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Christensen JW, Ismail A, Søndergaard SB, Bennedbæk FN, Nygaard B, Jensen LT, Trolle W, Holst‐Hahn C, Zerahn B, Kristensen B, Krakauer M. Preoperative imaging in primary hyperparathyroidism: Are 11 C-Choline PET/CT and 99m Tc-MIBI/ 123 Iodide subtraction SPECT/CT interchangeable or do they supplement each other? Clin Endocrinol (Oxf) 2022; 97:258-267. [PMID: 35150160 PMCID: PMC9542777 DOI: 10.1111/cen.14688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Preoperative location of hyperfunctioning parathyroid glands (HPGs) is vital when planning minimally invasive surgery in patients with primary hyperparathyroidism (PHPT). Dual-isotope subtraction scintigraphy with 99m Tc-MIBI/123 Iodide using SPECT/CT and planar pinhole imaging (Di-SPECT) has shown high sensitivity, but is challenged by high radiation dose, time consumption and cost. 11 C-Choline PET/CT (faster with a lower radiation dose) is non-inferior to Di-SPECT. We aim to clarify to what extent the two are interchangeable and how often there are discrepancies. DESIGN This is a prospective, GCP-controlled cohort study. PATIENTS AND MEASUREMENTS One hundred patients diagnosed with PHPT were included and underwent both imaging modalities before parathyroidectomy. Clinical implications of differences between imaging findings and negative imaging results were assessed. Surgical findings confirmed by biochemistry and pathology served as reference standard. RESULTS Among the 90 patients cured by parathyroidectomy, sensitivity was 82% (95% confidence interval [CI]: 74%-88%) and 87% (95% CI: 79%-92%) for Choline PET and Di-SPECT, respectively, p = .88. In seven cases at least one imaging modality found no HPG. Of these, neither modality found any true HPGs and only two were cured by surgery. When a positive finding in one modality was incorrect, the alternative modality was correct in approximately half of the cases. CONCLUSION Choline PET and Di-SPECT performed equally well and are both appropriate as first-line imaging modalities for preoperative imaging of PHPT. When the first-line modality fails to locate an HPG, additional preoperative imaging with the alternate modality offers no benefit. However, if parathyroidectomy is unsuccessful, additional imaging with the alternate modality has merit before repeat surgery.
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Affiliation(s)
| | - Afefah Ismail
- Department of Nuclear MedicineHerlev and Gentofte HospitalHerlevDenmark
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark
| | | | - Finn N. Bennedbæk
- Division of Endocrinology, Department of MedicineHerlev and Gentofte HospitalHerlevDenmark
| | - Birte Nygaard
- Division of Endocrinology, Department of MedicineHerlev and Gentofte HospitalHerlevDenmark
| | - Lars T. Jensen
- Department of Nuclear MedicineHerlev and Gentofte HospitalHerlevDenmark
| | - Waldemar Trolle
- Department of Otorhinolaryngology and Neck SurgeryNorth Zealand HospitalHilleroedDenmark
| | | | - Bo Zerahn
- Department of Nuclear MedicineHerlev and Gentofte HospitalHerlevDenmark
| | - Bent Kristensen
- Department of Nuclear MedicineHerlev and Gentofte HospitalHerlevDenmark
| | - Martin Krakauer
- Department of Nuclear MedicineHerlev and Gentofte HospitalHerlevDenmark
- Department of Clinical Physiology and Nuclear MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark
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Gillett D, Senanayake R, MacFarlane J, van der Meulen M, Koulouri O, Powlson AS, Crawford R, Gillett B, Bird N, Heard S, Kolias A, Mannion R, Aloj L, Mendichovszky IA, Cheow H, Bashari WA, Gurnell M. Localization of TSH-secreting pituitary adenoma using 11C-methionine image subtraction. EJNMMI Res 2022; 12:26. [PMID: 35524902 PMCID: PMC9079199 DOI: 10.1186/s13550-022-00899-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pituitary adenomas (PA) affect ~ 1:1200 of the population and can cause a wide range of symptoms due to hormone over-secretion, loss of normal pituitary gland function and/or compression of visual pathways, resulting in significantly impaired quality of life. Surgery is potentially curative if the location of the adenoma can be determined. However, standard structural (anatomical) imaging, in the form of MRI, is unable to locate all tumors, especially microadenomas (< 1 cm diameter). In such cases, functional imaging [11C-methionine PET/CT (Met-PET)] can facilitate tumor detection, although may be inconclusive when the adenoma is less metabolically active. We, therefore, explored whether subtraction imaging, comparing findings between two Met-PET scans with medical therapy-induced suppression of tumor activity in the intervening period, could increase confidence in adenoma localization. In addition, we assessed whether normalization to a reference region improved consistency of pituitary gland signal in healthy volunteers who underwent two Met-PET scans without medical suppression. RESULTS We found that the mean percentage differences in maximum pituitary uptake between two Met-PET scans in healthy volunteers were 2.4% for (SUVr) [cerebellum], 8.8% for SUVr [pons], 5.2% for SUVr [gray matter] and 23.1% for the SUVbw [no region]. Laterality, as measured by contrast-noise ratio (CNR), indicated the correct location of the adenoma in all three image types with mean CNR values of 6.2, 8.1 and 11.1 for SUVbw, SUVbwSub and SUVrSub [cerebellum], respectively. Subtraction imaging improved CNR in 60% and 100% of patients when using images generated from SUVbw [no region] and SUVr [cerebellum] scans compared to standard clinical SUVbw imaging. CONCLUSIONS Met-PET scans should be normalized to the cerebellum to minimize the effects of physiological variation in pituitary gland uptake of 11C-methionine, especially when comparing serial imaging. Subtraction imaging following endocrine suppression of tumor function improved lateralization of PA when compared with single time point clinical Met-PET but, importantly, only if the images were normalized to the cerebellum prior to subtraction.
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Affiliation(s)
- Daniel Gillett
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK. .,Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Russell Senanayake
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Merel van der Meulen
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Olympia Koulouri
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Andrew S Powlson
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Rosy Crawford
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Bethany Gillett
- East Anglian Regional Radiation Protection Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nick Bird
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sarah Heard
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Richard Mannion
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Luigi Aloj
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Iosif A Mendichovszky
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Heok Cheow
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Waiel A Bashari
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Mark Gurnell
- Cambridge Endocrine Molecular Imaging Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
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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: 18] [Impact Index Per Article: 6.0] [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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11C-Choline PET/CT vs. 99mTc-MIBI/ 123Iodide Subtraction SPECT/CT for Preoperative Detection of Abnormal Parathyroid Glands in Primary Hyperparathyroidism: A Prospective, Single-Centre Clinical Trial in 60 Patients. Diagnostics (Basel) 2020; 10:diagnostics10110975. [PMID: 33228254 PMCID: PMC7699496 DOI: 10.3390/diagnostics10110975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In patients with primary hyperparathyroidism (PHPT) locating hyperfunctioning glands (HPGs) is crucial when planning minimally invasive surgery. Dual-isotope subtraction scintigraphy with 99mTc-MIBI/123Iodide using SPECT/CT and planar pinhole imaging (Method A) has previously shown a sensitivity >93%. However, the method is costly and time consuming and entails a high radiation dose. 11C-Choline PET/CT (Method B) is an appealing candidate method unencumbered by these disadvantages. METHODS Sixty patients with newly diagnosed PHPT participated and were scanned using both methods prior to parathyroidectomy. We investigated whether sensitivities of Method A and Method B are similar in a method-to-method comparison when using surgical findings as the true location. RESULTS At the patient level, sensitivities were (A) 0.98 (95% CI: 0.90-1.00) and (B) 1.00 (95% CI: 0.93-1.00). At the gland level, sensitivities were (A) 0.88 (95% CI: 0.78-0.94) and (B) 0.87 (95% CI: 0.76-0.92). With a non-inferiority margin of ∆ = -0.1, we found a 1-sided p-value < 0.001. CONCLUSION Our methods comparison study found that sensitivity of Method B was not inferior to Method A. We suggest that 11C-Choline PET/CT is a clinically relevant first-choice candidate for preoperative imaging of PHPT and that Method B can likely replace Method A in the near future.
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Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy. Diagnostics (Basel) 2020; 10:diagnostics10090639. [PMID: 32867155 PMCID: PMC7555464 DOI: 10.3390/diagnostics10090639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Adding subtraction single-photon emission computed tomography/computed tomography (SPECT/CT) to dual isotope (I-123 and Tc-99m-sestamibi) subtraction parathyroid scintigraphy is not widely implemented. We aimed to assess the added value of dual isotope subtraction SPECT/CT over single isotope SPECT/CT as an adjunct to dual isotope planar pinhole subtraction scintigraphy. Methods: Parathyroid scintigraphies from 106 patients with an estimated total of 415 parathyroid glands who (1) were diagnosed with primary hyperparathyroidism, (2) underwent dual isotope subtraction scintigraphy in the Department of Nuclear Medicine, Gentofte Hospital, Denmark throughout 2017 and (3) underwent subsequent parathyroidectomy, were included. The original dual isotope planar pinhole subtraction plus dual isotope subtraction SPECT/CT (dual/dual method) exams were retrospectively re-evaluated using only Tc-99m-sestamibi SPECT/CT (dual/single method). Statistics were calculated per parathyroid. Surgical results confirmed by pathology served as reference standard. Results: The dual/dual method had higher sensitivity than the dual/single method (82% (95%CI 74%–88%) vs. 69% (95%CI 60%–77%)) while specificity, positive and negative predictive values (PPV and NPV) were similar (specificity 96% vs. 93%, PPV’s 87% vs. 82% and NPV’s 89% vs. 93%). Reader confidence was higher when employing the dual/dual method (p = 0.001). Conclusions: The dual/dual method can be considered superior to the dual/single method in the preoperative imaging in primary hyperparathyroidism.
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18F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism. J Clin Med 2020; 9:jcm9062005. [PMID: 32604786 PMCID: PMC7356908 DOI: 10.3390/jcm9062005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
The present retrospective study evaluates the diagnostic value of integrated 18F-Fluorocholine positron emission tomography/four-dimensional contrast-enhanced computed tomography (18F-FCH PET/4D-CT) as second-line imaging in preoperative work-up of primary hyperparathyroidism (pHPT), and compares 18F-FCH PET with 4D-CT. Patients with pHPT and negative/discordant first-line imaging addressed for integrated 18F-FCH PET/4D-CT were retrospectively selected. Sensitivity and detection rate (DR%) of 18F-FCH PET/CT, 4D-CT, and PET/4D-CT were calculated according to the per patient and per lesion analyses, and afterwards compared. Histology associated with a decrease more than 50% of perioperative parathyroid hormone (PTH) blood level was used as a gold standard. Persistent high serum PTH and calcium levels during a 6-month follow-up was considered as presence of pHPT in both operated and non-operated patients. 50 patients (55 glands) were included. 44/50 patients (88%) were surgically treated. On a per patient analysis, sensitivity was 93%, 80%, and 95%, and DR% was 82%, 68%, and 84%, respectively for PET/CT, 4D-CT, and PET/4D-CT. PET/CT was more sensitive than 4D-CT (p = 0.046). PET/4D-CT performed better than 4D-CT (p = 0.013) but was equivalent to PET/CT alone. On a per gland analysis, sensitivity PET/CT, 4D-CT, and PET/4D-CT was 88%, 66%, and 92%, and DR% was 79%, 57%, and 83%, respectively. PET/CT and PET/4D-CT were more sensitive than 4D-CT alone (p = 0.01, p < 0.001, respectively). However, PET/CT and PET/4D-CT performed similarly. In conclusion, 18F-FCH PET provides better identification of hyperfunctioning parathyroids than 4D-CT and the combination of both did not significantly improve diagnostic sensitivity. Further investigations involving larger populations are necessary to define the role of 18F-FCH PET/4D-CT as a “one-stop shop” second-line imaging in preoperative work-up of pHPT, especially considering the additional patient radiation exposure due to multi-phase CT.
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7
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Use of pinhole dual-phase Tc-99m sestamibi vs combined Tc-99m sestamibi and Tc-99m pertechnetate scintigraphy in patients with hyperparathyroidism where single-photon emission computed tomography/computed tomography is unavailable. Nucl Med Commun 2020; 41:87-95. [DOI: 10.1097/mnm.0000000000001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Kushchayeva YS, Tella SH, Kushchayev SV, Van Nostrand D, Kulkarni K. Comparison of hyperparathyroidism types and utility of dual radiopharmaceutical acquisition with Tc99m sestamibi and 123I for localization of rapid washout parathyroid adenomas. Osteoporos Int 2019; 30:1051-1057. [PMID: 30706095 DOI: 10.1007/s00198-019-04846-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/06/2019] [Indexed: 11/29/2022]
Abstract
UNLABELLED Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. We investigated the degree and causes of localization failure among different types of hyperparathyroidism. Pre-operative parathyroid hormone levels and size of the gland were major determinants of Tc99m-sestamibi positivity; 123I scan may be helpful in localization failures. INTRODUCTION Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. However, parathyroid adenomas/hyperplasia has been reported to washout as fast as normal thyroid tissue ("rapid washout") which may lead to diagnostic failure. We aimed to evaluate the determinants of rapid washout and to determine the role of subtraction imaging for detection of parathyroid adenomas/hyperplasia with rapid washout. METHODS Retrospective analysis of patients with hyperparathyroidism who have undergone Tc99m-sestamibi dual-time imaging and parathyroid surgery. Rapid washout was correlated to the type of hyperparathyroidism in surgically confirmed cases. Biochemical and pathological data were reviewed. RESULTS A total of 135 hyperparathyroidism patients met the inclusion criteria. Ninety-six (72%), 29 (21%), and 10 (7%) had primary, secondary, and tertiary hyperparathyroidisms, respectively. Rapid washout was identified in 28/87 glands (32%), 14/53 glands (26%), and 1/16 glands (6%) with primary, secondary, and tertiary hyperparathyroidisms, respectively. Glands that were positive on late-phase Tc99m-sestamibi scans were significantly large being 1.7 (IQR 1.4-2.3) vs. 1.45 (IQR 1-2) cm (p = 0.003). High parathyroid hormone levels (PTH) were associated with early-phase Tc99m-sestamibi positivity in both primary (p = 0.01) and secondary hyperparathyroidism (p = 0.03) but not with last phase (p = 0.11, p = 0.37, respectively). Correlative imaging with subtraction scintigraphy was positive in 14/16 (87.5%) parathyroid adenomas. CONCLUSION Pre-operative PTH levels and size of the gland were major determinants of Tc99m-sestamibi positivity on early-phase Tc99m-sestamibi scans, whereas size is an independent predictor of late-phase Tc99m-sestamibi positivity. Subtraction scintigraphy might be a useful tool in suspected cases of rapid washout adenomas/hyperplasia.
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Affiliation(s)
- Y S Kushchayeva
- Diabetes, Endocrinology, and Obesity Branch, NIDDK, NIH, Bethesda, MD, USA
| | - S H Tella
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - S V Kushchayev
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - D Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Suite GB1, Washington, DC, 20010, USA
| | - K Kulkarni
- Division of Nuclear Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Suite GB1, Washington, DC, 20010, USA.
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Zafereo M, Yu J, Angelos P, Brumund K, Chuang HH, Goldenberg D, Lango M, Perrier N, Randolph G, Shindo ML, Singer M, Smith R, Stack BC, Steward D, Terris DJ, Vu T, Yao M, Tufano RP. American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism. Head Neck 2019; 41:2398-2409. [PMID: 31002214 DOI: 10.1002/hed.25781] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Health care consumer organizations and insurance companies increasingly are scrutinizing value when considering reimbursement policies for medical interventions. Recently, members of several American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) committees worked closely with one insurance company to refine reimbursement policies for preoperative localization imaging in patients undergoing surgery for primary hyperparathyroidism. This endeavor led to an AAO-HNS parathyroid imaging consensus statement (https://www.entnet.org/content/parathyroid-imaging). The American Head and Neck Society Endocrine Surgery Section gathered an expert panel of authors to delineate imaging options for preoperative evaluation of surgical candidates with primary hyperparathyroidism. We review herein the current literature for preoperative parathyroid localization imaging, with discussion of efficacy, cost, and overall value. We recommend that planar sestamibi imaging, single photon emission computed tomography (SPECT), SPECT/CT, CT neck/mediastinum with contrast, MRI, and four dimensional CT (4D-CT) may be used in conjunction with high-resolution neck ultrasound to preoperatively localize pathologic parathyroid glands. PubMed literature on parathyroid imaging was reviewed through February 1, 2019.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Justin Yu
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Peter Angelos
- Section of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kevin Brumund
- Section of Head and Neck Surgery, UC San Diego Health System, San Diego, California
| | - Hubert H Chuang
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Texas
| | - David Goldenberg
- Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Miriam Lango
- Division of Head & Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nancy Perrier
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Russell Smith
- Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - David Steward
- Division of Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David J Terris
- Department of Otolaryngology, Medical College of Georgia, Augusta, Georgia
| | - Thinh Vu
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Mike Yao
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Asseeva P, Paladino NC, Guerin C, Castinetti F, Vaillant-Lombard J, Abdullah AE, Farman-Ara B, Loundou A, Sebag F, Taïeb D. Value of 123I/99mTc-sestamibi parathyroid scintigraphy with subtraction SPECT/CT in primary hyperparathyroidism for directing minimally invasive parathyroidectomy. Am J Surg 2019; 217:108-113. [DOI: 10.1016/j.amjsurg.2018.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022]
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11
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Huang Z, Lou C. 99mTcO 4-/ 99mTc-MIBI dual-tracer scintigraphy for preoperative localization of parathyroid adenomas. J Int Med Res 2018; 47:836-845. [PMID: 30556441 PMCID: PMC6381465 DOI: 10.1177/0300060518813742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the accuracy of dual-tracer scintigraphy for locating parathyroid adenomas in patients with primary hyperparathyroidism (PHPT). Methods We reviewed 268 patients with PHPT. All patients underwent technetium-99m pertechnetate (99mTcO4-) scintigraphy and technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) dual-tracer scintigraphy of the thyroid and parathyroid glands, respectively. 99mTcO4- planar scintigraphy was carried out initially followed by dual-phase 99mTc-MIBI single-photon emission computed tomography (SPECT)/CT the next day. The findings were combined and interpreted. Individual 99mTc-MIBI and dual-tracer scintigraphy were both analyzed. The sensitivity, specificity, and accuracy were determined in relation to surgical findings. The average interval between scan and surgery was 13 days. Results The positive and negative predictive values of 99mTc-MIBI SPECT/CT were 92.0% and 71.3%, respectively, and the sensitivity, specificity, and accuracy were 88.3%, 79.2%, and 85.8%, respectively. The positive and negative predictive values of dual-tracer scintigraphy were 96.3% and 82.3%, respectively, and the sensitivity, specificity, and accuracy were 92.9%, 90.3%, and 92.2%, respectively. Youden’s index for dual-tracer scintigraphy and 99mTc-MIBI SPECT/CT were 0.83 and 0.63, respectively. Conclusions These finding suggest that 99mTcO4- and 99mTc-MIBI dual-tracer scintigraphy is more accurate than other scintigraphy methods for detecting parathyroid adenoma, and may thus be the most suitable imaging technique in patients with PHPT.
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Affiliation(s)
| | - Cen Lou
- Lou Cen, Department of Nuclear Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 Qingchun East Road, 310016, Hangzhou, China.
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Parathyroid radionuclide imaging: update. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Frank E, Ale-Salvo D, Park J, Liu Y, Simental A, Inman JC. Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review. Head Neck 2018; 40:1577-1587. [DOI: 10.1002/hed.25111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/02/2017] [Accepted: 01/23/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ethan Frank
- Loma Linda University School of Medicine; Loma Linda California
| | | | - Joshua Park
- Department of Otolaryngology - Head and Neck Surgery; Loma Linda University Medical Center; Loma Linda California
| | - Yuan Liu
- Department of Otolaryngology - Head and Neck Surgery; Loma Linda University Medical Center; Loma Linda California
| | - Alfred Simental
- Department of Otolaryngology - Head and Neck Surgery; Loma Linda University Medical Center; Loma Linda California
| | - Jared C. Inman
- Department of Otolaryngology - Head and Neck Surgery; Loma Linda University Medical Center; Loma Linda California
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18F-Fluorocholine PET/CT as a second line nuclear imaging technique before surgery for primary hyperparathyroidism. Eur J Nucl Med Mol Imaging 2018; 45:654-657. [DOI: 10.1007/s00259-017-3920-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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99mTc-Sestamibi/ 123I Subtraction SPECT/CT in Parathyroid Scintigraphy: Is Additional Pinhole Imaging Useful? INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2017; 2017:2712018. [PMID: 29181196 PMCID: PMC5664318 DOI: 10.1155/2017/2712018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/21/2022]
Abstract
Objectives This retrospective study evaluated whether the use of additional anterior 99mTc-sestamibi/123I pinhole imaging improves the outcome of 99mTc-sestamibi/123I subtraction SPECT/CT in parathyroid scintigraphy (PS). Materials and Methods PS using simultaneous dual-isotope subtraction methods and an acquisition protocol combining SPECT/CT and planar pinhole imaging was performed for 175 patients with primary or secondary hyperparathyroidism. All patients who proceeded to surgery with complete postsurgery laboratory findings were included in this study (n = 94). SPECT/CT images alone and combined with pinhole images were evaluated. Results There were 111 enlarged parathyroid glands of which 104 and 108 glands were correctly visualized by SPECT/CT (seven false positives) or SPECT/CT with pinhole (three false positives), respectively. Both sensitivity and specificity were higher with combined SPECT/CT with pinhole than with SPECT/CT alone (97% versus 94% and 99% versus 98%, resp., not significant). The false-positive rate was 6% with SPECT/CT and decreased to 3% using combined SPECT/CT with pinhole. Conclusion 99mTc-sestamibi/123I subtraction SPECT/CT is a highly sensitive and specific protocol for PS. The use of additional anterior pinhole imaging increases both sensitivity and specificity of PS, although this increase is not statistically significant.
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SPECT/CT’s Advantage for Preoperative Localization of Small Parathyroid Adenomas in Primary Hyperparathyroidism. Clin Nucl Med 2017; 42:e109-e114. [DOI: 10.1097/rlu.0000000000001447] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JEM, Rejnmark L, Thakker R, D'Amour P, Paul T, Van Uum S, Shrayyef MZ, Goltzman D, Kaiser S, Cusano NE, Bouillon R, Mosekilde L, Kung AW, Rao SD, Bhadada SK, Clarke BL, Liu J, Duh Q, Lewiecki EM, Bandeira F, Eastell R, Marcocci C, Silverberg SJ, Udelsman R, Davison KS, Potts JT, Brandi ML, Bilezikian JP. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 2017; 28:1-19. [PMID: 27613721 PMCID: PMC5206263 DOI: 10.1007/s00198-016-3716-2] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/20/2016] [Indexed: 01/02/2023]
Abstract
The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.
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Affiliation(s)
- A A Khan
- McMaster University, Hamilton, Canada.
- Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON, Canada.
| | | | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | | | - L Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - T Paul
- Western University, London, ON, Canada
| | - S Van Uum
- Western University, London, ON, Canada
| | - M Zakaria Shrayyef
- Division of Endocrinology, University of Toronto, Mississauga, ON, Canada
| | | | - S Kaiser
- Dalhousie University, Halifax, Canada
| | - N E Cusano
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - A W Kung
- University of Hong Kong, Hong Kong, China
| | - S D Rao
- Henry Ford Hospital, Detroit, MI, USA
| | - S K Bhadada
- Postgraduate Institute of Medical Education and Research, Chandigarth, India
| | | | - J Liu
- Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Q Duh
- University of California, San Francisco, CA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - F Bandeira
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil
| | - R Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - C Marcocci
- Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy
| | - S J Silverberg
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - R Udelsman
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - J T Potts
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | | | - J P Bilezikian
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Wong KK, Chondrogiannis S, Bowles H, Fuster D, Sánchez N, Rampin L, Rubello D. Hybrid-fusion SPECT/CT systems in parathyroid adenoma: Technological improvements and added clinical diagnostic value. Rev Esp Med Nucl Imagen Mol 2016; 35:385-390. [PMID: 27554661 DOI: 10.1016/j.remn.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for the diagnostic investigation of a range of disorders of endocrine gland function. The usefulness of combining functional information with anatomy derived from computed tomography (CT), magnetic resonance imaging (MRI), and high resolution ultrasound (US), has long been appreciated, either using visual side-by-side correlation, or software-based co-registration. The emergence of hybrid SPECT/CT camera technology now allows the simultaneous acquisition of combined multi-modality imaging, with seamless fusion of 3D volume datasets. Thus, it is not surprising that there is growing literature describing the many advantages that contemporary SPECT/CT technology brings to radionuclide investigation of endocrine disorders, showing potential advantages for the pre-operative locating of the parathyroid adenoma using a minimally invasive surgical approach, especially in the presence of ectopic glands and in multiglandular disease. In conclusion, hybrid SPECT/CT imaging has become an essential tool to ensure the most accurate diagnostic in the management of patients with hyperparathyroidism.
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Affiliation(s)
- K K Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - S Chondrogiannis
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - H Bowles
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - D Fuster
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - N Sánchez
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - L Rampin
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - D Rubello
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy.
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Wong K, Chondrogiannis S, Bowles H, Fuster D, Sánchez N, Rampin L, Rubello D. Hybrid-fusion SPECT/CT systems in parathyroid adenoma: Technological improvements and added clinical diagnostic value. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wong KK, Gandhi A, Viglianti BL, Fig LM, Rubello D, Gross MD. Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography. World J Radiol 2016; 8:635-655. [PMID: 27358692 PMCID: PMC4919764 DOI: 10.4329/wjr.v8.i6.635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the benefits of single photon emission computed tomography (SPECT)/computed tomography (CT) hybrid imaging for diagnosis of various endocrine disorders.
METHODS: We performed MEDLINE and PubMed searches using the terms: “SPECT/CT”; “functional anatomic mapping”; “transmission emission tomography”; “parathyroid adenoma”; “thyroid cancer”; “neuroendocrine tumor”; “adrenal”; “pheochromocytoma”; “paraganglioma”; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts (case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.
RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the bio-distribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for 99mTc-sestamibi parathyroid scintigraphy and 99mTc-pertechnetate thyroid scintigraphy, 123I- or 131I-radioiodine for staging of differentiated thyroid carcinoma, 111In- and 99mTc- labeled somatostatin receptor analogues for detection of neuroendocrine tumors, 131I-norcholesterol (NP-59) scans for assessment of adrenal cortical hyperfunction, and 123I- or 131I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.
CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.
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A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism. Clin Nucl Med 2016; 41:93-100. [DOI: 10.1097/rlu.0000000000000988] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE The aim of the study was to determine the diagnostic utility of parathyroid scintigraphy with technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) for localization of parathyroid adenoma. MATERIALS AND METHODS We performed a systematic search of medical databases PubMed and Medline/OVID for literature on 99mTc-sestamibi SPECT/CT parathyroid scintigraphy, using the search terms hyperparathyroidism, parathyroid adenoma/hyperplasia, SPECT/CT, and SPECT-CT. Citations for 981 articles and 128 abstracts of full articles were reviewed by two coauthors for relevance. Twenty-four peer-reviewed studies on SPECT/CT parathyroid scintigraphy qualified for inclusion. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. Meta-analytical techniques were used to obtain pooled estimates of the parathyroid adenoma localization rate using a random-effects model. RESULTS A total of 24 studies published between January 2003 and March 2014 with 1276 patients (334 men, 762 women, and 180 of unspecified sex) met the inclusion criteria. Data on the test performance of dual-phase 99mTc-sestamibi SPECT/CT showed an estimated pooled sensitivity (per-patient analysis) of 0.86 [confidence interval (CI) 0.81-0.90]. Sensitivity of SPECT/CT was superior to that of SPECT (0.74; CI 0.66-0.82) and planar (0.70; CI 0.61-0.80) techniques. Heterogeneity was present in the reported literature (I2=80.3%). The rate of ectopic parathyroid adenomas ranged between 4 and 20% and SPECT/CT was superior to SPECT and planar imaging for localization of ectopic sites. CONCLUSION Utilization of SPECT/CT fusion imaging for 99mTc-sestamibi parathyroid scintigraphy improves the test performance compared with planar and SPECT imaging; it assists preoperative planning for a minimally invasive surgical approach for the neck and is of value in subgroups with ectopic glands or coexisting nodular thyroid disease.
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Michaud L, Balogova S, Burgess A, Ohnona J, Huchet V, Kerrou K, Lefèvre M, Tassart M, Montravers F, Périé S, Talbot JN. A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies. Medicine (Baltimore) 2015; 94:e1701. [PMID: 26469908 PMCID: PMC4616781 DOI: 10.1097/md.0000000000001701] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We compared (18)F-fluorocholine hybrid positron emission tomography/X-ray computed tomography (FCH-PET/CT) with ultrasonography (US) and scintigraphy in patients with hyperparathyroidism and discordant, or equivocal results of US and (123)I/(99m)Tc-sesta-methoxyisobutylisonitrile (sestaMIBI) dual-phase parathyroid scintigraphy. FCH-PET/CT was performed in 17 patients with primary (n = 11) lithium induced (n = 1) or secondary hyperparathyroidism (1 dialyzed, 4 renal-transplanted).The reference standard was based on results of surgical exploration and histopathological examination. The results of imaging modalities were evaluated, on site and by masked reading, on per-patient and per-lesion bases.In a first approach, equivocal images/foci were considered as negative. On a per-patient level, the sensitivity was for US 38%, for scintigraphy 69% by open and 94% by masked reading, and for FCH-PET/CT 88% by open and 94% by masked reading. On a per-lesion level, sensitivity was for US 42%, for scintigraphy 58% by open and 83% by masked reading, and for FCH-PET/CT 88% by open and 96% by masked reading. One ectopic adenoma was missed by the 3 imaging modalities. Considering equivocal images/foci as positive increased the accuracy of the open reading of scintigraphy or of FCH-PET/CT, but not of US. FCH-PET/CT was significantly superior to US in all approaches, whereas it was more sensitive than scintigraphy only for open reading considering equivocal images/foci as negative (P = 0.04). FCH uptake was more intense in adenomas than in hyperplastic parathyroid glands. Thyroid lesions were suspected in 9 patients. They may induce false-positive results as in one case of oncocytic thyroid adenoma, or false-negative results as in one case of intrathyroidal parathyroid adenoma. Thyroid cancer (4 cases) can be visualized with FCH as with (99m)Tc-sestaMIBI, but the intensity of uptake was moderate, similar to that of parathyroid hyperplasia.This pilot study confirmed that FCH-PET/CT is an adequate imaging tool in patients with primary or secondary hyperparathyroidism, since both adenomas and hyperplastic parathyroid glands can be detected. The sensitivity of FCH-PET/CT was better than that of US and was not inferior to that of dual-phase dual-isotope (123)I/(99m)Tc-scintigraphy. Further studies should evaluate whether FCH could replace (99m)Tc-sestaMIBI as the functional agent for parathyroid imaging, but US would still be useful to identify thyroid lesions.
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Affiliation(s)
- Laure Michaud
- From the Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France (LM, SB, JO, VH, KK, FM, J-NT); Department of Nuclear Medicine, Comenius University & St. Elisabeth Oncology Institute, Bratislava, Slovakia (SB); Department of Otolaryngology Head and Neck Surgery, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (AB, SP); Faculté de Médecine Pierre et Marie Curie (JO, FM, SP, J-NT); Department of Pathology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (ML); and Department of Radiology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France (MT)
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Treglia G, Sadeghi R, Schalin-Jäntti C, Caldarella C, Ceriani L, Giovanella L, Eisele DW. Detection rate of 99m
Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: A meta-analysis. Head Neck 2015; 38 Suppl 1:E2159-72. [DOI: 10.1002/hed.24027] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine; PET/CT and Thyroid Center, Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences; Mashhad Iran
| | - Camilla Schalin-Jäntti
- Division of Endocrinology; Abdominal Center, University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | | | - Luca Ceriani
- Department of Nuclear Medicine; PET/CT and Thyroid Center, Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine; PET/CT and Thyroid Center, Oncology Institute of Southern Switzerland; Bellinzona Switzerland
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Sommerauer M, Graf C, Schäfer N, Huber G, Schneider P, Wüthrich R, Schmid C, Steinert H. Sensitivity and Specificity of Dual-Isotope 99mTc-Tetrofosmin and 123I Sodium Iodide Single Photon Emission Computed Tomography (SPECT) in Hyperparathyroidism. PLoS One 2015; 10:e0129194. [PMID: 26079132 PMCID: PMC4469677 DOI: 10.1371/journal.pone.0129194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose Despite recommendations for 99mTc-tetrofosmin dual tracer imaging for hyperparathyroidism in current guidelines, no report was published on dual-isotope 99mTc-tetrofosmin and 123I sodium iodide single-photon-emission-computed-tomography (SPECT). We evaluated diagnostic accuracy and the impact of preoperative SPECT on the surgical procedures and disease outcomes. Methods Analysis of 70 consecutive patients with primary hyperparathyroidism and 20 consecutive patients with tertiary hyperparathyroidism. Imaging findings were correlated with surgical results. Concomitant thyroid disease, pre- and postoperative laboratory measurements, histopathological results, type and duration of surgery were assessed. Results In primary hyperparathyroidism, SPECT had a sensitivity of 80% and a positive predictive value of 93% in patient-based analysis. Specificity was 99% in lesion-based analysis. Patients with positive SPECT elicit higher levels of parathyroid hormone and higher weight of resected parathyroids than SPECT-negative patients. Duration of parathyroid surgery was on average, approximately 40 minutes shorter in SPECT-positive than in SPECT-negative patients (89±46 vs. 129±41 minutes, p=0.006); 86% of SPECT-positive and 50% of SPECT-negative patients had minimal invasive surgery (p = 0.021). SPECT had lower sensitivity (60%) in patients with tertiary hyperparathyroidism; however, 90% of these patients had multiple lesions and all of these patients had bilateral lesions. Conclusion Dual-isotope SPECT with 99mTc-tetrofosmin and 123I sodium iodide has a high diagnostic value in patients with primary hyperparathyroidism and allows for saving of operation time. Higher levels of parathyroid hormone and higher glandular weight facilitated detection of parathyroid lesion. Diagnostic accuracy of preoperative imaging was lower in patients with tertiary hyperparathyroidism.
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Affiliation(s)
- Michael Sommerauer
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- * E-mail:
| | - Carmen Graf
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Niklaus Schäfer
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Gerhard Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Paul Schneider
- Department of General, Visceral and Transplant Surgery, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Rudolf Wüthrich
- Division of Nephrology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Schmid
- Division of Endocrinology and Diabetology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Hans Steinert
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Direct Comparison of Neck Pinhole Dual-Tracer and Dual-Phase MIBI Accuracies With and Without SPECT/CT for Parathyroid Adenoma Detection and Localization. Clin Nucl Med 2015; 40:476-82. [DOI: 10.1097/rlu.0000000000000778] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guerin C, Lowery A, Gabriel S, Castinetti F, Philippon M, Vaillant-Lombard J, Loundou A, Henry JF, Sebag F, Taïeb D. Preoperative imaging for focused parathyroidectomy: making a good strategy even better. Eur J Endocrinol 2015; 172:519-26. [PMID: 25637075 DOI: 10.1530/eje-14-0964] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Surgical treatment for primary hyperparathyroidism (pHPT) has undergone a major paradigm shift during the last decades from bilateral cervicotomy with four-gland neck exploration to image-guided focused approaches. The primary objective of the present study was to compare the performances of parathyroid scintigraphy (PS), parathyroid ultrasonography (US), and the combination of both procedures for guiding a focused approach on the basis of modified interpretation criteria. METHODS Data from 199 patients operated for apparent sporadic pHPT and evaluated with US and PS using dual-isotope (123)I/(99m)Tc-sestamibi planar pinhole and single-photon emission computed tomography (SPECT) acqusitions were evaluated. RESULTS A total of 127 patients underwent a focused approach and the remainder had bilateral cervicotomy. In 42 cases, a focused approach was not performed due to the absence of concordant results between US and PS for a single-gland abnormality. Four patients had persistent disease and three had recurrent disease. A localizing preoperative PS had a sensitivity of 93.3%, positive predictive value of 85.8%, negative predictive value of 73.0%, and accuracy of 83.4% for predicting uniglandular disease. Additional SPECT images accurately localize posterior adenomas that are often missed by US. Compared with PS, US had a lower sensitivity (P<0.01). Our imaging protocol also enabled diagnosis of multiglandular disease in 60.6%. CONCLUSIONS PS using a highly sensitive dual-tracer subtraction method is the most accurate technique for directing a focused approach. PS could be sufficient for directing a focused approach in the presence of a negative US in two major circumstances: posterior locations due to acquired ectopia that could be missed by US, and previous history of thyroidectomy due to interpretation difficulties.
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Affiliation(s)
- Carole Guerin
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Aoife Lowery
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Sophie Gabriel
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Frédéric Castinetti
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Mélanie Philippon
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Josiane Vaillant-Lombard
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Anderson Loundou
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Jean-François Henry
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - Frédéric Sebag
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
| | - David Taïeb
- Departments of Endocrine SurgeryNuclear MedicineEuropean Center for Research in Medical ImagingEndocrinologyRadiologyLa Timone University Hospital, Aix-Marseille University, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, FranceDepartment of Public HealthAix-Marseille University, Marseille, France
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(99m)Technetium Sestamibi-(123)Iodine Scintigraphy Is More Accurate Than (99m)Technetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2015; 2015:391625. [PMID: 25722888 PMCID: PMC4333274 DOI: 10.1155/2015/391625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/14/2014] [Accepted: 12/19/2014] [Indexed: 11/30/2022]
Abstract
Objectives. Studies comparing outcome of single-99mTc-methoxyisobutylisonitrile (99mTc-sestamibi) and dual-tracer 99mTc-sestamibi scintigraphy in combination with 123I before primary surgery of primary hyperparathyroidism (PHPT) are scarce. Methods. We compared 99mTc-sestamibi/123I and 99mTc-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. Results. 99mTc-sestamibi/123I and 99mTc-sestamibi were positive in 206 (76.6%) and 111 (41.3%) of 269 patients, respectively (P < 0.001). Accuracies for 99mTc-sestamibi/123I and 99mTc-sestamibi were 63.4% and 34.9%, respectively (96% CI, P < 0.001). Prevalence of multiglandular disease was 15.2%. In multiglandular disease, 99mTc-sestamibi/123I and 99mTc-sestamibi revealed 43.8 and 22.1% of pathological glands, respectively (P < 0.001). Cure rate was similar for patients with (191/206; 92.7%) and without (59 of 63; 93.7%) a positive 99mTc-sestamibi/123I finding. Duration of targeted surgery (one or two quadrants) was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both P < 0.001). Higher serum calcium (P = 0.014) and PTH (P = 0.055) concentrations and larger tumours (P < 0.001) characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. Conclusions. 99mTc-sestamibi/123I scintigraphy is more accurate than 99mTc-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.
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Casella C, Rossini P, Cappelli C, Nessi C, Nascimbeni R, Portolani N. Radioguided Parathyroidectomy with Portable Mini Gamma-Camera for the Treatment of Primary Hyperparathyroidism. Int J Endocrinol 2015; 2015:134731. [PMID: 26451143 PMCID: PMC4586957 DOI: 10.1155/2015/134731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/03/2015] [Indexed: 11/17/2022] Open
Abstract
Background. A proper localisation of pathological parathyroid glands is essential for a minimally invasive approach in the surgical treatment of primary hyperparathyroidism (PHP). The recent introduction of portable mini gamma-cameras (pMGCs) enabled intraoperative scintigraphic scanning. The aim of our study is to evaluate the efficacy of this new method and compare it with the preoperative localisation surveys. Methods. 20 patients were studied; they were evaluated preoperatively by neck ultrasound and (99mm)Tc-sestaMIBI-scintigraphy and intraoperatively with the pMGC IP Guardian 2. The results obtained from the three evaluations were compared. Results. The pMGC presented a sensitivity of 95%, a specificity of 98.89%, and a diagnostic accuracy of 98.18%, which were higher than those of preoperative ultrasound (sensitivity 55%; specificity 95%; diagnostic accuracy 87%) and scintigraphy with (99mm)Tc-sestaMIBI (sensitivity 73.68%; specificity 96.05%; diagnostic accuracy 91.58%). Conclusions. The pMGC can be used effectively as an intraoperative method to find the correct location of the pathological parathyroid glands. The pMGC is more reliable than the currently used preoperative and intraoperative localisation techniques.
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Affiliation(s)
- Claudio Casella
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
- *Claudio Casella:
| | | | - Carlo Cappelli
- Department of Medical and Surgical Sciences, Spedali Civili, 2nd Division of Internal Medicine, University of Brescia, 25123 Brescia, Italy
| | - Chiara Nessi
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
| | - Nazario Portolani
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
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Wong KK, Fig LM, Youssef E, Ferretti A, Rubello D, Gross MD. Endocrine scintigraphy with hybrid SPECT/CT. Endocr Rev 2014; 35:717-46. [PMID: 24977318 DOI: 10.1210/er.2013-1030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.
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Affiliation(s)
- Ka Kit Wong
- Nuclear Medicine/Radiology Department (K.K.W., E.Y., M.D.G.), University of Michigan Hospital, Ann Arbor, Michigan 48109; Nuclear Medicine Service (K.K.W., L.M.F., M.D.G.), Department of Veterans Affairs Health System, Ann Arbor, Michigan 48105; and Department of Nuclear Medicine (A.F., D.R.), Radiology, Medical Physics, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy
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