1
|
Blanco-Saiz I, Goñi-Gironés E, Ribelles-Segura MJ, Salvador-Egea P, Díaz-Tobarra M, Camarero-Salazar A, Rudic-Chipe N, Saura-López I, Alomar-Casanovas A, Rabines-Juárez A, García-Torres J, Anda-Apiñániz E. Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:35-44. [PMID: 37268356 DOI: 10.1016/j.endien.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Selective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. METHODS The study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. RESULTS Selective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. CONCLUSION MIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.
Collapse
|
2
|
Wang Y, Liu Y, Li N, Xu K, Zhang W. Quantitative application of dual-phase 99mTc-sestamibi SPECT/CT imaging of parathyroid lesions: identification of optimal timing in secondary hyperparathyroidism. EJNMMI Phys 2023; 10:29. [PMID: 37079194 PMCID: PMC10119365 DOI: 10.1186/s40658-023-00548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/07/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE In this retrospective study, we compared the maximum standardized uptake values (SUVmax) of parathyroid lesions and the target-to-background ratio (TBR) of parathyroid lesions to thyroid tissue in early-phase single-photon emission computed tomography/computed tomography (SPECT/CT) versus delayed-phase SPECT/CT in patients with secondary hyperparathyroidism (SHPT) in order to determine the optimal timing of 99mTc- methoxyisobutylisonitrile (99mTc-MIBI) SPECT/CT imaging. METHODS Seventeen patients with a history of chronic kidney failure stage 5 on hemodialysis, underwent pre-operative parathyroid scintigraphy for detection and localization of parathyroid lesions. Retrospective analysis was conducted for lesions with focal accumulation of 99mTc-MIBI. All patients underwent dual-phase 99mTc-MIBI parathyroid scintigraphy and dual-phase SPECT/CT. SUVmax of parathyroid lesions and thyroid tissues was measured. RESULTS Mean SUVmax of parathyroid lesions was 4.86 on early-phase and 2.58 on delayed-phase SPECT/CT, respectively. Mean TBR was 1.14 on early phase and 1.48 on delayed-phase SPECT/CT, respectively. Statistically significant differences in SUVmax and TBR between dual-phase SPECT/CT were observed (P < 0.001). CONCLUSIONS Delayed-phase SPECT/CT in SHPT is required because of the better image contrast.
Collapse
Affiliation(s)
- Yuhua Wang
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ye Liu
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Na Li
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kang Xu
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wanchun Zhang
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
3
|
Blanco-Saiz I, Goñi-Gironés E, Ribelles-Segura MJ, Salvador-Egea P, Díaz-Tobarra M, Camarero-Salazar A, Rudic-Chipe N, Saura-López I, Alomar-Casanovas A, Rabines-Juárez A, García-Torres J, Anda-Apiñániz E. Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
4
|
Oral A, Guvenis A. Improving the detectability of overactive glands in dual-phase parathyroid SPECT/CT: a Monte Carlo simulation study. Biomed Phys Eng Express 2021; 7. [PMID: 34102614 DOI: 10.1088/2057-1976/ac0954] [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: 01/25/2021] [Accepted: 06/08/2021] [Indexed: 11/11/2022]
Abstract
Objective. SPECT-CT is a standard procedure conducted before minimally invasive surgery for the treatment of primary hyperthyroidism. In order to improve image quality, it is important to know how defect detectability is influenced by acquisition and processing parameters. The objective of this study is to continue prior physical phantom optimization studies by performing Monte Carlo simulations for the dual phase parathyroid SPECT-CT protocol using a digital anthropomorphic phantom.Methods. The dual phase parathyroid SPECT-CT imaging procedure with 99mTc-Sestamibi was simulated using the previously extensively validated SIMIND software for the first time. An anthropomorphic ZUBAL based phantom was built to represent an adenoma. Its diameter was set to 0.76 cm which corresponded to more than three times the pixel size and the target-to-background ratio was set to 16:1 based on previous studies. Four different collimators were tested. Contrast-to-noise (CNR) values were determined for different scatter correction options and processing parameter values. The OSEM algorithm was used for image reconstruction.Results. CNR values were improved from about zero (LEGP collimator, 16 iterations, attenuation correction: on, scatter correction: off) up to 3.7 (LEUHR collimator, 16 iterations, attenuation correction: on, scatter correction: off). The subjective visual assessment of detectability on simulated images agreed with the quantitative CNR values.Conclusion. Higher resolution collimators gave better CNR as confirmed by similar studies. The effect of scatter correction was found beneficial only if both the resolution and sensitivity of the collimator were relatively high. This is a significant finding since there is a shortage of definitive guideline on the use of scatter correction for parathyroid SPECT imaging.
Collapse
Affiliation(s)
- Aysegul Oral
- Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Cengelkoy, 34684 Istanbul, Turkey
| | - Albert Guvenis
- Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Cengelkoy, 34684 Istanbul, Turkey
| |
Collapse
|
5
|
Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2021; 40:222-228. [PMID: 34218884 DOI: 10.1016/j.remnie.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/14/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). METHODS A retrospective observational study was designed in 195 patients (mean age: 59.2 ± 13.0 years; 77% woman) with PHPT (calcium: 11,3 ± 1,1 mg/dl and PTH: 218 ± 295 pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. RESULT 50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146 ± 98 vs. 244 ± 334; p < 0,001), adenomas with smaller sonographic dimensions (maximum diameter: 1,2 ± 0,4 vs. 1,7 ± 0,9 cm; p = 0,001 and volume: 0,36 ± 0,43 vs. 1,7 ± 4,1 cm3; p < 0,001), localized more frequently in upper parathyroid glands (37% vs 14%; p = 0,005) and associated more frequently to thyroid nodules (72% vs 57%; p = 0,045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1,3 ± 0,5 vs. 1,9 ± 1,1 cm; p = 0,008 and volume: 0,30 ± 0,20 vs. 1,2 ± 1,1 cm3; p < 0,001), less heavy (567 ± 282 vs. 1470 ± 1374 mgr.; p = 0,030) and were localized more frequently in upper situation (65% vs 16%; p < 0,001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1 cm (OR: 5,77; IC 95: 1,46-22,71) and upper adenoma localization were observed (OR: 8,05; IC 95%: 2,22-29,16). CONCLUSIONS One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1 cm and upper adenoma localization.
Collapse
|
6
|
Carral F, Jiménez AI, Tomé M, Alvarez J, Díez A, Partida F, Ayala C. Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2020. [PMID: 33246888 DOI: 10.1016/j.remn.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). MATERIAL AND METHODS A retrospective observational study was designed in 195 patients (mean age: 59.2±13.0years; 77% woman) with PHPT (calcium: 11.3±1.1mg/dl and PTH: 218±295pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. RESULTS 50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146±98 vs. 244±334; p<0.001), adenomas with smaller sonographic dimensions (maximum diameter: 1.2±0.4 vs. 1.7±0.9cm; p=0.001 and volume: 0.36±0.43 vs. 1.7±4.1cm3; p<0.001), localized more frequently in upper parathyroid glands (37% vs. 14%; p=0.005) and associated more frequently to thyroid nodules (72% vs. 57%; p=0.045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1.3±0.5 vs. 1.9±1.1cm; p=0.008 and volume: 0.30±0.20 vs. 1.2±1.1cm3; p<0.001), less heavy (567±282 vs. 1470±1374mg; p=0.030) and were localized more frequently in upper situation (65% vs. 16%; p<0.001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1cm (OR: 5.77; 95% CI: 1.46-22.71) and upper adenoma localization were observed (OR: 8.05; 95% IC: 2.22-29.16). CONCLUSIONS One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1cm and upper adenoma localization.
Collapse
Affiliation(s)
- F Carral
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, España.
| | - A I Jiménez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, España
| | - M Tomé
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, España
| | - J Alvarez
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Puerto Real, Cádiz, España
| | - A Díez
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Puerto Real, Cádiz, España
| | - F Partida
- Servicio de Medicina Nuclear, Hospital Universitario Puerta del Mar, Cádiz, España
| | - C Ayala
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, España
| |
Collapse
|
7
|
Chen J, Feng J, Zhou Q, Zheng W, Meng X, Wang Y, Wang J. Intraoperative 99mTc-MIBI-Guided Parathyroidectomy Improves Curative Effect of Parathyroidectomy, Bone Metabolism, and Bone Mineral Density. Am Surg 2020; 87:463-472. [PMID: 33047971 DOI: 10.1177/0003134820951467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to compare the postoperative effects of total parathyroidectomy plus forearm transplantation and radioguided parathyroidectomy on bone metabolism and bone mineral density (BMD). From June 2013 to October 2017, 67 patients with renal secondary hyperparathyroidism (SHPT) received surgical treatment. The control group included 30 cases of classical total parathyroidectomy plus forearm transplantation for SHPT. In the experimental group, 37 patients underwent 99mTc-MIBI-guided parathyroidectomy. Demographics, parathyroid hormone (PTH) level, blood calcium level, and pathological results were compared between the 2 groups. The curative effect of parathyroidectomy and its effect on BMD were also compared. The BMDs in the L1-L4 segments and femoral neck in both groups were significantly improved after operation (all P < .05). The T scores of the L1-L4 segments and femoral neck in both groups were significantly improved after operation (all P < .05). The improvement in the T score of the L4 in the experimental group was significantly higher than that in the control group (P < .05). No significant differences in the improvement in the L1-L3 segments and femoral neck were found between the 2 groups. Both traditional total parathyroidectomy plus forearm transplantation and 99mTc-MIBI-guided parathyroidectomy can improve PTH level, blood calcium level, phosphorus level, bone metabolism, and BMD to varying degrees in patients with SHPT. Compared with the traditional surgery, 99mTc-MIBI-guided parathyroidectomy can improve blood calcium and phosphorus metabolisms, reduce PTH level, and improve the T scores of L4 to a greater extent.
Collapse
Affiliation(s)
- Jun Chen
- 56694 Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jialin Feng
- 56694 Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qinyi Zhou
- 56694 Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjie Zheng
- 56694 Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiangchao Meng
- 56694 Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - You Wang
- 56694 Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiadong Wang
- 56694 Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
8
|
Ishii S, Sugawara S, Yaginuma Y, Kobiyama H, Hiruta M, Watanabe H, Yamakuni R, Hakozaki M, Fujimaki H, Ito H. Causes of false negatives in technetium-99 m methoxyisobutylisonitrile scintigraphy for hyperparathyroidism: influence of size and cysts in parathyroid lesions. Ann Nucl Med 2020; 34:892-898. [PMID: 32920750 DOI: 10.1007/s12149-020-01520-4] [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] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to elucidate the causes of false-negative cases of technetium-99 m methoxyisobutylisonitrile scintigraphy (MIBI) for hyperparathyroidism. METHODS Consecutive MIBI examinations performed in 154 patients between April 2011 and March 2017 were retrospectively reviewed. Sensitivities of MIBI, CT and US were calculated. The effects of serum calcium, phosphorus, PTH, weight of parathyroid lesions, use of NSAIDs and Ca-channel blocker (CCB), presence of cyst in parathyroid lesions, and a number of lesions observed by MIBI were investigated. RESULTS Seventy-nine patients (21 men and 58 women), ranging from 18 to 88 years of age (mean ± SD: 57.6 ± 15.3 years), who underwent parathyroidectomy, were included. MIBI and preoperative US were performed in the 79 patients and single-phase parenchymal contrast-enhanced CT (CE-CT) was performed in 55 patients. A total of 120 parathyroid proliferative nodules were detected by MIBI and US, and 92 lesions were detected by CE-CT. In the lesion base, MIBI detected 82 out of the 120 lesions (sensitivity = 68.3%), US detected 103 out of the 120 lesions (sensitivity = 85.8%), CE-CT detected 63 out of the 92 lesions (sensitivity = 68.5%), and MIBI plus CE-CT detected 72 of the 92 lesions (sensitivity = 78.3%). A significant difference in the sensitivity was found between US and MIBI (P < 0.01), and between US and CT (P < 0.01). In the patient base, MIBI detected 67 out of the 79 patients (sensitivity = 84.8%), US detected 74 out of the 79 patients (sensitivity = 93.7%), CE-CT detected 45 out of the 55 patients (sensitivity = 81.8%), and MIBI plus CE-CT detected 52 out of the 55 patients (sensitivity = 94.5%). No significant difference was observed in any of the comparisons. A significant difference was observed in lesion weight (P < 0.01), single or multiple lesions (P = 0.02), and presence of cyst (P < 0.01) between the MIBI false-negative (n = 38) and the true-positive groups (n = 82). CONCLUSION The presence of cyst in parathyroid proliferative lesions as well as small size and multiple number of parathyroid lesions contribute to false negative in parathyroid MIBI scan.
Collapse
Affiliation(s)
- Shiro Ishii
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan.
| | - Shigeyasu Sugawara
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Yuuki Yaginuma
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Honami Kobiyama
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Mahori Hiruta
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hirotake Watanabe
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Ryo Yamakuni
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Motoharu Hakozaki
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hideki Fujimaki
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, Japan
| |
Collapse
|
9
|
Baj J, Sitarz R, Łokaj M, Forma A, Czeczelewski M, Maani A, Garruti G. Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas. Molecules 2020; 25:E1724. [PMID: 32283730 PMCID: PMC7181220 DOI: 10.3390/molecules25071724] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands' localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the 'ideal' approach for the diagnosis of parathyroid adenomas.
Collapse
Affiliation(s)
- Jacek Baj
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
| | - Robert Sitarz
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
- Department of Surgery, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland;
| | - Marek Łokaj
- Department of Surgery, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland;
| | - Alicja Forma
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
| | - Marcin Czeczelewski
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-950 Lublin, Poland;
| | - Amr Maani
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
| | - Gabriella Garruti
- Section of Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro” Medical School, 70124 Bari, Italy;
| |
Collapse
|
10
|
MacPherson DS, Fung K, Cook BE, Francesconi LC, Zeglis BM. A brief overview of metal complexes as nuclear imaging agents. Dalton Trans 2019; 48:14547-14565. [PMID: 31556418 PMCID: PMC6829947 DOI: 10.1039/c9dt03039e] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Metallic radionuclides have been instrumental in the field of nuclear imaging for over half a century. While recent years have played witness to a dramatic rise in the use of radiometals as labels for chelator-bearing biomolecules, imaging agents based solely on coordination compounds of radiometals have long played a critical role in the discipline as well. In this work, we seek to provide a brief overview of metal complex-based radiopharmaceuticals for positron emission tomography (PET) and single photon emission computed tomography (SPECT). More specifically, we have focused on imaging agents in which the metal complex itself rather than a pendant biomolecule or targeting moiety is responsible for the in vivo behavior of the tracer. This family of compounds contains metal complexes based on an array of different nuclides as well as probes that have been used for the imaging of a variety of pathologies, including infection, inflammation, cancer, and heart disease. Indeed, two of the defining traits of transition metal complexes-modularity and redox chemistry-have both been creatively leveraged in the development of imaging agents. In light of our audience, particular attention is paid to structure and mechanism, though clinical data is addressed as well. Ultimately, it is our hope that this review will not only educate readers about some of the seminal work performed in this space over the last 30 years but also spur renewed interest in the creation of radiopharmaceuticals based on small metal complexes.
Collapse
Affiliation(s)
- Douglas S MacPherson
- Department of Chemistry, Hunter College of the City University of New York, New York, NY 10028, USA.
| | | | | | | | | |
Collapse
|
11
|
Vu TH, Schellingerhout D, Guha-Thakurta N, Sun J, Wei W, Kappadth SC, Perrier N, Kim EE, Rohren E, Chuang HH, Wong FC. Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT. AJNR Am J Neuroradiol 2018; 40:142-149. [PMID: 30523145 DOI: 10.3174/ajnr.a5901] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/14/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT). MATERIALS AND METHODS We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference. RESULTS Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT. CONCLUSIONS For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT.
Collapse
Affiliation(s)
- T H Vu
- From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
| | - D Schellingerhout
- From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
| | - N Guha-Thakurta
- From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
| | - J Sun
- Biostatistics (J.S., W.W.)
| | - W Wei
- Biostatistics (J.S., W.W.)
| | | | | | - E E Kim
- Department of Radiological Sciences (E.E.K.), University of California at Irvine, Orange, California
| | - E Rohren
- Baylor College of Medicine (E.R.), Houston, Texas
| | - H H Chuang
- Nuclear Medicine (H.H.C., F.C.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - F C Wong
- Nuclear Medicine (H.H.C., F.C.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
12
|
Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun 2018; 39:1129-1137. [PMID: 30239472 PMCID: PMC6254783 DOI: 10.1097/mnm.0000000000000921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The aim of this study was to evaluate the value of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) imaging and ultrasound in preoperative localization of parathyroid adenoma (PA) and parathyroid hyperplasia (PH). Participants and methods A retrospective study of 99mTc-MIBI double-phase scintigraphy (DPS) was performed in 187 hyperparathyroidism cases with pathologically diagnosed PA or PH. Of these patients, 167 cases underwent ultrasound, and 146 cases underwent 99mTc-MIBI single-photon emission computed tomography/computed tomography (SPECT/CT). The sensitivity and diagnostic accuracy of ultrasound, 99mTc-MIBI DPS, and SPECT/CT were compared between PA and PH. Differences in 99mTc-MIBI DPS, serum parathyroid hormone (PTH), serum calcium and phosphorus, as well as the weight and longest diameter of lesion between PA and PH were also compared. Results As per patient-based analysis, the sensitivity of ultrasound, 99mTc-MIBI DPS, and SPECT/CT was 90.70% (39/43), 95.56% (43/45), and 100.00% (30/30), respectively, for PA, and 93.55% (116/124), 90.85% (129/142), and 93.10% (108/116), respectively, for PH. There were no significant differences in sensitivity of these three imaging methods between PA and PH. However, per lesion-based analysis, the accuracy of ultrasound, 99mTc-MIBI DPS, and SPECT/CT in detecting PA was 78.43% (40/51), 86.79% (46/53) and 96.88% (31/32), respectively, and the accuracy of 99mTc-MIBI DPS was higher than that of ultrasound (χ2=6.507, P=0.011), and for PH, it was 49.69% (160/322), 40.71% (171/420), and 43.80% (152/347), respectively. The accuracy of ultrasound was higher than that of 99mTc-MIBI DPS (χ2=5.940, P=0.015). The accuracy of a combination of all three examinations of ultrasound+99mTc-MIBI DPS, ultrasound+99mTc-MIBI SPECT/CT, 99mTc-MIBI DPS+SPECT/CT, and ultrasound+99mTc-MIBI DPS+99mTc-MIBI SPECT/CT was 51.51% (154/299), 53.85% (161/299), 50.17% (150/299), and 54.18% (162/299), respectively, which was higher than that of ultrasound (χ2=5.273, P=0.022; χ2=8.226, P=0.004; χ2=3.880, P=0.049; χ2=8.702, P=0.003, respectively). Serum levels of PTH and phosphorus were lower in patients with PA than in patients with PH (P<0.001), and serum calcium level, the weight, and the longest diameter of lesion and early uptake rate of 99mTc-MIBI DPS were higher in patients with PA than in patients with PH (P<0.01). Serum PTH level is often less than 1000 pg/ml in PA, but usually more than 1000 pg/ml in PH. Conclusion Ultrasound, 99mTc-MIBI DPS, and SPECT/CT all have a higher value in the diagnosis of PA than PH. 99mTc-MIBI SPECT/CT should be optimal for detecting PA, and early SPECT/CT scan might be better than delayed scan. Compared with 99mTc-MIBI DPS and SPECT/CT, ultrasound has a slight advantage in localization of PH lesions. The combination of ultrasound and 99mTc-MIBI DPS or SPECT/CT imaging could improve the accuracy in localization of PH lesions and should be considered as the first-line method for detecting PH.
Collapse
|
13
|
LeBlanc RA, Isaac A, Abele J, Biron VL, Côté DWJ, Hearn M, O'Connell DA, Seikaly H, Harris JR. Validation of a novel method for localization of parathyroid adenomas using SPECT/CT. J Otolaryngol Head Neck Surg 2018; 47:65. [PMID: 30367667 PMCID: PMC6203983 DOI: 10.1186/s40463-018-0307-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/07/2018] [Indexed: 12/19/2022] Open
Abstract
Background Accurate localization of parathyroid adenomas is of critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT is considered the investigation of choice but has limitations regarding localization of superior versus inferior adenomas. We proposed a novel method for localization using SPECT/CT by determining the anterior-posterior relationship of the adenoma to a horizontal line in the coronal plane through the tracheoesophageal groove. Our objective was to determine the accuracy, validity, and inter-rater reliability of this method. Method This was a retrospective review of patients who underwent parathyroidectomy for a single adenoma between 2010-2017. SPECT/CT images were reviewed by two staff Otolaryngologists, a Radiologist, an Otolaryngology fellow and Otolaryngology resident. Results were compared using intra-operative report as the gold standard. Overall accuracy in determining superior/inferior and right/left adenomas was calculated, as well as Cohen's Kappa to determine agreement with operative report and inter-rater reliability. The performance was compared to that of the original radiology report. Results One hundred thirty patients met criteria and were included. Our method correctly identified the location of the adenoma in terms of both side and superior/inferior position in 80.4% [76 - 84%] of patients, which considerably outperformed the original radiology report at 48.5% [4-78%] accuracy. The agreement level between our method and operative report was high (Kappa=0.717 [0.691-0.743]), as was the inter-rater reliability (Kappa=0.706 [0.674-0.738]). Conclusion We report a novel method for localization of parathyroid adenomas using SPECT/CT which outperforms standard radiology reporting. This tool can be used by surgeons and radiologists to better inform and plan for minimally invasive parathyroidectomy.
Collapse
Affiliation(s)
- Rachelle A LeBlanc
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Jonathan Abele
- Department of Radiology & Diagnostic Imaging, Royal Alexandra Hospital, 1046 Royal Alexandra Hospital - Diagnostic Treatment Center, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 Street, Edmonton, AB, T6G 2R7, Canada
| | - Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David W J Côté
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Matthew Hearn
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey R Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada.
| |
Collapse
|
14
|
Chen J, Zhou Q, Feng J, Wang J. Combined use of a nanocarbon suspension and 99mTc-MIBI for the intra-operative localization of the parathyroid glands. Am J Otolaryngol 2018; 39:138-141. [PMID: 29336900 DOI: 10.1016/j.amjoto.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the combined use of a nanocarbon (NC) suspension and low-dose 99mTc-MIBI for parathyroid localization during surgery in patients with secondary hyperparathyroidism (sHPT). METHODS Between March 2010 and September 2015, 40 patients with sHPT were enrolled in this study and were randomized to receive either low-dose 99mTc-MIBI+NC (group I) or low-dose 99mTc-MIBI (group II). Pre- and post-operative serum levels of intact PTH (iPTH), calcium and phosphorus between groups were compared and the intra-operative radioactive counts of the parathyroid glands were measured. RESULTS The post-operative iPTH level was significantly lower in patients of group I (24.2±31ng/L) than in those of group II (106±155ng/L) (P=0.03) while there were no significant differences in intra-operative parathyroid gland radioactive counts between the groups. The duration of the surgical procedure was shorter for patients of group I than patients of group II. There were no serious intra-operative or post-operative complications. CONCLUSION The combined use of an NC suspension and 99mTc-MIBI for patients with sHPT is strongly recommended for the localization of parathyroid glands during surgery and is likely to improve clinical outcomes for patients.
Collapse
|
15
|
Gatu A, Velicescu C, Grigorovici A, Danila R, Muntean V, Mogoş SJ, Mogoş V, Vulpoi C, Preda C, Branisteanu D. THE VOLUME OF SOLITARY PARATHYROID ADENOMA IS RELATED TO PREOPERATIVE PTH AND 25OH-D3, BUT NOT TO CALCIUM LEVELS. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:441-446. [PMID: 31149214 DOI: 10.4183/aeb.2017.441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH). Patients and Methods Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid. Results We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively). Conclusions The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.
Collapse
Affiliation(s)
- A Gatu
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - C Velicescu
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of General Surgery, "St. Spiridon" Hospital, Romania.,"Gr.T.Popa" University of Medicine and Pharmacy, 4th unit of surgery, Romania
| | - A Grigorovici
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of General Surgery, "St. Spiridon" Hospital, Romania
| | - R Danila
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of General Surgery, "St. Spiridon" Hospital, Romania
| | - V Muntean
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Dept. of Surgery, Romania
| | - S J Mogoş
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - V Mogoş
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania.,"Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Iasi, Romania
| | - C Vulpoi
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - C Preda
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - D Branisteanu
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| |
Collapse
|