Importância da complementação com SPECT e 99mTc na cintilografia das paratiroides e da correlação clínica, laboratorial, ultrassonográfica e citológica na localização pré-operatória do adenoma de paratiroide - ensaio pictórico

Abstract

Tc durante a cintilografia das paratiroides com Setamibi não é rotina em nosso meio, sendo comum a aquisição apenas das imagens planas − precoce (15 minutos) e tardia (2 horas). Resultados: Na nossa experiência, tem-se percebido que a realização do protocolo completo contribui de maneira decisiva na sensibilidade da localização pré-operatória da paratiroide. Conclusão: A aplicação completa de todos os métodos cintilográficos disponíveis (SPECT e 99m Tc) e a análise cuidadosa das imagens em um contexto multidisciplinar podem aumentar a acurácia da cintilografia das paratiroides. Arq Bras Endocrinol Metab. 2010;54(4):352-61 Descritores Paratiroide; cintilografia; MIBI; localização; hiperparatiroidismo primário absTRacT Objective: In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach. Materials and methods: The additional acquisition of SPECT and Technetium-99m images, during parathyroid scintigraphy with Sestamibi, is not common practice. Usually, only planar image acquisition, 15 minutes prior and 2 hours after radiopharmaceutical administration, is performed. Results: In our experience, the complete protocol in parathyroid scintigraphy increases the accuracy of pre-operative parathyroid localization. Conclusion: The complete utilization of all available nuclear medicine methods (SPECT e 99m Tc) and image interpretation in a multidisciplinary context can improve the accuracy of parathyroid scintigraphy.Arq Bras Endocrinol Metab. 2010;54(4):352-61

Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

“…The high uptake in hyper functioning parathyroid is explained by that in this cells there is a large number of abnormal mitochondria for which Sestamibi has high affinity, since the washout of the thyroid is faster (6,7). In most services, only two dimensional planar images are made, which caused the first scintigraphy in this case to be misinterpreted.…”

“…The adoption of techniques that combine images with 99m Tcpertechnetate, SPECT scintigraphy and conven tional computed tomography ( 99m TcSestamibi), increa se sensitivity, provide useful topographical information for the differentiation between parathyroid and thyroid tissue, and may help to decrease the percentage of un successful surgeries due to ectopic adenomas not found intraoperatively (7). Finally, the use of IOPTH can help detecting the surgical cure or the need to keep surgical exploration when there is no decrease in the tracer.…”