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.

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.

Accurate Preoperative Localization of Parathyroid Adenomas With C-11 Methionine PET/CT

2013 ◽  
Vol 257 (6) ◽  
pp. 1124-1128 ◽  
Author(s):  
Theresia Weber ◽  
Clemens Maier-Funk ◽  
Dagmar Ohlhauser ◽  
Andreas Hillenbrand ◽  
Gregor Cammerer ◽  
...  
Keyword(s):  
Preoperative Localization ◽  
Pet Ct ◽  
Parathyroid Adenomas

scholarly journals Parathyroid Imaging by 18F-Fluorocholine PET/CT in Patients With Primary Hyperparathyroidism and Inconclusive Conventional Methods: Clinico-Pathological Correlations

2018 ◽  
pp. S551-S557 ◽  
Author(s):  
K. ZAJÍČKOVÁ ◽  
D. ZOGALA ◽  
J. KUBINYI
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Mean Size ◽  
Parathyroid Imaging ◽  
Mibi Scintigraphy

18F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and 99Tc-sestaMIBI SPECT (MIBI) scintigraphy in patients with primary hyperparathyroidism (PHPT) to localize abnormal parathyroid glands before surgery. The results were retrospectively evaluated and compared to postoperative histopathological findings. 13 patients with PHPT were enrolled (mean age 64.3 years, preoperative calcium 2.74 mmol/l and parathyroid hormone 114.6 ng/l). FCH localized hyperfunctioning parathyroid glands in 12 patients of 13 (per patient sensitivity 92 % and positive predictive value (PPV) 100 %). Fourteen parathyroid lesions (11 adenomas, 3 hyperplastic glands) were resected with a mean size of 11.9 mm (per lesion sensitivity 93 % and PPV 81 %). Four adenomas and one hyperplastic gland were composed of only chief cells, whereas five lesions contained both chief and oxyphil cells. In three patients an exclusively oxyphil adenoma was found, surprisingly with negative MIBI scintigraphy in spite of a high mitochondria content in the oxyphil parathyroid cells. 12 of 13 patients had thyroid disease. In our limited study sample, FCH correctly identified parathyroid adenomas and/or hyperplastic glands in 92 % of patients with previously inconclusive conventional imaging. Unlike MIBI, FCH successfully localized small, hyperplastic and multiple hyperfunctioning parathyroid glands, irrespective of their histopathological composition.

scholarly journals The Role of Autophagy for the Regeneration of the Aging Liver

2020 ◽  
Vol 21 (10) ◽  
pp. 3606
Author(s):  
Fengming Xu ◽  
Chuanfeng Hua ◽  
Hans-Michael Tautenhahn ◽  
Olaf Dirsch ◽  
Uta Dahmen
Keyword(s):  
Liver Regeneration ◽  
The Elderly ◽  
Surgical Removal ◽  
Remnant Liver ◽  
Hepatic Tumors ◽  
Curative Surgery ◽  
Increased Risk ◽  
High Incidence ◽  
Patients At Risk

Age is one of the key risk factors to develop malignant diseases leading to a high incidence of hepatic tumors in the elderly population. The only curative treatment for hepatic tumors is surgical removal, which initiates liver regeneration. However, liver regeneration is impaired with aging, leading to an increased surgical risk for the elderly patient. Due to the increased risk, those patients are potentially excluded from curative surgery. Aging impairs autophagy via lipofuscin accumulation and inhibition of autophagosome formation. Autophagy is a recycling mechanism for eukaryotic cells to maintain homeostasis. Its principal function is to degrade endogenous bio-macromolecules for recycling cellular substances. A number of recent studies have shown that the reduced regenerative capacity of the aged remnant liver can be restored by promoting autophagy. Autophagy can be activated via multiple mTOR-dependent and mTOR-independent pathways. However, inducing autophagy through the mTOR-dependent pathway alone severely impairs liver regeneration. In contrast, recent observations suggest that inducing autophagy via mTOR-independent pathways might be promising in promoting liver regeneration. Conclusion: Activation of autophagy via an mTOR-independent autophagy inducer is a potential therapy for promoting liver regeneration, especially in the elderly patients at risk.

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.

Differential calcium response of normal and adenomatous parathyroid glands

1984 ◽  
Vol 107 (3) ◽  
pp. 375-381 ◽  
Author(s):  
Manfred Diete ◽  
Fritz Hölzel ◽  
Hartmut Arps ◽  
Max Bressel
Keyword(s):  
Intercellular Space ◽  
Hormone Secretion ◽  
Reference Value ◽  
Parathyroid Glands ◽  
Surgical Removal ◽  
Calcium Response ◽  
Parathyroid Adenomas ◽  
Pth Level ◽  
Stimulation Of

Abstract. In vitro parathyroid hormone secretion of normal (n = 10) and adenomatous (n = 20) human parathyroid glands was compared in response to different calcium (Ca++) concentrations. The glands, prepared for tissue culture immediately after surgical removal, were incubated under identical conditions for 6 h. The medium was changed hourly and analyzed for PTH and cAMP using radioimmunoassay. During the first 2 h of the experiment, the Ca++ concentrations of all preparations was kept constant at 1.2 mm equivalent to the normal Ca++ level of the intercellular space. The PTH level of the 2nd h was defined as reference value corresponding to 100%. After the 2nd h of incubation the Ca++ concentration in the medium was shifted either to low (0.9 or 0.6 mm) or to high (1.9 or 2.6 mm) values. In low Ca++ concentrations (0.6 mm) the normal parathyroid glands responded by stimulation of the PTH release up to 310% in relation to the reference value, whereas the adenomas enhanced the PTH release to 160% only. The incubations in 0.9 mm Ca++ resulted in a slightly lower degree of stimulation. During the incubation in high Ca++ the PTH secretion was reduced to 28% by normal glands and to 52% by adenomatous parathyroid glands. Movements of cAMP measurements paralleled PTH values. The study provides evidence for an abnormally low responsiveness of parathyroid adenomas to Ca++ when compared with normal glands. The reduction in Ca++ responsiveness of adenomatous cells appears to have a fundamental role in primary hyperparathyroidism since the tumour cells may obviously recognize normal Ca++ levels as 'hypocalcaemic' and react by a stimulated PTH secretion.

Robotic Resection of Ectopic Parathyroid Glands in the Superior Posterior Mediastinum

2019 ◽  
Vol 29 (5) ◽  
pp. 677-680 ◽  
Author(s):  
Daniel E. Mansour ◽  
Madonna E. Lee ◽  
Desmond M. D'Souza ◽  
Robert E. Merritt ◽  
Peter J. Kneuertz
Keyword(s):  
Posterior Mediastinum ◽  
Parathyroid Glands ◽  
Ectopic Parathyroid ◽  
Robotic Resection

Preoperative localization of parathyroid glands

2004 ◽  
Vol 43 (03) ◽  
pp. 85-90 ◽  
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.

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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