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Lalonde MN, Correia RD, Syktiotis GP, Schaefer N, Matter M, Prior JO. Parathyroid Imaging. Semin Nucl Med 2023; 53:490-502. [PMID: 36922339 DOI: 10.1053/j.semnuclmed.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/13/2023] [Indexed: 03/17/2023]
Abstract
Primary hyperparathyroidism (1° HPT) is a relatively common endocrine disorder usually caused by autonomous secretion of parathormone by one or several parathyroid adenomas. 1° HPT causing hypercalcemia, kidney stones and/or osteoporosis should be treated whenever possible by parathyroidectomy. Accurate preoperative location of parathyroid adenomas is crucial for surgery planning, mostly when performing minimally invasive surgery. Cervical ultrasonography (US) is usually performed to localize parathyroid adenomas as a first intention, followed by 99mTc- sestamibi scintigraphy with SPECT/CT whenever possible. 4D-CT is a possible alternative to 99mTc- sestamibi scintigraphy. Recently, 18F-fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) has made its way in the clinics as it is the most sensitive method for parathyroid adenoma detection. It can eventually be combined to 4D-CT to increase its diagnostic performance, although this results in higher dose exposure to the patient. Other forms of hyperparathyroidism consist in secondary (2° HPT) and tertiary hyperparathyroidism (3° HPT). As parathyroidectomy is not usually part of the management of patients with 2° HPT, parathyroid imaging is not routinely performed in these patients. In patients with 3° HPT, total or subtotal parathyroidectomy is often performed. Localization of hyperfunctional glands is an important aid to surgery planning. As 18F-FCH PET/CT is the most sensitive modality in multigland disease, it is the preferred imaging technic in 3° HPT patients, although its cost and availability may limit its widespread use in this setting.
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Affiliation(s)
- Marie Nicod Lalonde
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ricardo Dias Correia
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerasimos P Syktiotis
- Diabetology and Endocrinology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Niklaus Schaefer
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Maurice Matter
- Visceral Surgery Department, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland.
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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.
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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.
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Kwon K, Hwang D, Oh D, Kim JH, Yoo J, Lee JS, Lee WW. CT-free quantitative SPECT for automatic evaluation of %thyroid uptake based on deep-learning. EJNMMI Phys 2023; 10:20. [PMID: 36947267 PMCID: PMC10033819 DOI: 10.1186/s40658-023-00536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/16/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Quantitative thyroid single-photon emission computed tomography/computed tomography (SPECT/CT) requires computed tomography (CT)-based attenuation correction and manual thyroid segmentation on CT for %thyroid uptake measurements. Here, we aimed to develop a deep-learning-based CT-free quantitative thyroid SPECT that can generate an attenuation map (μ-map) and automatically segment the thyroid. METHODS Quantitative thyroid SPECT/CT data (n = 650) were retrospectively analyzed. Typical 3D U-Nets were used for the μ-map generation and automatic thyroid segmentation. Primary emission and scattering SPECTs were inputted to generate a μ-map, and the original μ-map from CT was labeled (268 and 30 for training and validation, respectively). The generated μ-map and primary emission SPECT were inputted for the automatic thyroid segmentation, and the manual thyroid segmentation was labeled (280 and 36 for training and validation, respectively). Other thyroid SPECT/CT (n = 36) and salivary SPECT/CT (n = 29) were employed for verification. RESULTS The synthetic μ-map demonstrated a strong correlation (R2 = 0.972) and minimum error (mean square error = 0.936 × 10-4, %normalized mean absolute error = 0.999%) of attenuation coefficients when compared to the ground truth (n = 30). Compared to manual segmentation, the automatic thyroid segmentation was excellent with a Dice similarity coefficient of 0.767, minimal thyroid volume difference of - 0.72 mL, and a short 95% Hausdorff distance of 9.416 mm (n = 36). Additionally, %thyroid uptake by synthetic μ-map and automatic thyroid segmentation (CT-free SPECT) was similar to that by the original μ-map and manual thyroid segmentation (SPECT/CT) (3.772 ± 5.735% vs. 3.682 ± 5.516%, p = 0.1090) (n = 36). Furthermore, the synthetic μ-map generation and automatic thyroid segmentation were successfully performed in the salivary SPECT/CT using the deep-learning algorithms trained by thyroid SPECT/CT (n = 29). CONCLUSION CT-free quantitative SPECT for automatic evaluation of %thyroid uptake can be realized by deep-learning.
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Affiliation(s)
- Kyounghyoun Kwon
- Department of Health Science and Technology, The Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Donghwi Hwang
- Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dongkyu Oh
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Jihyung Yoo
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Jae Sung Lee
- Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Won Woo Lee
- Department of Health Science and Technology, The Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
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Liu S, Li M, Pang H, Zuo R, Kong L, Wang Z, Li W, Xia Z, Wang D, Xu L. Clinical application of 18F-FCH PET/CT in the diagnosis and treatment of hyperparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1100056. [PMID: 37113486 PMCID: PMC10126393 DOI: 10.3389/fendo.2023.1100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Objective We evaluated the difference in parathyroid visualization on 18F-FCH PET/CT images obtained at 5 and 60 min, and quantitatively analyzed the mode of FCH uptake at different time points, to determine the best imaging time for FCH PET/CT. Methods This retrospective study included 73 patients with hyperparathyroidism (HPT) who underwent 18F-FCH PET/CT imaging between December 2017 and December 2021. The diagnostic efficiency of 5- and 60-min dual time point imaging for the diagnosis of hyperparathyroidism and parathyroid adenoma and hyperplasia, were compared using visual and quantitative analyses. Results Dual-time 18F-FCH PET/CT imaging visual analysis had diagnostic value for HPT. The receiver operating characteristic curve of PET/CT quantitative parameters for the diagnosis of HPT and lesions showed that the parathyroid/thyroid SUVmax ratio for 60-min imaging had a higher sensitivity and specificity (based on patient, sensitivity: 90.90% and specificity: 85.71%; based on focus, sensitivity: 83.06% and specificity: 85.71%) compared to that for 5-min imaging. PET/CT quantitative parameters can distinguish parathyroid adenoma and hyperplasia. The 60-min parathyroid SUVmax value had the highest diagnostic value (cutoff: 3.945; area under the curve: 0.783). Conclusion The quantitative parameters of 60min 18F-FCH PET/CT have more advantages in aiding in the pathologica diagnosis and clinical treatment of HPT.
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Affiliation(s)
- Shuang Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengdan Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Zuo
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingquan Kong
- Department of Breast Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenbo Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhu Xia
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Lu Xu,
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Hong CM, Jeong YJ, Kim HW, Ahn BC. KSNM60 in Nuclear Endocrinology: from the Beginning to the Future. Nucl Med Mol Imaging 2022; 56:17-28. [PMID: 35186157 PMCID: PMC8828839 DOI: 10.1007/s13139-021-00728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023] Open
Abstract
Nuclear endocrinology is the main ignitor for founding the Korean Society of Nuclear Medicine (KSNM) in the early 1960s by outstanding pioneering medical doctors. Management of thyroid diseases required nuclear medicine technology in the early days of the KSNM and was rapidly developed by advancements in nuclear medicine technology. Nuclear thyroidology remains one of the main clinical applications in nuclear medicine worldwide. Nuclear medicine technology provides essential information for diagnosing and assessing diseases of the parathyroid glands, pituitary gland, and neuroendocrine tumors (NETs). In addition, therapeutic nuclear medicine is essential for managing nonresectable NETs. Nuclear endocrinology remains a major section in clinical nuclear medicine, and members of the KSNM have contributed to progressing better management of benign and malignant endocrine diseases. This review summarizes the historical activities and milestone contributions to nuclear endocrinology made by the members of the KSNM over the past 60 years to congratulate the KSNM on its 60-year anniversary.
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Affiliation(s)
- Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung Gu, Daegu, 41944 South Korea
| | - Young Jin Jeong
- Department of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung Gu, Daegu, 41944 South Korea
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Lee WW, Ryu JS. KSNM 60 in General Nuclear Medicine: the Old Dream Comes True. Nucl Med Mol Imaging 2022; 56:71-79. [PMID: 35464669 PMCID: PMC8976866 DOI: 10.1007/s13139-021-00731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
Since the establishment of the Korean Society of Nuclear Medicine (KSNM) in 1961 by Professor Munho Lee, the KSNM has been progressing in various medical fields. Many papers have been published in the Korean Journal of Nuclear Medicine (KJNM), the official journal of KSNM, since 1967 and other domestic/international journals. Here, we tried to highlight the academic activities of KSNM members from the perspective of general nuclear medicine. After the introduction of the 99Mo/99mTc generator, general nuclear medicine has widened the field of clinical application with the advancement of imaging technology and emerging new radiopharmaceuticals; however, there have been many ups and downs. Treatment, as well as diagnosis, was a major concern in Korean nuclear medicine. With the recent advent of single-photon emission computed tomography/computed tomography, we hope that our old dream (diagnosis and treatment under the same principle of nuclear medicine) comes true.
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