1
|
Akgun E, Ibrahimli A, Rahman M, Griffith C, Berber E. Correlation Between Near-Infrared Autofluorescence Properties and Sestamibi Uptakes of Parathyroid Glands in Primary Hyperparathyroidism. Otolaryngol Head Neck Surg 2024. [PMID: 39154258 DOI: 10.1002/ohn.948] [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: 05/20/2024] [Revised: 07/29/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE Near-infrared autofluorescence (NIRAF) characteristics of parathyroid glands in primary hyperparathyroidism (pHPT) vary, with unclarity regarding the underlying mechanism. Similarly, 99mTc-sestamibi uptake in diseased parathyroid glands is variable. There is a suggestion that oxyphilic cell content may influence both imaging modalities. This study aims to analyze the relationship between NIRAF imaging characteristics, 99mTc-sestamibi uptake, and cellular composition in pHPT. STUDY DESIGN Retrospective analysis of an Institutional Review Board-monitored prospective database. SETTING Single tertiary referral center. METHODS NIRAF characteristics of parathyroid glands of patients with pHPT between 2019 and 2024 were compared with 99mTc-sestamibi scan findings from a prospective database. Using third-party software, brightness intensity and heterogeneity index (HI) of the glands were calculated. A subgroup of parathyroid glands obtained from consecutive patients with pHPT in 2020 to 2021 underwent histological analysis. RESULTS A total of 428 patients with 638 diseased parathyroid glands were analyzed. Forty-seven percent of the glands showed an uptake on 99mTc-sestamibi scans. The brightness intensity of the NIRAF signals from parathyroid glands that were seen versus not seen on sestamibi was 2.1 versus 2.3 (P = .002) and HI 0.18 versus 0.17 (P = .35), respectively. On multivariate analysis, low autofluorescence intensity, high gland volume, and single adenoma were associated with detectability on 99mTc-sestamibi scan (P < .0001). Intraglandular adipose tissue content was lower in diseased glands that were detected on 99mTc-sestamibi scans (0% vs 5%, P < .0001). CONCLUSION Our findings indicate an inverse relationship between autofluorescence intensity and detectability on 99mTc-sestamibi scans and a lack of correlation between different cell types and autofluorescence properties.
Collapse
Affiliation(s)
- Ege Akgun
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arturan Ibrahimli
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mobeen Rahman
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Lu L, Shang HQ. Advances in the application of auxiliary imaging techniques in parathyroid diseases. World J Clin Cases 2024; 12:2946-2950. [PMID: 38898826 PMCID: PMC11185382 DOI: 10.12998/wjcc.v12.i17.2946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
Hypoparathyroidism is one of the main complications after total thyroidectomy, severely affecting patients' quality of life. How to effectively protect parathyroid function after surgery and reduce the incidence of hypoparathyroidism has always been a key research area in thyroid surgery. Therefore, precise localization of parathyroid glands during surgery, effective imaging, and accurate surgical resection have become hot topics of concern for thyroid surgeons. In response to this clinical phenomenon, this study compared several different imaging methods for parathyroid surgery, including nanocarbon, indocyanine green, near-infrared imaging techniques, and technetium-99m methoxyisobutylisonitrile combined with gamma probe imaging technology. The advantages and disadvantages of each method were analyzed, providing scientific recommendations for future parathyroid imaging. In recent years, some related basic and clinical research has also been conducted in thyroid surgery. This article reviewed relevant literature and provided an overview of the practical application progress of various imaging techniques in parathyroid surgery.
Collapse
Affiliation(s)
- Lei Lu
- Department of Breast and Thyroid Surgery, Beijing Haidian Hospital, Beijing 100080, China
| | - Hong-Qing Shang
- Department of Breast and Thyroid Surgery, Beijing Haidian Hospital, Beijing 100080, China
| |
Collapse
|
3
|
Adarve Castro A, Domínguez Pinos D, Soria Utrilla V, O'Farrell Del Campo JA, Sendra Portero F, Ruiz-Gómez MJ. Update in imaging tests used for the localization of parathyroid pathology. RADIOLOGIA 2024; 66:236-247. [PMID: 38908885 DOI: 10.1016/j.rxeng.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/28/2023] [Indexed: 06/24/2024]
Abstract
Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET). There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.
Collapse
Affiliation(s)
- A Adarve Castro
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - D Domínguez Pinos
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Hospital Universitario Virgen de la Victoria, Málaga, Spain.
| | | | | | - F Sendra Portero
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - M J Ruiz-Gómez
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| |
Collapse
|
4
|
Yu D, Zou L, Jin Y, Wei M, Wu X, Zuo L, Wu M, Jiang Y. Semiquantitative assessment of 99mTc-MIBI uptake in parathyroids of secondary hyperparathyroidism patients with chronic renal failure. Front Endocrinol (Lausanne) 2022; 13:915279. [PMID: 36157459 PMCID: PMC9492857 DOI: 10.3389/fendo.2022.915279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the valuably influential factors and improve the diagnostic accuracy and efficiency of 99mTc-methoxyisobutylisonitrile (MIBI) uptake in parathyroids of secondary hyperparathyroidism (SHPT) patients with chronic renal failure (CRF). METHODS The correlation analysis was performed between clinical indices related to CRF and 99mTc-MIBI uptake intensity TBR (the gray value mean ratio between the parathyroid target and the bilateral neck background, semiquantitatively calculated with ImageJ software). All clinical indices and TBRs were compared by a three- or two-level grouping method of MIBI uptake, which was visually qualitatively assessed. The three-level grouping method comprised slight, medium, and high groups with little, faint, and distinct MIBI concentration in parathyroids, respectively. The two-level grouping method comprised insignificant and significant groups with TBR greater than or less than 0.49-0.71, respectively. RESULTS MIBI uptake was significantly positively related to patient age, CRF course, hemodialysis vintage, serum parathyroid hormone (PTH), and alkaline phosphatase (AKP) but was significantly negatively related to serum uric acid (UA). MIBI washout was significantly positively related to patient age but was significantly negatively related to serum phosphorus (P) and calcium (Ca) × P. Oral administration of calcitriol and calcium could significantly reduce the MIBI uptake. MIBI uptake tendency might alter. Such seven indices, namely the MIBI uptake, CRF course, hemodialysis vintage, serum AKP, calcium, cysteine proteinase inhibitor C, and PTH, were comparable between the slight and medium groups but were significantly different between the slight and high groups or between the medium and high groups. The above seven indices plus blood urea nitrogen/creatinine were all significantly different between the insignificant and significant groups. All above significances were with P < 0.05. CONCLUSIONS Patient age, CRF course, hemodialysis vintage, serum PTH, AKP, UA, phosphorus, Ca × P, oral administration of calcitriol and calcium, and parathyroids themselves can significantly influence MIBI uptake in parathyroids of SHPT patients with CRF. The two-level grouping method of MIBI intensity should be adopted to qualitatively diagnose the MIBI uptake.
Collapse
Affiliation(s)
- Dafu Yu
- Department of Nuclear Medicine, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Dafu Yu, ; Yong Jiang,
| | - Lin Zou
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Jin
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Mingxiang Wei
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiaoqun Wu
- Department of Respiratory Disease, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Lingjing Zuo
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Mingkang Wu
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yong Jiang
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Dafu Yu, ; Yong Jiang,
| |
Collapse
|
5
|
Zheng Y, Chi X, Qi Y, Jiang Y, Huang K, He Y, Wang S, Li G. [Preoperative diagnostic value of 99mTc- MIBI SPECT/CT imaging combined with semiquantitative analysis in hyperparathyroidism and factors affecting its efficacy]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1577-1582. [PMID: 34755675 DOI: 10.12122/j.issn.1673-4254.2021.10.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic efficacy of technetium-99m methoxyisobutylisonitrile single photon emission/ computed tomography (99mTc- MIBI SPECT/CT), 99mTc- MIBI double- phase scintigraphy (DPS) DPS and ultrasound (US) in preoperative localization of hyperparathyroidism (HPT) and explore the factors affecting the diagnostic efficacy of 99mTc-MIBI SPECT/CT. METHODS We retrospectively analyzed the data of 104 patients with HPT undergoing surgical resection between January, 2015 and July, 2019. Preoperative 99mTc-MIBI imaging was performed in all the patients, and 82 patients also received US examination preoperatively. Semi-quantitative analysis was used to draw the region of interest and calculate the lesion/ ipsilateral deltoid muscle (T/NT) uptake ratio. The sensitivity and detection performance of 99mTc-MIBI SPECT/CT, DPS and US in the diagnosis of HPT patients were compared, and the correlations of the T/NT ratios of parathyroid adenoma (PA) and parathyroid hyperplasia (PH) with the expression levels of COX-2 and Bcl-2 were analyzed. RESULTS The diagnostic sensitivity of 99mTc- MIBI SPECT/CT, DPS and US for HPT was 95.19% (99/104), 91.3% (95/104) and 81.71% (67/82), respectively, demonstrating a significantly higher diagnostic sensitivity of 99mTc-MIBI SPECT/CT than US (χ2=9.59, P=0.008). For PH lesions, 99mTc-MIBI SPECT/CT had the highest diagnostic sensitivity, followed by DPS and then by US (P < 0.05), but their sensitivity did not differ significantly for PA (P>0.05). The T/NT ratio in fatty hyperplastic glands was significantly lower than that in fat-free hyperplastic glands (P=0.009). In PA, Bcl-2 expression was significantly lower in false negative lesions than in true positive lesions (P=0.046), but Cox-2 expression did not show such a difference (P>0.05). In PH lesions, the expressions of Bcl-2 and Cox- 2 did not differ significantly between false negative than true positive lesions (P>0.05). CONCLUSIONS 99mTc-MIBI SPECT/CT has a high sensitivity for HPT localization, and the T/NT ratio is positively correlated with the lesion volume. An increased expression of Bcl-2 in PA lesions and a decreased cell fat content in PH lesions can facilitate the detection of HPT glands by 99mTc-MIBI SPECT/CT.
Collapse
Affiliation(s)
- Y Zheng
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X Chi
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y Qi
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y Jiang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - K Huang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y He
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - S Wang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - G Li
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
6
|
Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules? SURGERIES 2021. [DOI: 10.3390/surgeries2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases; one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules.
Collapse
|
7
|
Erovic BM, Goldstein DP, Asa SL, Janik S, Mete O, Irish JC. VEGFR-2 is downregulated in sestamibi-negative parathyroid adenomas. Head Neck 2019; 41:3564-3569. [PMID: 31291025 DOI: 10.1002/hed.25871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the expression profile of several biomarkers in sestamibi-positive (n = 23) and sestamibi-negative (n = 6) parathyroid adenomas. METHODS A tissue microarray of parathyroid adenomas from 29 patients was constructed and slides were stained for several proteins involved in angiogenesis, inflammation, cell adhesion, cell cycle, apoptosis, and with markers of the sonic hedgehog, mTOR, Forkhead box O and WNT signal transduction pathways. Protein expression was determined using an image-analysis software (Spectrum Plus©, 38 Aperio). RESULTS Protein expression analysis revealed that the vascular endothelial growth factor receptor 2 (VEGFR2) score was significantly higher in the sestamibi-positive cohort compared to sestamibi-negative adenomas (P = .038). Other proteins were not differentially expressed between sestamibi-positive and sestamibi-negative adenomas. CONCLUSION It is hypothesized that VEGFR-2 overexpression in parathyroid adenomas increases vascular permeability resulting in a higher uptake of sestamibi.
Collapse
Affiliation(s)
- Boban M Erovic
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia L Asa
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Janik
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Sun X, Huang L, Wu J, Tao Y, Yang F. Novel homozygous inactivating mutation of the calcium-sensing receptor gene in neonatal severe hyperparathyroidism responding to cinacalcet therapy: A case report and literature review. Medicine (Baltimore) 2018; 97:e13128. [PMID: 30407334 PMCID: PMC6250440 DOI: 10.1097/md.0000000000013128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Calcium-sensing receptor (CaSR) mutations can cause life-threatening neonatal severe hyperparathyroidism (NSHPT). The medical management of NSHPT is often challenging and complex. Here, we present a case of NSHPT caused by a novel homozygous CaSR mutation. PATIENT CONCERNS A Chinese female infant presented with poor feeding, constipation, severe hypotonia, and periodic bradycardia. Biochemistry tests revealed markedly elevated serum levels of Ca and parathyroid hormone (PTH). DIAGNOSES Genetic sequencing revealed a previously undescribed CaSR mutation in exon 3 (c.242T>A; p.I81K). A diagnosis of NSHPT secondary to homozygously inherited familial hypocalciuric hypercalcemia syndrome was established. INTERVENTIONS Cinacalcet was administered after the common treatments (low-calcium intake, hydration, and furosemide), calcitonin, and pamidronate therapy all failed. OUTCOMES Serum Ca decreased and stabilized with cinacalcet therapy. During a 10-month follow-up, total calcium was maintained within the high-normal range and PTH was normalized. LESSONS A trial of cinacalcet therapy might be undertaken in cases of NSHPT while definitive results of the genetic analysis are awaited.
Collapse
MESH Headings
- Calcimimetic Agents/therapeutic use
- Calcium/blood
- Cinacalcet/therapeutic use
- Female
- Genetic Testing
- Homozygote
- Humans
- Hyperparathyroidism, Primary/diagnosis
- Hyperparathyroidism, Primary/drug therapy
- Hyperparathyroidism, Primary/genetics
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/genetics
- Mutation
- Parathyroid Hormone/blood
- Receptors, Calcium-Sensing/genetics
Collapse
Affiliation(s)
- Xiaomei Sun
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education
| | - Liang Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wu
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education
| | - Yuhong Tao
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education
| | - Fan Yang
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education
| |
Collapse
|