Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism

Published on Apr 1, 2010in Clinical Radiology2.118
· DOI :10.1016/J.CRAD.2009.12.005
C.N. Patel1
Estimated H-index: 1
(Leeds Teaching Hospitals NHS Trust),
C.N. Patel5
Estimated H-index: 5
(Leeds Teaching Hospitals NHS Trust)
+ 1 AuthorsAndrew Scarsbrook29
Estimated H-index: 29
(Leeds Teaching Hospitals NHS Trust)
Aim To evaluate the accuracy of ultrasound and parathyroid scintigraphy using single photon-emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of solitary parathyroid adenomas in patients with primary hyperparathyroidism who would be suitable for minimally invasive parathyroid surgery. Materials and methods Retrospective study of 63 consecutive patients with biochemical evidence of primary hyperparathyroidism referred for preoperative localization of parathyroid adenoma that proceeded to surgery in the same institution. All patients underwent high-resolution ultrasound and Technetium-99m sestamibi scintigraphy with planar and SPECT/CT imaging. The accuracy of preoperative imaging was compared to surgical and histological findings as the reference standard. Results Fifty-nine patients had solitary parathyroid adenomas, three patients had multiglandular hyperplasia, and one patient had multiple parathyroid adenomas confirmed at surgery and histology. Thirty-five solitary parathyroid adenomas were identified preoperatively with ultrasound (64%) and 53 with SPECT-CT (90%). Concordant ultrasound and SPECT/CT findings were found in 35 cases (59%). An additional three adenomas were found with ultrasound alone and 18 adenomas with SPECT/CT alone. Fifty-one of the 56 adenomas localized using combined ultrasound and SPECT/CT were found at the expected sites during surgery. Combined ultrasound and SPECT/CT has an overall sensitivity of 95% and accuracy of 91% for the preoperative localization of solitary parathyroid adenomas. Conclusions The combination of ultrasound and SPECT/CT has incremental value in accurately localizing solitary parathyroid adenomas over either technique alone, and allows selection of patients with primary hyperparathyroidism who would be suitable for minimally invasive surgery.
📖 Papers frequently viewed together
682 Citations
306 Citations
301 Citations
#1Kamran Akram (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 1
#2John ParkerH-Index: 17
Last. Gerald M. KolodnyH-Index: 33
view all 4 authors...
Abstract:The parathyroid glands are located posterior to the upper and lower poles of the thyroid and are derived from the third and fourth pharyngeal pouches. Usually there are only 2 superior glands, whereas only 40% of patients have their inferior glands located near the inferior thyroid poles. E
28 CitationsSource
#1Elif HindiéH-Index: 44
#2Omer Ugur (Hacettepe University)H-Index: 18
Last. Domenico RubelloH-Index: 72
view all 10 authors...
The present guidelines were issued by the Parathyroid Task Group of the European Association of Nuclear Medicine. The main focus was imaging of primary hyperparathyroidism. Dual-tracer and single-tracer parathyroid scintigraphy protocols were discussed as well as the various modalities of image acquisition. Primary hyperparathyroidism is an endocrine disorder with high prevalence, typically caused by a solitary parathyroid adenoma, less frequently (about 15%) by multiple parathyroid gland diseas...
301 CitationsSource
#2H. HollemaH-Index: 1
Last. J. T. Plukker (D.A.R.E.: Drug Abuse Resistance Education)H-Index: 10
view all 6 authors...
Objective: P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP) are membrane efflux pumps that may have a role in the kinetics of Tc-99m-sestamibi (MIBI) in parathyroid tumors. P-gp and MRP1 expression in parathyroid tumors was studied and related to histology, weight and pre- and intraoperative MIBI imaging results. Design: Patient cohort study Setting: Tertiary referral center Patients: Thirty-three patients underwent radioguided parathyroidectomy for primary or secondary hy...
7 CitationsSource
#1Mitchell E. Tublin (University of Pittsburgh)H-Index: 24
#2Daniel A. PrymaH-Index: 26
Last. Sally E. CartyH-Index: 52
view all 7 authors...
Objective. The purpose of this study was to determine the utility of radiologist-performed sonography as the principal modality for parathyroid localization before minimally invasive parathyroidectomy. Methods. Both sonography and technetium Tc 99m sestamibi single-photon emission computed tomography (SPECT) are commonly performed during imaging evaluation of patients with primary hyperparathyroidism (HPTH). Sonographic examinations ordered during the study period were performed by 1 author (M.E...
100 CitationsSource
#1Donald R. Neumann (Cleveland Clinic)H-Index: 20
#2Nancy A. ObuchowskiH-Index: 72
Last. Frank Difilippo (Case Western Reserve University)H-Index: 8
view all 3 authors...
UNLABELLED: The trend toward focused surgical parathyroidectomy requires precise preoperative localization of parathyroid lesions in patients with hyperparathyroidism. The purpose of this study was to directly compare the diagnostic accuracy of (99m)Tc-sestamibi/(123)I subtraction SPECT with SPECT/CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. METHODS: A total of 61 consecutive surgical patients with primary hyperparathyroidism underwent both...
115 CitationsSource
#1Luke Harris (UWO: University of Western Ontario)H-Index: 1
#2John Yoo (UWO: University of Western Ontario)H-Index: 30
Last. Ronald L. Holliday (UWO: University of Western Ontario)H-Index: 17
view all 7 authors...
Background. This study evaluated the accuracy of single photon emission computed tomography (SPECT)- CT imaging for the preoperative localization of parathyroid adenomas. Methods. This study included both a quantitative and quali- tative accuracy measure. The quantitative measure was the dis- tance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively. Qualita- tively, surgeons were asked whether or not the adenoma was in the exact location pre...
61 CitationsSource
#1Chirag Patel (National Health Service)H-Index: 13
#2Fahmid U. ChowdhuryH-Index: 18
Last. Andrew ScarsbrookH-Index: 29
view all 3 authors...
OBJECTIVE. Imaging of endocrine neoplasms often involves a combination of anatomic and functional techniques including sonography, CT, MRI, and scintigraphy. Recent technologic advances have enabled hybrid imaging using SPECT-CT, which combines anatomic and functional techniques to allow accurate localization of tumors, increased detection of recurrent and metastatic disease, and exclusion of physiologic uptake.CONCLUSION. SPECT-CT provides improved specificity and diagnostic confidence helping ...
20 CitationsSource
#1Laura J. Sawyer (RUH: Royal United Hospital)H-Index: 1
#2Hazel C. StarrittH-Index: 1
Last. Martyn J. EvansH-Index: 2
view all 4 authors...
BackgroundNuclear medicine scans may be accompanied by CT acquisitions to provide localization of radioisotope uptake through image fusion and for use in attenuation correction. The effective doses to patients resulting from radioisotope administrations and from diagnostic CT scans are well document
50 CitationsSource
#1Yashdeep GuptaH-Index: 19
#1Y GuptaH-Index: 1
Last. Gordon C. WishartH-Index: 24
view all 6 authors...
Background: The detection of parathyroid adenomas by 99mTc-labelled hexakis 2-methoxyisobutyl isonitrile (sestamibi) scintigraphy is influenced by several factors, including tumour size and serum level of parathyroid hormone (PTH). This study examined the relationship between sestamibi accumulation and multidrug resistance (MDR)-related P-glycoprotein (P-gp) expression in a large series of surgically excised parathyroid tumours. Methods: Seventy-eight patients underwent dual-phase sestamibi imag...
20 CitationsSource
#1William C. Lavely (Johns Hopkins University)H-Index: 10
#2Sibyll Goetze (Johns Hopkins University)H-Index: 7
Last. Harvey A. Ziessman (Johns Hopkins University)H-Index: 33
view all 10 authors...
Various methodologies for 99mTc-sestamibi parathyroid scintigraphy are in clinical use. There are few direct comparisons between the different methods and even less evidence supporting the superiority of one over another. Some reports suggest that SPECT is superior to planar imaging. The addition of CT to SPECT may further improve parathyroid adenoma localization. The purpose of our investigation was to compare hybrid SPECT/CT, SPECT, and planar imaging and to determine whether dual-phase imagin...
306 CitationsSource
Cited By177
#1Sang-Woo Lee (KNU: Kyungpook National University)H-Index: 28
#2Sung Ryul Shim (KU: Korea University)H-Index: 10
Last. Seong-Jang Kim (PNU: Pusan National University)H-Index: 25
view all 4 authors...
Importance Accurate preoperative localization of primary hyperparathyroidism (pHPT) is an important and challenging issue for a successful parathyroidectomy. Although new imaging modalities have been introduced during the past decade, direct comparative studies on advanced imaging techniques are limited. Objective To compare the performance of different preoperative imaging modalities for the localization of pHPT by performing a network meta-analysis (NMA). Data Sources PubMed, Embase, and the C...
1 CitationsSource
#1Yong Hu (UCLA: University of California, Los Angeles)H-Index: 2
#2Albert Y Han (UCLA Medical Center)H-Index: 6
Last. Maie A. St. JohnH-Index: 25
view all 9 authors...
OBJECTIVES/HYPOTHESIS Identification of parathyroid glands and adjacent tissues intraoperatively can be quite challenging because of their small size, variable locations, and indistinct external features. The objective of this study is to test the efficacy of the dynamic optical contrast imaging (DOCI) technique as a tool in specifically differentiating parathyroid tissue and adjacent structures, facilitating efficient and reliable tissue differentiation. STUDY DESIGN Prospective study. METHODS ...
#1Cecilia Botti (University of Modena and Reggio Emilia)H-Index: 4
Last. Angelo GhidiniH-Index: 10
view all 8 authors...
1. The correct localization of parathyroid adenomas is one of the main difficulties during mini-invasive parathyroidectomy. 2. To ease the surgical localization of pathological parathyroid tissue and reduce surgical manipulation, we have introduced in our clinical practice a bidimensional visual map based on preoperative ultrasonography. 3. The ultrasonography-based visual map is a reliable tool which can be easily consulted by the surgeon preoperatively and during surgery. 4. The map is drawn w...
#1Colleen M. Kiernan (VUMC: Vanderbilt University Medical Center)H-Index: 14
#2Giju Thomas (Vandy: Vanderbilt University)H-Index: 9
Last. Carmen C Solόrzano (VUMC: Vanderbilt University Medical Center)
view all 4 authors...
BACKGROUND AND OBJECTIVE The Food and Drug Administration has cleared a probe-based near-infrared autofluorescence (NIRAF) detection system called PTeye™ as an adjunct tool for label-free intraoperative parathyroid gland (PG) identification. Since PTeye™ has been investigated only in a "blinded" manner to date, this study describes the preliminary impressions of PTeye™ when used by surgeons without being blinded to the device output. METHODS Patients undergoing thyroid and parathyroid procedures...
#1Petra Petranović Ovčariček (University of Zagreb)H-Index: 4
#2Luca Giovanella (UZH: University of Zurich)H-Index: 11
Last. Frederik A. Verburg (EUR: Erasmus University Rotterdam)H-Index: 1
view all 10 authors...
Introduction Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ...
1 CitationsSource
#1M E Noltes (UMCG: University Medical Center Groningen)H-Index: 4
#2Schelto Kruijff (UMCG: University Medical Center Groningen)H-Index: 18
Last. Adrienne H. Brouwers (UMCG: University Medical Center Groningen)H-Index: 36
view all 7 authors...
BACKGROUND Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a next in-line scan after primary negative or discordant first-line imaging. METHODS This was a retrospective single-center cohort study. All patients with pHPT that were scanned utilizing 11C-choline PET/CT, after prior negativ...
#1Alessandro Galani (University of Brescia)H-Index: 8
#2Riccardo Morandi (University of Brescia)H-Index: 1
Last. Claudio Casella (University of Brescia)H-Index: 17
view all 9 authors...
BACKGROUND Primary hyperparathyroidism is an endocrine pathology that affects calcium metabolism. Patients with primary hyperparathyroidism have high concentrations of serum calcium or high concentrations of parathyroid hormone, or incorrect parathyroid hormone levels for serum calcium values. Primary hyperparathyroidism is due to the presence of an adenoma/single-gland disease in 80-85%. Multiple gland disease or hyperplasia accounts for 10-15% of cases of primary hyperparathyroidism. Atypical ...
2 CitationsSource
OBJECTIVE To evaluate the safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate (PTH-FNA) in patients with primary hyperparathyroidism and suspicious parathyroid adenomas. METHODOLOGY A retrospective observational study was performed in 47 patients (57.7±11.2 years of average age, 74% women) attending an endocrinology clinic for primary hyperparathyroidism (average calcemia: 11.6±1.6mg/dl and PTH: 276±477pg/ml) in which PTH-FNA was made. Sensibility, specificity,...
#1Carmen C. Solorzano (VUMC: Vanderbilt University Medical Center)H-Index: 24
#2Giju Thomas (Vandy: Vanderbilt University)H-Index: 9
Last. Anita Mahadevan-Jansen (Vandy: Vanderbilt University)H-Index: 48
view all 4 authors...
OBJECTIVE: With the recent approval of 2 NIRAF-based devices for label-free identification of PG by the Food and Drug Administration, it becomes crucial to educate the surgical community on the realistic scope of this emerging technology. Here, we have compiled a review of studies that utilize NIRAF and present a critical appraisal of this technique for intraoperative PG detection. BACKGROUND: Failure to visualize PGs could lead to accidental damage/excision of healthy PGs or inability to locali...
12 CitationsSource
#1Jiacheng Wang (Beijing Chao-Yang Hospital)H-Index: 1
#2Qian Wang (Beijing Chao-Yang Hospital)H-Index: 1
Last. Bojun Wei (Beijing Chao-Yang Hospital)
view all 8 authors...
The expression pattern of exosomal miRNAs derived from parathyroid tumor is still unknown. In the present work, we aimed to examine the differences on microRNA (miRNA) expression, present in serum exosomes, by comparing parathyroid carcinoma (PC) and parathyroid adenoma (PA). MiRNA expression profile of serum exosomes, derived from 4 PC patients and 4 PA patients, were analyzed by next-generation sequencing technology. The differential expressions of target miRNAs were further verified in both s...