Guang Yang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Huijuan Mao
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Bo Zhang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Xiangbao Yu
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Yiyao Cui
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Bin Sun
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Chun Ouyang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Yifei Ge
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Yao Jiang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Caixia Yin
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Xiaoming Zha
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
| | - Ningning Wang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China
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Lee JB, Kim WY, Lee YM. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism. Ann Surg Treat Res 2015; 89:300-5. [PMID: 26665124 PMCID: PMC4672093 DOI: 10.4174/astr.2015.89.6.300] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The role of preoperative localization studies is controversial in surgery of secondary hyperparathyroidism (sHPT). The aim of study was to evaluate the accuracy of preoperative ultrasonography (USG), CT, and (99m)Tc sestamibi scintigraphy (MIBI) in localizing enlarged parathyroid glands and to find the impact of correct localization in successful parathyroidectomy. METHODS We compared operative findings with the preoperative localization of ultrasonography, computerized tomography and sestamibi scintigraphy in 109 patients with sHPT and identified well-visualized locations of abnormal parathyroid glands by evaluating the sensitivity of each imaging study with regard to typical locations of glands. We investigated the effect of preoperative imaging localization on the surgical outcomes by measuring the intraoperative parathyroid hormone (ioPTH) decrement for positive or negative imaging localization. RESULTS USG (91.5%) had the highest sensitivity and MIBI (56.1%) had the lowest among 3 modalities. The sensitivity of combined USG and CT (95.0%) was the highest among combined 2 modalities. The combination of all 3 modalities (95.4%) had the highest sensitivity among the combinations of modalities. The reduction of ioPTH in patients with positive imaging localization (86.6%) was greater than negative imaging localization (84.2%), with no significant difference (P = 0.586). The recurrence or persistence of sHPT was not correlated with preoperative imaging localization (19 patients in negative, 16 in positive; P = 0.14). CONCLUSION Preoperative imaging localization contributed to surgical success but not to surgical outcomes. The combination of ioPTH measurement with imaging localization might be valuable for better surgical results in sHPT.
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Affiliation(s)
- Jae Bok Lee
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Young Kim
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Secondary Hyperparathyroidism With “Superscan-Like” Hypermetabolic FDG PET/CT Pattern. Clin Nucl Med 2015; 40:888-9. [DOI: 10.1097/rlu.0000000000000952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yuan LL, Kan Y, Ma DQ, Yang JG. Combined application of ultrasound and SPECT/CT has incremental value in detecting parathyroid tissue in SHPT patients. Diagn Interv Imaging 2015; 97:219-25. [PMID: 26432401 DOI: 10.1016/j.diii.2015.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/02/2015] [Accepted: 08/26/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE The goal of this study is to investigate whether combined application of ultrasound and 99mTc-sestamibi SPECT/CT had the incremental value in accurately detecting parathyroid tissue in patients with SHPT over either method alone. PATIENTS AND METHODS Sixty patients with SHPT on hemodialysis were evaluated preoperatively with parathyroid 99mTc-sestamibi SPECT/CT scintigraphy and ultrasound prior to parathyroidectomy. The sensitivity, specificity and accuracy of 99mTc-sestamibi SPECT/CT scintigraphy, ultrasound and combined application were determined respectively. RESULTS The sensitivity, specificity and accuracy of ultrasound were 81% (155/192), 47% (17/36) and 82% (172/228), respectively. The sensitivity, specificity and accuracy of 99mTc-sestamibi SPECT/CT were 85% (163/192), 58% (21/36) and 89% (184/228) respectively. The accuracy of 99mTc-sestamibi SPECT/CT in the diagnosis of parathyroid tissue in patients with SHPT is significantly higher than that of ultrasound. The sensitivity, specificity and accuracy of combined application of ultrasound and 99mTc-sestamibi SPECT/CT were 93% (178/192), 61% (22/36) and 97% (200/228). The sensitivity, specificity and accuracy of combined application of ultrasound and 99mTc-sestamibi SPECT/CT were higher than those of either ultrasound or 99mTc-sestamibi SPECT/CT. CONCLUSIONS The combined application of ultrasound and 99mTc-sestamibi SPECT/CT had incremental value in accurately detecting parathyroid tissue in patients with SHPT over either method alone.
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Affiliation(s)
- L L Yuan
- Capital Medical University, Beijing Friendship Hospital, Department of Nuclear Medicine, 95, Yong An Road, Xi Cheng district, 100050 Beijing, People's Republic of China
| | - Y Kan
- Capital Medical University, Beijing Friendship Hospital, Department of Nuclear Medicine, 95, Yong An Road, Xi Cheng district, 100050 Beijing, People's Republic of China
| | - D Q Ma
- Capital Medical University, Beijing Friendship Hospital, Radiology Department, 95, Yong An Road, Xi Cheng district, 100050 Beijing, People's Republic of China.
| | - J G Yang
- Capital Medical University, Beijing Friendship Hospital, Department of Nuclear Medicine, 95, Yong An Road, Xi Cheng district, 100050 Beijing, People's Republic of China.
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Hindié E, Zanotti-Fregonara P, Tabarin A, Rubello D, Morelec I, Wagner T, Henry JF, Taïeb D. The Role of Radionuclide Imaging in the Surgical Management of Primary Hyperparathyroidism. J Nucl Med 2015; 56:737-44. [DOI: 10.2967/jnumed.115.156018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/25/2015] [Indexed: 02/07/2023] Open
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Andrade JSCD, Mangussi-Gomes JP, Rocha LAD, Ohe MN, Rosano M, das Neves MC, Santos RDO. Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-Sestamibi scintigraphy. Braz J Otorhinolaryngol 2014; 80:29-34. [PMID: 24626889 PMCID: PMC9443960 DOI: 10.5935/1808-8694.20140008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/12/2013] [Indexed: 11/21/2022] Open
Abstract
Introdução O hiperparatireoidismo é uma consequência metabólica esperada na doença renal crônica (DRC). Paratireoides (PT) ectópicas e/ou supranumerárias podem ser causa de falha cirúrgica nos pacientes submetidos à paratireoidectomia total (PTX). Objetivo Definir cirurgicamente a localização das PT, em pacientes com hiperparatireoidismo associado à DRC, correlacionar esses achados com os exames pré-operatórios. Materiais e métodos Foi conduzido um estudo retrospectivo com 166 pacientes submetidos à PTX. A localização das PT no intraoperatório foi registrada, sendo classificada como tópica ou ectópica. A localização pré-operatória, definida pela ultrassonografia (USG) e pela cintilografia Tc99m-Sestamibi (MIBI), foi comparada com aos achados cirúrgicos. Resultados Nos 166 pacientes, foram identificadas 664 PT. Foram classificadas como tópicas e ectópicas 577 (86,4%) e 91(13,6%) glândulas, respectivamente. Oito PT supranumerárias foram encontradas (7 tópicas e 1 ectópica). As localizações mais comuns de PT ectópicas foram as regiões retroesofágica e tímica. Associadas, a USG e a MIBI não identificaram 56 glândulas (61,5%) ectópicas. Entretanto, a MIBI foi positiva para 69,7% daquelas localizadas nas regiões tímicas e mediastinal. Conclusão A presença de glândulas ectópicas e supranumerárias em pacientes com hiperparatireoidismo associado à DRC é significativa. Os exames de imagem pré-operatórios não localizaram a maioria das glândulas ectópicas. A MIBI pode ter importância na identificação de PT nas regiões tímica e mediastinal.
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Affiliation(s)
- José Santos Cruz de Andrade
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - João Paulo Mangussi-Gomes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Lillian Andrade da Rocha
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Nefrologia, São PauloSP, Brasil, Departamento de Nefrologia, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Monique Nakayama Ohe
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Endocrinologia Clínica, São PauloSP, Brasil, Departamento de Endocrinologia Clínica, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Marcello Rosano
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Murilo Catafesta das Neves
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Rodrigo de Oliveira Santos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
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Value of dual-phase (99m)Tc-sestamibi scintigraphy with neck and thoracic SPECT/CT in secondary hyperparathyroidism. AJR Am J Roentgenol 2014; 202:180-4. [PMID: 24370142 DOI: 10.2214/ajr.13.11053] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgical intervention in the form of parathyroidectomy is generally considered only for severe secondary hyperparathyroidism (sHPT). However, correct location of the parathyroid glands before parathyroidectomy is a challenge. The purpose of this study was to compare the diagnostic value of early and delayed phase (99m)Tc-sestamibi SPECT/CT in the detection of parathyroid tissue to guide operative treatment of patients with sHPT. SUBJECTS AND METHODS Eighty patients with sHPT who were undergoing hemodialysis were evaluated preoperatively with dual-phase (99m)Tc-sestamibi SPECT/CT parathyroid scintigraphy to locate parathyroid tissue before parathyroidectomy. The scintigraphic results were classified as positive or negative. The accuracy of (99m)Tc sestamibi early and delayed phase SPECT/CT scintigraphy was determined. RESULTS Early phase (99m)Tc-sestamibi SPECT/CT depicted 3.57 parathyroid glands (PTGs) and delayed phase (99m)Tc-sestamibi SPECT/CT depicted 3.55 PTGs per study. The specificity of both early and delayed phase (99m)Tc-sestamibi SPECT/CT in detecting PTGs was 100%. The (99m)Tc-sestamibi SPECT/CT images of 7 of 80 patients showed positive findings in the delayed phase and negative findings in the early phase. The (99m)Tc-sestamibi SPECT/CT images of 6 of 80 patients showed positive findings in the early phase and negative findings in the delayed phase. CONCLUSION The results of our study indicate that both early and delayed phase (99m)Tc-sestamibi SPECT/CT should be performed in the preoperative evaluation of hemodialysis patients with sHPT due to chronic kidney disease. Performance of both early and delayed phase (99m)Tc-sestamibi SPECT/CT did not increase the radiation dose compared with the use of only the early or the delayed phase.
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Parathyroid scintigraphy in renal hyperparathyroidism: the added diagnostic value of SPECT and SPECT/CT. Clin Nucl Med 2014; 38:630-5. [PMID: 23751837 DOI: 10.1097/rlu.0b013e31829af5bf] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Secondary hyperparathyroidism (sHPT) is a major complication for patients with end-stage renal disease on long-term hemodialysis or peritoneal dialysis. When the disease is resistant to medical treatment, patients with severe sHPT are typically referred for parathyroidectomy (PTx), which usually improves biological parameters as well as clinical signs and symptoms. Unfortunately, early surgical failure with persistent disease may occur in 5%-10% of patients and recurrence reaches 20%-30% at 5 years. Presently, the use of parathyroid scintigraphy in sHPT is usually limited to the management of surgical failures after initial PTx. This review describes the strengths and limitations of typical (99m)Tc-sestamibi imaging protocols, and highlights the potential benefits of using parathyroid scintigraphy in the initial workup of surgical patients.
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Advantages of pinhole collimator double-phase scintigraphy with 99mTc-MIBI in secondary hyperparathyroidism. Clin Nucl Med 2013; 38:878-81. [PMID: 24089071 DOI: 10.1097/rlu.0b013e3182a77d0d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to determine if pinhole collimator-acquired images can improve the detection of hyperfunctioning parathyroid glands in patients with secondary hyperparathyroidism. METHODS Forty-two patients being treated with cinacalcet for secondary hyperparathyroidism were studied prospectively. Patients were divided into 2 groups according to their levels of parathyroid hormone (PTH), the hormone that defines response to treatment: "responders" (PTH <300 pg/mL) and "nonresponders" (PTH ≥ 300 pg/mL). Double-phase scintigraphy using 888 MBq of (99m)Tc-MIBI was used to acquire early and late parallel-hole and pinhole collimator images. Neck ultrasonography was performed on all patients to identify intrathyroid nodules. All focal uptake in any of the acquired scintigraphic images was considered positive. RESULTS The responder group included 24 patients, whereas 18 patients were considered as nonresponders. At least 1 parathyroid gland with (99m)Tc-MIBI uptake was detected in 33 of 42 patients, with a total of 50 parathyroid glands located. We found significant differences between the detection rates of late pinhole collimator and the late parallel-hole images (74% vs 48%, P = 0.0036). This detection rate was highest with late parallel-hole images in the nonresponder group (89%). CONCLUSIONS The late pinhole collimator acquisition showed the highest detection rate of hyperfunctioning parathyroid glands using (99m)Tc-MIBI scintigraphy in secondary hyperparathyroidism patients treated with cinacalcet.
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Current trends in surgery for renal hyperparathyroidism (RHPT)--an international survey. Langenbecks Arch Surg 2012; 398:121-30. [PMID: 23143163 DOI: 10.1007/s00423-012-1025-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/23/2012] [Indexed: 01/28/2023]
Abstract
PURPOSE The indications and results of preoperative localization, surgical strategy, indication for thymectomy, the application of intraoperative parathyroid hormone (PTH) monitoring, cryopreservation, and replantation of cryopreserved parathyroid tissue are not well documented in renal hyperparathyroidism (RHPT). The current trends in surgery for RHPT are to be evaluated in an international online survey. METHODS Thirty-three questions regarding preoperative localization, surgical management of RHPT, intraoperative PTH monitoring, immediate/delayed autotransplantation (AT), and parathyroid cryopreservation were sent to members of various societies of endocrine surgeons. RESULTS The data from 86 responses were analyzed, 61.6 % reported more than 50 parathyroid surgeries per year, and 62.7 % operated on less than 16 patients with RHPT per year. Subtotal or total parathyroidectomy (with/without AT) was the standard procedure in 98.8 % of the cases. Immediate AT was performed in 40.7 % (72.7 % in the forearm). In most patients, the onset of graft function was documented later than 1 week after AT. Cryopreservation was routinely performed in 27.4 %. In 10.7 %, replantation was performed in more than five patients (hypo- or aparathyroidism: n = 41; fresh graft failure: n = 13; reoperations: n = 9). Intraoperative PTH monitoring (in RHPT) was routinely used in 46.2 %. Its influence on surgical strategy was confirmed in 40 %. CONCLUSIONS The survey reflects the divergent strategies applied for AT, cryopreservation, and PTH monitoring in RHPT.
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Parathyroid-gland ultrasonography in clinical and therapeutic evaluation of renal secondary hyperparathyroidism. LA RADIOLOGIA MEDICA 2012; 118:707-22. [DOI: 10.1007/s11547-012-0882-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/29/2012] [Indexed: 10/27/2022]
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Preoperative localizing studies for initial parathyroidectomy in MEN1 syndrome: is there any benefit? World J Surg 2012; 36:1368-74. [PMID: 22350475 DOI: 10.1007/s00268-012-1451-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND The objective of the present study was to evaluate the utility of preoperative localizing studies in patients with MEN1 undergoing initial bilateral neck exploration (BNE) and parathyroidectomy for pHPT. METHODS We performed a retrospective analysis of patients diagnosed with MEN1 who underwent initial parathyroidectomy between December 1993 and December 2010. Results of preoperative localizing studies were compared with intraoperative findings and outcome. RESULTS Sixty patients with MEN1 (32 females and 28 males) underwent initial subtotal parathyroidectomy. The median age at the time of surgery was 33 years (range: 13-78 years). Fifty-three patients had one or more positive localizing study results. Neck ultrasonography, sestamibi scan, parathyroid protocol computed tomography scan, and neck and mediastinum magnetic resonance imaging were performed in 93, 91, 32, and 19% of patients, respectively. Fifty-three patients (88%) had cervical thymectomy. Twenty patients had 24 ectopic parathyroid glands; 18 glands were in the thymus (75%). Preoperative localizing studies identified 9 of 24 ectopic parathyroid glands (38%), including 4 ectopic glands outside the thymus in 4 patients (7%); 3 were detected by ultrasonography. There were no supernumerary glands identified on preoperative localizing studies. CONCLUSIONS In patients with MEN1, preoperative localizing studies identified a subset of ectopic glands (38%). Preoperative localizing studies may alter the operative approach in 7% of patients. Ultrasonography can detect most ectopic parathyroid glands outside thymus. This suggests that routine preoperative localizing studies to identify ectopic and supernumerary enlarged parathyroid glands is not useful in the majority of patients with MEN1 undergoing bilateral neck exploration and subtotal parathyroidectomy with cervical thymectomy.
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Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using ⁹⁹mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med 2012; 26:794-803. [PMID: 22875577 DOI: 10.1007/s12149-012-0643-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Parathyroid scintigraphy using (99m)Tc-MIBI is not currently considered a valuable diagnostic tool for the localization of involved glands in patients with secondary hyperparathyroidism (SHPT). However, published data about its diagnostic accuracy are discordant and a meta-analysis about this topic is still lacking. The aim of our study is to meta-analyze the published data about the diagnostic performance of (99m)Tc-MIBI parathyroid scintigraphy in patients with SHPT. METHODS A comprehensive computer literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through September 2011 and regarding the diagnostic accuracy of (99m)Tc-MIBI parathyroid scintigraphy in patients with SHPT was carried out. Only articles in English language in which at least 10 patients with SHPT underwent planar (99m)Tc-MIBI parathyroid scintigraphy were selected. Pooled sensitivity, pooled specificity and area under the ROC curve on a per lesion-based analysis were calculated to measure the diagnostic accuracy of (99m)Tc-MIBI parathyroid scintigraphy in SHPT patients. RESULTS Twenty-four studies comprising 471 patients were included in this meta-analysis. The pooled sensitivity and specificity of (99m)Tc-MIBI parathyroid scintigraphy in detecting hyperplastic glands in SHPT patients were 58 % [95 % confidence interval (95 % CI) 52-65 %] and 93 % (95 % CI 85-100 %), respectively, on a per lesion-based analysis. Area under ROC curve was 0.75. CONCLUSIONS In patients with SHPT and diffuse or nodular hyperplasia, planar parathyroid scintigraphy using (99m)Tc-MIBI has demonstrated an inadequate diagnostic accuracy. Therefore, it should not be considered as a first-line diagnostic imaging method in the pre-surgical detection of hyperplastic parathyroid glands.
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Affiliation(s)
- Carmelo Caldarella
- Department of Bioimaging and Radiological Sciences, Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Hunter GJ, Schellingerhout D, Vu TH, Perrier ND, Hamberg LM. Accuracy of four-dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Radiology 2012; 264:789-95. [PMID: 22798226 DOI: 10.1148/radiol.12110852] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate multiphase multidetector four-dimensional computed tomography (CT) as a technique to correctly localize abnormal parathyroid glands in patients with primary hyperparathyroidism. MATERIALS AND METHODS Informed consent was waived by the institutional review body for this retrospective, chart review study. Radiology reports from four-dimensional CT and surgical notes were reviewed in 143 patients with primary hyperparathyroidism (35 men, 108 women; median ages, 58 and 60 years, respectively) who underwent parathyroid surgery between August 2004 and January 2007 and in whom four-dimensional CT predicted a single lesion. Accuracy of four-dimensional CT was stratified by patient and was determined separately for localization to the correct side and quadrant (upper and lower for each side), with surgical findings serving as standard of reference. RESULTS In 143 patients, 148 abnormal parathyroid glands were found at surgery; 137 (93%) of these were weighed, with mean and median weights of 757 and 417 mg, respectively. Four-dimensional CT lateralized the abnormal glands with 93.7% accuracy (134 of 143). For localization according to quadrant, the accuracy was 86.6% (116 of 134). CONCLUSION Four-dimensional CT has sufficiently high accuracy in presurgical localization to allow confident performance of unilateral parathyroidectomy in patients with sporadic primary hyperparathyroidism. The superior accuracy compared with that of ultrasonography and technetium 99m sestamibi scanning may be sufficient to allow four-dimensional CT to be used as the sole presurgical localization method.
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Affiliation(s)
- George J Hunter
- Department of Neuroradiology, Massachusetts General Hospital, 55 Fruit St, Gray 273a, Boston, MA 02114, USA.
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VULPIO C, MARESCA G, DISTASIO E, CACACI S, PANOCCHIA N, LUCIANI G, BOSSOLA M. Switch from calcitriol to paricalcitol in secondary hyperparathyroidism of hemodialysis patients: Responsiveness is related to parathyroid gland size. Hemodial Int 2011; 15:69-78. [DOI: 10.1111/j.1542-4758.2010.00514.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Komaba H, Nakanishi S, Fujimori A, Tanaka M, Shin J, Shibuya K, Nishioka M, Hasegawa H, Kurosawa T, Fukagawa M. Cinacalcet effectively reduces parathyroid hormone secretion and gland volume regardless of pretreatment gland size in patients with secondary hyperparathyroidism. Clin J Am Soc Nephrol 2010; 5:2305-14. [PMID: 20798251 DOI: 10.2215/cjn.02110310] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients with secondary hyperparathyroidism. However, it has not been proven whether parathyroid gland size predicts response to therapy and whether cinacalcet is capable of inducing a reduction in parathyroid volume. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This 52-week, multicenter, open-label study enrolled hemodialysis patients with moderate to severe secondary hyperparathyroidism (intact PTH >300 pg/ml). Doses of cinacalcet were adjusted between 25 and 100 mg to achieve intact PTH <180 pg/ml. Ultrasonography was performed to measure the parathyroid gland size at baseline, week 26, and week 52. Findings were also compared with those of historical controls. RESULTS Of the 81 subjects enrolled, 56 had parathyroid glands smaller than 500 mm(3) (group S) and 25 had at least one enlarged gland larger than 500 mm(3) (group L). Treatment with cinacalcet effectively decreased intact PTH by 55% from baseline in group S and by 58% in group L. A slightly greater proportion of patients in group S versus group L achieved an intact PTH <180 pg/ml (46 versus 32%) and a >30% reduction from baseline (88 versus 78%), but this was not statistically significant. Cinacalcet therapy also resulted in a significant reduction in parathyroid gland volume regardless of pretreatment size, which was in sharp contrast to historical controls (n = 87) where parathyroid gland volume progressively increased with traditional therapy alone. CONCLUSIONS Cinacalcet effectively decreases serum PTH levels and concomitantly reduces parathyroid gland volume, even in patients with marked parathyroid hyperplasia.
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Affiliation(s)
- Hirotaka Komaba
- Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe, Japan
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