Preoperative Localization of Parathyroid Adenomas Using 4-Dimensional Computed Tomography: A Pictorial Essay

2013 ◽  
Vol 64 (3) ◽  
pp. 258-268 ◽  
Author(s):  
Shehanaz Ellika ◽  
Suresh Patel ◽  
Todd Aho ◽  
Horia Marin
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Parathyroid Gland ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Parathyroid Surgery ◽  
Parathyroid Adenomas ◽  
Pictorial Essay ◽  
Imaging Classification

Accurate preoperative localization is the key to successful parathyroid surgery in the era of minimally invasive parathyroid surgery. This article presents and discusses the embryologic basis of parathyroid gland and ectopic location and different imaging modalities helpful in diagnosing and localizing parathyroid adenomas and/or hyperplasia. We also aim to review the current surgical concepts in treatment of parathyroid adenomas and/or hyperplasia, the utility of 4-dimensional computed tomography for accurate preoperative localization of hyperfunctioning parathyroid glands, imaging classification of adenomas and/or hyperplasia, and, finally, present some of the limitations of 4-dimensional computed tomography.

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.

scholarly journals Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Fernando Mendoza-Moreno ◽  
Ángel Rodriguez-Pascual ◽  
María Rocío Díez-Gago ◽  
Marina Pérez-González ◽  
Laura Jiménez‐Alvárez ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Imaging Techniques ◽  
High Sensitivity ◽  
Parathyroid Glands ◽  
Parathyroid Surgery ◽  
Thyroid Lobe ◽  
The Impact ◽  
Supernumerary Gland

Introduction. The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report. A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions. The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.

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.

scholarly journals Can Met-PET/CT Predict Sporadic Multiglandular Hyperparathyroidism? Report of a Case and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Andreas Hillenbrand ◽  
Johannes Lemke ◽  
Doris Henne-Bruns ◽  
Ambros J. Beer ◽  
Vikas Prasad
Keyword(s):  
Posterior Mediastinum ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Surgical Removal ◽  
Increased Risk ◽  
Pet Ct ◽  
Parathyroid Adenomas ◽  
Patients At Risk ◽  
Ectopic Parathyroid ◽  
Met Pet

Background. Primary hyperparathyroidism (pHPT) is a common endocrine disorder of the parathyroid glands. In most cases pHPT is caused by single gland disease, but about 10% of patients suffer from sporadic multiglandular disease (MGD). Patients with MGD, especially with ectopic parathyroid adenomas, have an increased risk for persistence/recurrence after surgery. Normally, sporadic MGD cannot be diagnosed preoperatively by parathyroid scintigraphy. We analyzed the potential of positron emission tomography/computed tomography (Met-PET/CT) to predict MGD. Methods and Case Presentation. We reviewed the literature, if preoperative Met-PET/CT could predict MGD in patients with pHPT. Further, we present a 71-year-old female with ectopic MGD. Preoperative localization via Met-PET/CT showed MGD with two areas suspected to be enlarged parathyroid glands (left lateral to the thyroid lobe and posterior mediastinum). Both diagnostic findings were extirpated and parathormone dropped into normal levels. Results. We identified four additional manuscripts, referring to MGD and Met-PET/CT with divergent results. Preoperative localization diagnostics using Met-PET/CT may not necessarily identify MGD. In most cases, Met-PET/CT localized only one adenoma and localizes larger adenomas more reliably than smaller adenomas. Conclusion. Identifying patients at risk of MGD preoperatively remains challenging. We found MET-PET/CT seems to predict MGD in patients with large size and high weight PTH adenomas. For ectopic parathyroid adenomas, accurate preoperative localization is the key to successful surgical removal. Met-PET/CT appears to have great potential in soft-tissue analysis of complex anatomical regions and can predict ectopic parathyroid adenomas.

scholarly journals The EANM practice guidelines for parathyroid imaging

2021 ◽  
Author(s):  
Petra Petranović Ovčariček ◽  
Luca Giovanella ◽  
Ignasi Carrió Gasset ◽  
Elif Hindié ◽  
Martin W. Huellner ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Nuclear Medicine ◽  
Minimally Invasive ◽  
Minimally Invasive Parathyroidectomy ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Invasive Parathyroidectomy ◽  
Positron Emission ◽  
Parathyroid Imaging

Abstract 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 ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration. Methods Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT. Conclusion These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.

scholarly journals Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 231
Author(s):  
Cristina Ferrari ◽  
Giulia Santo ◽  
Paolo Mammucci ◽  
Antonio Rosario Pisani ◽  
Angela Sardaro ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Parathyroid Gland ◽  
Laboratory Data ◽  
Parathyroid Glands ◽  
Preoperative Imaging ◽  
Emission Computed Tomography ◽  
Choline Uptake ◽  
Comprehensive Overview ◽  
Choline Pet ◽  
Imaging Results

Hyperparathyroidism is a metabolic disorder characterized by the excessive production of the parathyroid hormone. The diagnosis is based on clinical and laboratory data. In most cases the only treatment is surgery and a correct preoperatory localization of the hyperfunctioning parathyroid gland(s) is essential. Currently, ultrasonography combined with [99mTc]Tc-MIBI parathyroid scintigraphy, optionally associated with single photon emission computed tomography/computed tomography (SPECT/CT), represent the standard preoperative imaging. In recent years, a number of studies have evaluated the potential role of choline positron emission tomography (PET) in hyperparathyroidism with promising results. Most of the recent evidence underlined its higher sensitivity and diagnostic accuracy in the localization of hyperfunctioning parathyroid glands. Choline PET has a higher spatial resolution that is useful for the detection of smaller parathyroid glands and it also has shorter examination times and favorable radiation exposure. These are just a few of the aspects that support it to overcome traditional imaging. Moreover, from the preliminary data, the choline uptake mechanism seems to also have an impact on its better performance. For these reasons, if first used as second level imaging in patients with negative or inconclusive traditional imaging results, several authors have supported its use as a first line investigation. This comprehensive overview aims to provide an accurate description of the preliminary results available in the literature about the use of choline PET/CT in hyperparathyroidism and to compare these results with the performance of traditional imaging methods.

scholarly journals Parathyroid Lesions: Our single center experience for the last 5 years

2021 ◽  
Author(s):  
Sümeyye Ekmekci ◽  
Mehmet Üstün ◽  
Yasemen Adali ◽  
Semra Demirli Atıcı ◽  
Ülkü Küçük ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Parathyroid Gland ◽  
Clinical Laboratory ◽  
Hormone Levels ◽  
Single Center Experience ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Invasive Method ◽  
The Mean

INTRODUCTION: Parathyroid neoplasms are tumors seen in about 0.1% of the population.Although parathyroid adenomas are the most common,carcinomas are also rarely seen.Our aim in this study is to evaluate the clinical, laboratory and histopathological characteristics of patients who underwent parathyroidectomy in our hospital in the last 5 years. METHODS: 156 patients who underwent parathyroidectomy in our hospital and examined in the pathology department were included in the study.The types of operations performed in cases were grouped as those who underwent only parathyroid excision and those who underwent thyroid partial/total excision with parathyroid excision.Age,gender, pre- and post-operative parathyroid hormone values, size,weight,pathological diagnosis of the parathyroid gland, presence of complications,comorbidities and clinical follow-up were evaluated. RESULTS: 84% of 156 cases were female,16% were male.The mean age is 53.82+13.49.The mean preoperative parathyroid hormone levels of the cases are 415.18+491.15 mg/dl, and the mean post-operative parathyroid hormone levels are 64.02+110.72 mg/dl.The mean volume of parathyroid tissues was calculated as 5.13+8.85 and the mean weight as 2.78+2.88 g. Pathological diagnoses are 83.3% adenoma,10.9% hyperplasia,2.6% atypical adenoma, 1.9% carcinoma, 0.6% normal parathyroid and 0.6% lymph node.It was observed that as the postoperative PTH level increased,the weight of the parathyroid gland increased and the lesion weight was higher in males.The addition of thyroidectomy to the treatment, conventional parathyroidectomy instead of the minimally invasive method,and the high size and volume of the parathyroid gland were found to be associated with complicated complications in the postoperative period. DISCUSSION AND CONCLUSION: In terms of thyroid pathologies that may accompany,it will be more appropriate to evaluate preoperative cases in detail and to continue the treatment with minimally invasive methods for the comfort of the patient in postoperative processes.It is highly important to always take a multidisciplinary management in the approach to parathyroid masses and to evaluate the clinical, laboratory, intraoperative and pathological findings of the case together.

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