scholarly journals The value of scintigraphy and ultrasonography in the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism and concomitant thyroid disease

HORMONES ◽  
2006 ◽  
Vol 5 (1) ◽  
pp. 42-51 ◽  
Author(s):  
Theodore Alexandrides ◽  
Konstantina Kouloubi ◽  
Apostolos Vagenakis ◽  
Spyros Yarmenitis ◽  
Trifon Spyridonidis ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Thyroid Disease ◽  
Parathyroid Glands ◽  
Preoperative Localization

S178 – Utility of CT-Sestamibi Fusion in Parathyroid Exploration

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P135-P136
Author(s):  
Michael J Clark ◽  
Phillip Pellitteri
Keyword(s):  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Image Fusion ◽  
Fusion Imaging ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Minimally Invasive Surgical ◽  
Sestamibi Imaging ◽  
Invasive Surgical Approach ◽  
Operative Findings

Objectives 1) Delineate the role of CT-technetium 99m sestamibi (CT-MIBI) fusion in directed parathyroidectomy. 2) Determine the clinical situations where CT-MIBI fusion would be strongly recommended. Methods Charts from 190 patients with primary hyperparathyroidism who underwent CT-MIBI mage fusion as a part of a scan directed, minimally invasive parathyroid exploration protocol were reviewed. The results of conventional sestamibi imaging and CT-MIBI image fusion were compared with operative findings. Results CT-MIBI image fusion accurately localized solitary hyperfunctional parathyroid glands in 70% of patients imaged; 55% of patients were localized with conventional sestamibi imaging. CT-MIBI fusion imaging was most accurate and predictive when conventional images suggested that the solitary gland was separated from the thyroid or when the adenoma was located in the retro-thyroidal/ retro-esophageal plane or mediastinum. Conclusions CT-MIBI image fusion is not superior to conventional sestamibi imaging when utilized for routine localization of hyperfunctional parathyroid glands. CT-MIBI fusion is of greatest benefit in guiding the directed approach to solitary glands, which are separate from the thyroid or ectopically located, regions where conventional imaging has proven to be less accurate. This imaging technique will augment the minimally invasive surgical approach in selected patients with primary hyperparathyroidism in order to further refine the focused technique. Its utility as the standard preoperative localization modality is not yet established and requires further investigation. Evaluation of differences in facility utilization with CT-MIBI image fusion and conventional sestamibi imaging may be helpful in determining its role in preoperative localization for hyperparathyroidism.

Value of Ultrasonography, CT and MR Imaging in the Diagnosis of Primary Hyperparathyroidism

1996 ◽  
Vol 37 (3P2) ◽  
pp. 720-726 ◽  
Author(s):  
C. Tziakouri ◽  
E. Eracleous ◽  
S. Skannavis ◽  
A. Pierides ◽  
P. Symeonides ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Primary Hyperparathyroidism ◽  
Detection Rate ◽  
Cost Effective ◽  
Clinical Results ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Confirmatory Test ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.

Scintigraphy of the Parathyroid Glands with 201TI: Experience with 250 Operated Patients

1989 ◽  
Vol 28 (01) ◽  
pp. 26-28 ◽  
Author(s):  
P. Zanco ◽  
M. Camerani ◽  
B. Saitta ◽  
G. Ferlin ◽  
N. Borsato
Keyword(s):  
Primary Hyperparathyroidism ◽  
Digital Image ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Parathyroid Scintigraphy ◽  
Image Subtraction ◽  
Correct Image ◽  
Digital Image Subtraction

Parathyroid scintigraphy confirmed its validity in the preoperative localization of enlarged parathyroids, showing a sensitivity of 82% in a series of 250 patients suffering from primary hyperparathyroidism and successfully operated on. The glands better visualized were in an ectopic site or they were completely or partially outside the thyroid so that they were easily visible without employing digital image subtraction. This is nevertheless necessary to visualize parathyroids in a retrothyroid site but some problems arise, related not only to movements of the patient but also to the instrumentation to perform a correct image subtraction.

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