The 4-hook anchor coaxial needle with scaled suture is superior to the double spring coil for preoperative localization

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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The value of parathyroid hormone determination in ultrasound-guided fine-needle aspirates (FNA-PTH) for preoperative localization of parathyroid lesions.

Endocrine Abstracts ◽

10.1530/endoabs.35.p610 ◽

2014 ◽

Author(s):

Magdalena Kochman ◽

Waldemar Misiorowski ◽

Lucyna Papierska ◽

Elzbieta Stachlewska-Nasfeter ◽

Witold Chudzinski ◽

...

Keyword(s):

Parathyroid Hormone ◽

Preoperative Localization ◽

Ultrasound Guided ◽

Fine Needle ◽

Fine Needle Aspirates ◽

Parathyroid Lesions

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Preoperative Localization of Parathyroid Hyperplasia

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.58.398 ◽

2007 ◽

Vol 58 (4) ◽

pp. 398-403

Author(s):

Shogo Shinohara ◽

Masahiro Kikuchi ◽

Yasushi Naito ◽

Keizo Fujiwara ◽

Tsunemichi Adachi ◽

...

Keyword(s):

Parathyroid Hyperplasia ◽

Preoperative Localization

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Trial Comparing 2 Diagnostic Strategies for Preoperative Localization of Parathyroid Adenoma in Primary Hyperparathyroidism:TEMP / CT With Tc99m-sestaMIBI or PET / CT With F18-choline in First Intention

Case Medical Research ◽

10.31525/ct1-nct04040946 ◽

2019 ◽

Author(s):

Keyword(s):

Parathyroid Adenoma ◽

Preoperative Localization ◽

Diagnostic Strategies ◽

Pet Ct

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S178 – Utility of CT-Sestamibi Fusion in Parathyroid Exploration

Otolaryngology ◽

10.1016/j.otohns.2008.05.352 ◽

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.

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