Preoperative localization of parathyroid lesions

2008 ◽  
Vol 47 (04) ◽  
pp. 158-162 ◽  
Author(s):  
E. Mirallié ◽  
T. Carlier ◽  
H. Abbey-Huguenin ◽  
F. Aubron ◽  
F. Kraeber-Bodéré ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Accurate Method ◽  
Sex Characteristics ◽  
Double Phase ◽  
Imaging Results ◽  
Parathyroid Lesions ◽  
99Mtc Mibi ◽  
The Impact ◽  
Pth Level ◽  
Mibi Spect

SummaryThe aim of our study was to assess retrospectively the value of 99mTc-MIBI SPECT in the localization of parathyroid lesions in primary hyperparathyroidism and to determine the impact of PTH level, age, sex, characteristics of the lesions and thyroid nodules on the sensitivity of imaging. Patients, methods: Fifty nine patients who were cured after the resection of 60 lesions (50 adenomas, 9 hyperplasias and 1 carcinoma, 9 of them in ectopy) were selected. 99mTcO4-, early and late 99mTc-MIBI planar images (n = 59), 99mTc-MIBI SPECT (n = 58) and ultrasound (n = 50) performed preoperatively were analyzed. The imaging results were compared to surgical and histological findings and correlated to different factors suspected of influencing the imaging's sensitivity. Results: Sensitivity of double phase 99mTc-MIBI/99mTcO4- scintigraphy was higher than that of early or late scintigraphy alone. SPECT increased the sensitivity of scintigraphy from 85% to 92% and was useful to confirm doubtful foci and to localize ectopic lesions. Ultrasound (US) had the lowest sensitivity (56%) and the highest rate of false-positive results (n = 10), but identified 2 adenomas which were not detected by scintigraphy. Combining all imaging modalities, sensitivity reached 96%. Better sensitivities were observed when age < 69 years, preoperative PTH level ≥155 pg/ml, weight of the gland ≥0.80 g and in the absence of thyroid nodules. US was more influenced by these factors than scintigraphy. Conclusion: Combination of US, double-phase 99mTc- MIBI/99mTcO4- planar scintigraphy and SPECT is the most accurate method for the detection of parathyroid lesions and should be performed before minimally invasive surgery, especially when PTH level is low, in older patients and in cases of multinodular goiter.

scholarly journals Factors That Affect the Sensitivity of Imaging Modalities in Primary Hyperparathyroidism

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Minting Zhu ◽  
Yang He ◽  
Tingting Liu ◽  
Bei Tao ◽  
Weiwei Zhan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Preoperative Localization ◽  
Imaging Modalities ◽  
Emission Computed Tomography ◽  
Imaging Results ◽  
Parathyroid Lesions ◽  
99Mtc Mibi ◽  
Serum Pth ◽  
Mibi Spect

Background. Cervical ultrasound, 99mTc-sestamibi single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT), and cervical CT are routinely used in preoperative localization of primary hyperparathyroidism (PHPT). However, false-negative imaging results are also frequently encountered in clinical practice. Exploring the factors that affect the sensitivity of these imaging modalities is important for the surgical management of PHPT patients. Methods. Clinical data of 352 PHPT patients hospitalized in our center from January 2011 to December 2015 were retrospectively collected to evaluate the sensitivity of 3 imaging modalities in the preoperative localization of parathyroid lesions. The ROC curve analysis was used to explore the clinical factors affecting the sensitivity of localization, and the cut-point(s) of related factors were determined. Results. 99mTc-MIBI SPECT/CT has the highest sensitivity among the localization modalities commonly used, reaching 91.1% (86.0%–94.8%). When the lengths of parathyroid lesions were ≤1.3 cm, the sensitivity of neck ultrasonography significantly decreased, while the sensitivity of 99mTc-MIBI SPECT/CT decreased with parathyroid lesions ≤1.3 cm or serum PTH≤252 pg/ml. 99mTc-MIBI SPECT/CT was less effective in localizing the hyperplasia lesions. Neck ultrasonography combined with 99mTc-MIBI SPECT/CT can effectively improve the accuracy of preoperative localization of parathyroid lesions to 96.2% (92.7%–98.1%). Conclusions. Small parathyroid lesion and mild elevation of serum PTH would reduce the accuracy of parathyroid localization in PHPT patients.

Percutaneous microwave ablation of benign thyroid nodules

2015 ◽  
Vol 54 (01) ◽  
pp. 13-19 ◽  
Author(s):  
F. Nimsdorf ◽  
C. Happel ◽  
H. Ackermann ◽  
F. Grünwald ◽  
H. Korkusuz
Keyword(s):  
Microwave Ablation ◽  
Thyroid Nodules ◽  
Volume Reduction ◽  
Clinical Issue ◽  
New Approach ◽  
99Mtc Mibi ◽  
The Impact ◽  
Percutaneous Microwave Ablation ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

SummaryAim: Thyroid nodules represent a common clinical issue. Amongst other minimally invasive procedures, percutaneous microwave ablation (MWA) poses a promising new approach. The goal of this retrospective study is to find out if there is a correlation between volume reduction after 3 months and 99mTcuptake reduction of treated thyroid nodules. Patients, methods: 14 patients with 18 nodules were treated with MWA. Pre-ablative assessment included sonographical and functional imaging of the thyroid with 99mTcpertechnetate and 99mTc-MIBI. Additionally, patients underwent thyroid scintigraphy 24 hours after ablation in order to evaluate the impact of the treatment on a functional level and to ensure sufficient ablation of the targeted area. At a 3-month follow-up, ultrasound examination was performed to assess nodular volume reduction. Results: Mean relative nodular volume reduction after three months was 55.4 ± 17.9% (p < 0.05). 99mTcuptake 24 hours after treatment was 45.2 ± 31.9% (99mTc-MIBI) and 35.7 ± 20.3% (99mTcpertechnetate) lower than prior to ablation (p < 0.05). Correlating reduction of volume and 99mTc-uptake, Pearson's r was 0.41 (p < 0.05) for nodules imaged with 99mTc-MIBI and –0.98 (p < 0.05) for 99mTc-pertechnetate. According to scintigraphy 99.6 ± 22.6% of the determined target area could be successfully ablated. Conclusions: MWA can be considered as an efficient, low-risk and convenient new approach to the treatment of benign thyroid nodules. Furthermore, scintigraphy seems to serve as a potential prognostic tool for the later morphological outcome, allowing rapid evaluation of the targeted area in post-ablative examination.

scholarly journals Evaluation of the effectiveness of the double indicator method of scintigraphy in the differential diagnosis of thyroid nodules

2012 ◽  
Vol 93 (3) ◽  
pp. 447-450
Author(s):  
L A Timofeeva
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Indicator Method ◽  
Negative Results ◽  
99Mtc Pertechnetate ◽  
Double Phase ◽  
Sonographic Patterns ◽  
Histological Data ◽  
99Mtc Mibi

Aim. To evaluate the effectiveness of double indicator scintigraphy in the differential diagnosis of thyroid nodules. Methods. Analyzed was the data of radionuclide investigations of 25 patients with thyroid disease at the age of 36 to 72 years, who were operated on in 2009-2011. The radioisotope study was conducted in two stages. Evaluation of the scintigraphic uptake pattern of the radiopharmaceutical in the studied areas was performed visually and quantitatively. Results. The scintigraphic results were compared with cytological and histological studies. In the diagnosis of papillary thyroid cancer the sensitivity of the radioisotope investigation was 95%, specificity - 92%, diagnostic accuracy - 94%. The method was less precise and specific in the diagnosis of follicular cancer and macro-micro follicular adenomas (it gave positive results in the cases of adenoma and negative results in cases of follicular thyroid cancer). On average, the specificity of the double-phase radioisotope scintigraphy method using 99mTc-pertechnetate and technetril (99mTc-MIBI) in our study was 69%, accuracy - 75%, sensitivity - 79%. Conclusion. Radionuclide double-phase scintigraphy with the usage of 99mTc-pertechnetate and technetril (99mTc-MIBI) - is a highly informative method for the differential diagnosis of thyroid nodules, which can be used during atypical sonographic patterns and in the absence of clear histological data.

scholarly journals 99mTc-MIBI SPECT/CT imaging contribution in the diagnosis of patients with hyperparathyroidism

2019 ◽  
Author(s):  
Manevska Nevena ◽  
Stojanoski Sinisa ◽  
Stoilovska Bojana ◽  
Sazdova Irena
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Late Phase ◽  
Parathyroid Tissue ◽  
Added Value ◽  
Planar Scintigraphy ◽  
Complementary Method ◽  
Double Phase ◽  
Planar Images ◽  
99Mtc Mibi ◽  
Mibi Spect

Introduction: Hyperparathyroidism is presented with increased parathyroid hormone (PTH) secretion due to hyperfunctioning of one or more of the four parathyroid glands. Primary hyperparathyroidism (p-HPT) can be due to parathyroid adenoma, hyperplasia or carcinoma of the parathyroid gland. Secondary hyperparathyroidism (s-HPT) is usually a response to hypocalcaemia and consecutive hyperplasia of the glands. Our aim was to compare the efficacy of 99mTcmethoxyisobutylisonitrile (MIBI) SPECT/CT in identification of the location of the lesion(s) in cases of HPT by comparing these results with the findings of ultrasound (US) and planar scintigraphy. Methods: Forty one consecutive patients (54±17 age, 12 males and 29 females) with primary or secondary hyperparathyroidism were included. All patients were examined by US and afterwards patients underwent conventional double-phase 99mTc-MIBI scintigraphy combined with neck SPECT/CT procedure. Planar images (early and delayed), US and SPECT/CT image sets were evaluated for adenoma localization at the neck and thorax. Regions of interest (ROIs), equal sized, were selected and compared, over the hyperfunctioning parathyroid tissue (accumulated impulses-counts value) and over the contralateral lobe of the thyroid gland (control counts value). Results: The ultrasonography detected 24 positive findings. The late phase of planar scan detected 26 positive findings. SPECT/CT presented with bigger detection rate than late planar phase or US (75.6%, 63.4%, 61.5%) and with higher sensitivity (100%, 83.8%, 77.4%), respectively. Conclusion: The SPECT/CT study seems reliable, sensitive and with added value in diagnosing hyperparathyroidism as a complementary method to planar scintigraphy. US as compatible method, should be performed prior the scintigraphy protocols.

Molecular genetic markers for thyroid FNAB

2015 ◽  
Vol 54 (03) ◽  
pp. 94-100 ◽  
Author(s):  
P. B. Musholt ◽  
T. J. Musholt
Keyword(s):  
Genetic Markers ◽  
Thyroid Nodules ◽  
Molecular Genetic ◽  
Genetic Alterations ◽  
Diagnostic Tools ◽  
Ultrasound Screening ◽  
Thyroid Malignancy ◽  
Thyroid Carcinomas ◽  
Molecular Genetic Markers ◽  
The Impact

SummaryAim: Thyroid nodules > 1 cm are observed in about 12% of unselected adult employees aged 18–65 years screened by ultrasound scan (40). While intensive ultrasound screening leads to early detection of thyroid diseases, the determination of benign or malignant behaviour remains uncertain and may trigger anxieties in many patients and their physicians. A considerable number of thyroid resections are consecutively performed due to suspicion of malignancy in the detected nodes. Fine needle aspiration biopsy (FNAB) has been recommended for the assessment of thyroid nodules to facilitate detection of thyroid carcinomas but also to rule out malignancy and thereby avoid unnecessary thyroid resections. However, cytology results are dependent on experience of the respective cytologist and unfortunately inconclusive in many cases. Methods: Molecular genetic markers are already used nowadays to enhance sensitivity and specificity of FNAB cytology in some centers in Germany. The most clinically relevant molecular genetic markers as pre-operative diagnostic tools and the clinical implications for the intraoperative and postoperative management were reviewed. Results: Molecular genetic markers predominantly focus on the preoperative detection of thyroid malignancies rather than the exclusion of thyroid carcinomas. While some centers routinely assess FNABs, other centers concentrate on FNABs with cytology results of follicular neoplasia or suspicion of thyroid carcinoma. Predominantly mutations of BRAF, RET/PTC, RAS, and PAX8/PPARγ or expression of miRNAs are analyzed. However, only the detection of BRAF mutations predicts the presence of (papillary) thyroid malignancy with almost 98% probability, indicating necessity of oncologic thyroid resections irrespective of the cytology result. Other genetic alterations are associated with thyroid malignancy with varying frequency and achieve less impact on the clinical management. Conclusion: Molecular genetic analysis of FNABs is increasingly performed in Germany. Standardization, quality controls, and validation of various methods need to be implemented in the near future to be able to compare the results. With increasing knowledge about the impact of genetic alterations on the prognosis of thyroid carcinomas, recommendations have to be defined that may lead to individually optimized treatment strategies.

Comparison of diagnostic accuracy of 18F-FDG PET, 123I-IMT- and 99mTc-MIBI SPECT

2006 ◽  
Vol 45 (01) ◽  
pp. 49-56 ◽  
Author(s):  
N. Özdemir-Sahin ◽  
P. Hipp ◽  
W. Mier ◽  
M. Eisenhut ◽  
J. Debus ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fdg Pet ◽  
Tumour Progression ◽  
Roc Curves ◽  
Low Grade ◽  
Who Grade ◽  
Pet Tracer ◽  
Patient Groups ◽  
99Mtc Mibi ◽  
Mibi Spect

Summary Aim was to evaluates the diagnostic accuracy of the SPECTtracers 3-123I-α-methyl-L-tyrosine (IMT) and 99mTc(I)- hexakis(2-methoxyisobutylisonitrile) (MIBI) as well as the PET-tracer 2-18F-2-deoxyglucose (FDG) for detecting tumour progression in irradiated low grade astrocytomas (LGA). Patients, methods: We examined 91 patients (56 males; 35 females; 44.7 ± 11.5 years), initially suffering from histologically proven LGAs (mean WHO grade II) and treated by stereotactic radiotherapy (59.0 ± 4.6 Gy). On average 21.9 ± 11.2 months after radiotherapy, patients presented new Gd-DTPA enhancing lesions on MRI, which did not allow a differentiation between progressive tumour (PT) and non-PT (nPT) at this point of time. PET scans (n=82) were acquired 45 min after injection of 208 ± 32 MBq FDG. SPECT scans started 10 min after injection of 269 ± 73 MBq IMT (n=68) and 15 min after injection of 706 ± 63 MBq MIBI (n=34). Lesions were classified as PT and nPT based on prospective follow-up (clinically, MRI) for 17.2 ± 9.9 months after PET/SPECT. Lesion-to-normal ratios (L/N) were calculated using contra lateraly mirrored reference regions for the SPECT examinations and reference regions in the contra lateral grey (GM) and white matter (WM) for FDG PET. Ratios were evaluated by Receiver Operating Characteristic (ROC) analysis. Results: In the patient groups nPT and PT, L/N ratios for FDG (GS) were 0.6 ± 0.3 vs. 1.2 ± 0.5 (p = 0.003), for FDG (WS) 1.2 ± 0.4 vs. 2.6 ± 0.4 (p <0.001), for IMT 1.1 ± 0.1 vs. 1.8 ± 0.4 (p <0.001) and for MIBI 1.6 ± 0.7 vs. 2.6 ± 2.2 (p = 0.554). Areas under the non-parametric ROC-curves were: 0.738 ± 0.059 for FDG (GS), 0.790 ± 0.057 for FDG (WS), 0.937 ± 0.037 for IMT and 0.564 ± 0.105 for MIBI. Conclusion: MIBI-SPECT examinations resulted in a low accuracy and especially in a poor sensitivity even at modest specificity values. A satisfying diagnostic accuracy was reached with FDG PET. Using WM as reference region for FDG PET, a slightly higher AUC as compared to GM was calculated. IMT yielded the best ROC characteristics and the highest diagnostic accuracy for differentiating between PT and nPT in irradiated LGA.

Einschränkung der myokardialen Perfusionsreserve bei Mikrovaskular-Angina (Syndrom X): Nachweis durch 99mTc-MIBI-SPECT

1996 ◽  
Vol 35 (06) ◽  
pp. 193-197 ◽  
Author(s):  
B. Beuthien-Baumann ◽  
M. Lübeck ◽  
C. Fuchs ◽  
M. A. Schneider ◽  
C. Volk ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
99Mtc Mibi ◽  
Mibi Spect

Zusammenfassung Ziel: An 22 Patienten mit typischer Angina pectoris und normalen Koronararterien (Mikrovaskular-Angina, Syndrom X) wurde geprüft, ob mit 99mTc-MIBI-SPECT eine Einschränkung der myokardialen Perfusionsreserve nachweisbar ist. Methode: Die Untersuchung mit 99rnTc-MIBI-SPECT erfolgte in Ruhe und unter Vasodilatation nach einer Infusion mit Dipyridamol im Vergleich zu einer normalen Datenbank. Eine normale myokardiale Perfusionsreserve wurde bei einer differenziellen 99mTc-MIBI-Aufnahme von > 20% angesehen. Ergebnisse: 2/22 (9%) der Patienten wiesen eine Perfusionsreserve <20% mit im Mittel 37% auf, 91 % der Patienten wiesen eine relativ oder absolut verminderte 99mTc-MIBI-Aufnahme unter Vasodilatation auf. Bei 9/22 (41 %) Patienten war die Perfusionsreserve relativ gemindert mit einer Zunahme der 99mTc-MIBI-Aktivität von 6%, bei 11/22 wurde eine Abnahme der 99mTc-MIBI-Aktivität um 13% unter Vasodilatation dokumentiert. Schlußfolgerung: Bei guter Bildqualität ist die 99mTc-MIBI-SPECT zur semiquantitativen Bestimmung der Perfusionsreserve bei Patienten mit Mikrovaskular-Angina geeignet.

99mTc-MIBI-SPECT: Eine nicht invasive, sensitive Lokalisationsdiagnostik bei Verdacht auf Nebenschilddrüsenadenom

2018 ◽  
Vol 41 (02) ◽  
pp. 121-127
Author(s):  
Christina Schneider ◽  
Constanza Chiapponi ◽  
Monika Ortmann ◽  
Michael Faust ◽  
Markus Dietlein ◽  
...  
Keyword(s):  
Vitamin D ◽  
Pet Ct ◽  
Ablative Verfahren ◽  
99Mtc Mibi ◽  
Met Pet ◽  
Mibi Spect

ZusammenfassungDie Aufgabe des Nuklearmediziners nach Diagnosestellung eines meist primären Hyperparathyreoidismus besteht in der erfolgreichen Lokalisation eines oder mehrerer Nebenschilddrüsenadenome. Die präoperative Lokalisation erlaubt die gezielte, heutzutage oft minimalinvasive Resektion. Hierzu ist 99 mTc-MIBI-SPECT eine klinisch fest etablierte Methode mit hoher Sensitivität. Wichtig ist die Kenntnis über Einflussfaktoren, die zu falsch-positiven oder falsch-negativen Ergebnissen führen. Eine wichtige Differenzialdiagnose für eine pathologische Anreicherung ist ein MIBI-positiver Schilddrüsenknoten. Häufigere Ursachen für negative Befunde sind kleinere hyperplastische Nebenschilddrüsen oder ein Vitamin-D-Mangel. In manchen Zentren ist als weiterführende Lokalisationsmethode C-11-MET PET/CT verfügbar. Ob sich neben der chirurgischen Therapie in Zukunft perkutan-ablative Verfahren etablieren können, was eine gezielte prätherapeutische Lokalisation voraussetzt, kann zum jetzigen Zeitpunkt noch nicht definitiv beantwortet werden.

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