Localization of Parathyroid Adenomas By 99mTc-Sestamibi Scanning: Upper Neck Versus Lower Neck Lesions (original) (raw)
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Journal of Clinical Ultrasound, 2007
Purpose. To evaluate the sensitivity, specificity, and usefulness of dual-phase 99mTc-Sestamibi scintigraphy (SS) and sonography (US) of the neck, alone and in combination, as noninvasive adenoma localizing procedures in patients with primary hyperparathyroidism prior to parathyroidectomy.Methods. We retrospectively analyzed the charts of 79 patients with parathyroid (PT) adenomas and confirmed diagnosis of hyperparathyroidism who were evaluated with SS and US prior to successful parathyroidectomy.Results. Ninety-three adenomas were removed during bilateral neck exploration. SS alone showed a sensitivity of 76% and a specificity of 79% compared with 89% and 75%, respectively, for US performed after SS on the same day. Combination of the 2 procedures yielded a sensitivity of 89% and a specificity of 90%, with 22% discordant results. The differences in sensitivity and specificity between the 2 techniques alone or in combination were not statistically significant.Conclusions. No benefit was gained from using both SS and US for the preoperative localization of PT adenomas in patients with primary hyperparathyroidism. Each technique can be negatively affected by thyroid enlargment and nodularity. US, when performed by a skilled operator, is a reliable tool for PT adenoma localization. If the US findings are inconclusive, SS should be used. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007
Asian Journal of Medicine and Health
Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder with increased secretion of parathyroid hormone and elevated serum calcium level. Parathyroid adenoma is the most common cause. The introduction of preoperative localization of parathyroid adenoma using 99mTc-sestaMIBI has made parathyroid surgery minimally invasive. It becomes important to determine its usefulness in actual localization of parathyroid adenoma by correlating such with surgical and histological outcomes. Methods: This is a retrospective evaluation which involved electronic data retrieval for patients with biochemical diagnosis of hyperparathyroidism who presented for parathyroid nuclear scan and subsequently had surgical resection and histopathological diagnosis at the UAH. A total of 11
Osteoporosis International, 2019
Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. We investigated the degree and causes of localization failure among different types of hyperparathyroidism. Pre-operative parathyroid hormone levels and size of the gland were major determinants of Tc99m-sestamibi positivity; 123 I scan may be helpful in localization failures. Introduction Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. However, parathyroid adenomas/hyperplasia has been reported to washout as fast as normal thyroid tissue (Brapid washout^) which may lead to diagnostic failure. We aimed to evaluate the determinants of rapid washout and to determine the role of subtraction imaging for detection of parathyroid adenomas/hyperplasia with rapid washout. Methods Retrospective analysis of patients with hyperparathyroidism who have undergone Tc99m-sestamibi dual-time imaging and parathyroid surgery. Rapid washout was correlated to the type of hyperparathyroidism in surgically confirmed cases. Biochemical and pathological data were reviewed. Results A total of 135 hyperparathyroidism patients met the inclusion criteria. Ninety-six (72%), 29 (21%), and 10 (7%) had primary, secondary, and tertiary hyperparathyroidisms, respectively. Rapid washout was identified in 28/87 glands (32%), 14/53 glands (26%), and 1/16 glands (6%) with primary, secondary, and tertiary hyperparathyroidisms, respectively. Glands that were positive on late-phase Tc99m-sestamibi scans were significantly large being 1.7 (IQR 1.4-2.3) vs. 1.45 (IQR 1-2) cm (p = 0.003). High parathyroid hormone levels (PTH) were associated with early-phase Tc99m-sestamibi positivity in both primary (p = 0.01) and secondary hyperparathyroidism (p = 0.03) but not with last phase (p = 0.11, p = 0.37, respectively). Correlative imaging with subtraction scintigraphy was positive in 14/16 (87.5%) parathyroid adenomas. Conclusion Pre-operative PTH levels and size of the gland were major determinants of Tc99m-sestamibi positivity on earlyphase Tc99m-sestamibi scans, whereas size is an independent predictor of late-phase Tc99m-sestamibi positivity. Subtraction scintigraphy might be a useful tool in suspected cases of rapid washout adenomas/hyperplasia.
Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2015
This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid aden...
Irish Journal of Medical Science, 2011
Background There are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT). Aim We aimed to evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method. Methods We performed a retrospective review of 57 patients with a biochemical diagnosis of PHPT who had sestamibi scintigraphy performed. Results The sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation. Conclusion Sestamibi scintigraphy was more likely to be positive in younger patients without nodular thyroid disease who have larger parathyroid adenomas with more severe hyperparathyroidism.
Clinical Imaging, 2012
Purpose: We aimed to compare the efficacy of three different parathyroid adenoma screening tools-high-resolution ultrasonography (USG), technetium Tc 99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy, and magnetic resonance imaging (MRI)-and we evaluated the factors affecting the detection success rates. Methods: Parathyroid imaging was evaluated by USG, double-phase 99mTc-MIBI parathyroid scintigraphy, and cervical MRI in patients with hyperparathyroidism (n=39). Results: Among the 39 patients, USG, parathyroid scintigraphy, and MRI correctly identified 35 adenomas (89.7%), 28 adenomas (71.8%), and 26 adenomas (66.7%), respectively. Positive predictive values for USG (34/35), scintigraphy (27/28), and cervical MR (26/26) imaging were 97.1%, 96%, and 100%, respectively. Parathyroid adenomas were detected with 92.3% (36/39) certainty when both USG and scintigraphy modalities were applied together. Minimally invasive parathyroidectomy under local anesthesia with unilateral incision was successfully performed in 24 (61.5%) patients. Conclusions: Minimally invasive surgery for parathyroid adenomas has been developed and has equal success with traditional surgery. However, accurate localization of adenomas should be obtained prior to surgery. In this study, ultrasound was found to be effective in localizing adenomas for successful surgery. Adding other imaging modalities does not improve localizing the parathyroid adenomas.
Thyroid-Related Factors that Influence Preoperative Localization of Parathyroid Adenomas
Endocrine Practice, 2012
Objective: To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas. Methods: This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration. Results: Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P<.001). Conclusion: Our results suggest that ultrasonography is more sensitive than MIBI scan in the detection of parathyroid adenomas, particularly in the presence of small parathyroid adenomas or other thyroid related-factors.
Parathyroid adenoma imaging-preoperative localization
ARS Medica Tomitana, 2015
ABSTRACTPrimary hyperparathyroidism (PHPT) is a frequent endocrine disorder that can only be cured by a surgical procedure that is parathyroidectomy. The main causes are usually solitary benign adenoma (80-85%), diffuse or nodular hyperplasia (10-15%), or parathyroid carcinoma (<1%). Out of the known localization techniques, ultrasonography, nuclear scintigraphy and computer tomography (CT scan) are most commonly used [1].The aim of this study is to evaluate the sensibility of ultrasonography by comparison to scintigraphy and CT scan for the preoperative localization of parathyroid adenoma in patients with biochemically confirmed primary hyperparathyroidism. Localization studies were correlated with intraoperative findings, histopathological outcomes. In a retrospective study we analyzed 60 patients out of 245 patients who had undergone parathyroidectomy for PHPT between 2012-2013 in the Surgery Department of the National Institute of Endocrinology, Bucharest.Preoperative evaluat...
European Journal of Endocrinology, 2000
OBJECTIVE: To evaluate the usefulness of the combination of Tc-sestamibi/Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. DESIGN AND METHODS: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. RESULTS: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma a...