S178 – Utility of CT-Sestamibi Fusion in Parathyroid Exploration

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.

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Imaging of the parathyroid glands in primary hyperparathyroidism

Acta Endocrinologica ◽

10.1530/eje-15-0565 ◽

2016 ◽

Vol 174 (1) ◽

pp. D1-D8 ◽

Cited By ~ 21

Author(s):

Salvatore Minisola ◽

Cristiana Cipriani ◽

Daniele Diacinti ◽

Francesco Tartaglia ◽

Alfredo Scillitani ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Invasive Procedure ◽

Parathyroid Glands ◽

Definitive Treatment ◽

Preoperative Imaging ◽

Disease Etiology ◽

Minimally Invasive Surgical ◽

Asymptomatic Patients ◽

Surgical Expertise

Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

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Preoperative localization of parathyroid glands

Nuklearmedizin ◽

10.1055/s-0038-1625596 ◽

2004 ◽

Vol 43 (03) ◽

pp. 85-90 ◽

Cited By ~ 27

Author(s):

E. Lopez Hänninen ◽

Th. Steinmüller ◽

T. Rohlfing ◽

H. Bertram ◽

M. Gutberlet ◽

...

Keyword(s):

Image Fusion ◽

Single Photon ◽

Imaging Techniques ◽

Photon Emission ◽

Parathyroid Glands ◽

Preoperative Localization ◽

Mri Findings ◽

99Mtc Mibi ◽

Weighted Sequences ◽

Mibi Scintigraphy

Summary Aim: Minimally invasive resection of hyperfunctional parathyroid glands is an alternative to open surgery. However, it requires a precise preoperative localization. This study evaluated the diagnostic use of magnetic resonance (MR) imaging, parathyroid scintigraphy, and consecutive image fusion. Patients, methods: 17 patients (9 women, 8 men; age: 29-72 years; mean: 51.2 years) with primary hyperparathyroidism were included. Examination by MRI used unenhanced T1- and T2-weighted sequences as well as contrast-enhanced T1-weighted sequences. 99mTc-MIBI scintigraphy consisted of planar and SPECT (single photon emission tomography) imaging techniques. In order to improve the anatomical localization of a scintigraphic focus, SPECT-data were fused with the corresponding MR-data using a modified version of the Express 5.0 software (Advanced Visual Systems, Waltham, MA). Results of image fusion were then compared to histopathology. Results: In 14/17 patients, a single parathyroid adenoma was found. There were 3 cases with hyperplastic glands. MRI detected 10 (71%), scintigraphy 12 (86%) adenomas. Both modalities detected 1/3 patients with hyperplasia. Image fusion improved the anatomical assignment of the 13 scintigraphic foci in five patients and was helpful in the interpretation of inconclusive MR-findings in two patients. Conclusions: Both MRI and 99mTc-MIBI scintigraphy sensitively detect parathyroid adenomas but are less reliable in case of hyperplastic glands. In case of a scintigraphic focus, image fusion considerably improves its topographic assignment. Furthermore, it facilitates the evaluation of inconclusive MRI findings.

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Mitral valve pathology in severely impaired left ventricles can be successfully managed using a right-sided minimally invasive surgical approach

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezt144 ◽

2013 ◽

Vol 44 (1) ◽

pp. e1-e7 ◽

Cited By ~ 7

Author(s):

J. Garbade ◽

J. Seeburger ◽

D. R. Merk ◽

B. Pfannmuller ◽

M. Vollroth ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Surgical Approach ◽

Minimally Invasive Surgical ◽

Invasive Surgical Approach ◽

Valve Pathology

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The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221498389 ◽

2012 ◽

Vol 94 (1) ◽

pp. 17-23 ◽

Cited By ~ 9

Author(s):

SR Aspinall ◽

S Nicholson ◽

RD Bliss ◽

TWJ Lennard

Keyword(s):

Minimally Invasive Surgery ◽

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Negative Predictive Value ◽

Invasive Surgery ◽

Predictive Value ◽

Surgical Practice ◽

Parathyroid Disease ◽

Operative Findings ◽

The Impact

INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

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