CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism

Wimmer, Gerd; Profanter, Christoph; Kovács, Péter; Sieb, Michael; Gabriel, Michael; Putzer, Daniel; Bale, Reto; Margreiter, Raimund; Prommegger, Rupert

doi:10.1007/s00423-009-0545-1

Cited by 43 publications

(36 citation statements)

References 19 publications

(24 reference statements)

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“…The following year, SPECT/CT depicted ectopic parathyroid glands in 4 patients, aiding surgical planning (231). The utility of SPECT/CT for detection of cervical parathyroid adenomas has been confirmed in multiple subsequent SPECT/CT studies in primary, secondary and tertiary hyperparathyroidism, subgroups of patients with concurrent nodular thyroid disease, multigland disease, and in those with previously failed surgery (232)(233)(234)(235)(236)(237)(238)(239)(240)(241)(242)(243)(244)(245)(246)(247)(248)(249). Regardless of the protocols used, parathyroid scintigraphy SPECT/CT has been found to improve sensitivity and specificity for detection of single adenomas, providing key preoperative localization information.…”

Section: Parathyroid and Thyroid Scintigraphy With Spect/ctmentioning

confidence: 93%

“…SPECT/CT has sensitivities ranging from 70% to 100% and specificities from 83% to 100%; these vary depending on cohort studied, protocols used, surgical follow-up, study design and whether patient-or lesion-based analysis was used (232)(233)(234)(235)(236)(237)(238)(239)(240)(241)(242)(243)(244)(245)(246). SPECT/CT is clearly more sensitive than planar imaging.…”

Section: Image Interpretationmentioning

confidence: 99%

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Endocrine Scintigraphy with Hybrid SPECT/CT

et al. 2014

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Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.

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Section: Parathyroid and Thyroid Scintigraphy With Spect/ctmentioning

confidence: 93%

Section: Image Interpretationmentioning

confidence: 99%

Endocrine Scintigraphy with Hybrid SPECT/CT

et al. 2014

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“…CT and SPECT datasets were acquired separately and then fused by means of special image fusion software allowing a ''virtual neck exploration'' by showing the suspected gland three-dimensionally in relationship to anatomical landmarks. The same authors also used this acquisition protocol in selected series of patients with single-gland disease or MGD at their first surgical exploration [51,52], comparing SPECT/CT image fusion with CT and SPECT alone. These studies provided evidence that SPECT/CT is superior to the other two diagnostic procedures for the preoperative localization of enlarged parathyroid glands.…”

Section: Spect/ct In Patients With Previous Neck Surgerymentioning

confidence: 99%

SPECT/CT in hyperparathyroidism

Spanu

Schillaci

Piras

et al. 2014

Clin Transl Imaging

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Hybrid SPECT/CT imaging is playing an increasingly important role in nuclear medicine in several oncological and non-oncological fields. This review presents a literature survey on the use of SPECT/CT as an adjunct to parathyroid scintigraphy in patients with hyperparathyroidism (HPT), highlighting the certainties and the controversies that have so far emerged in this regard. SPECT/CT, providing both functional and anatomical data, has proved to be superior to conventional planar parathyroid scintigraphy and to SPECT for the precise localization and characterization of areas of marked uptake of radiotracers (MIBI or tetrofosmin) corresponding to abnormal parathyroid glands, thus facilitating their surgical treatment. The major benefits of SPECT/CT have been observed in patients with ectopic adenomas, mainly in the mediastinum, and in those with previous neck surgery. In some studies, SPECT/ CT has also demonstrated a higher sensitivity than conventional planar or SPECT scans particularly in the detection of low-weight parathyroid adenomas and in the presence of concomitant nodular goiter. In other studies, SPECT/CT has also been found to be more specific, with the anatomical data provided by the CT component shown to be of help in correctly categorizing MIBI-avid non-parathyroid lesions. No definitive conclusions on the clinical value of SPECT/CT in patients with secondary HPT and multiglandular disease can be done due to the small number of studies thus far conducted, but the current available data nevertheless seem to suggest that hybrid imaging is able to detect a significantly higher number of hyperplastic glands than planar scanning can.

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“…Pre-operative imaging did not locate any ectopic or supernumerary glands in any of the 30% of the patients who had one [65]. A recent study by Wimmer et al [66] found that computed tomography-(99m)Tc-sestamibi-single photon emission computed tomography (CT-MIBI-SPECT) image fusion identified abnormal glands in 46.7% (14/30) of the patients with multiglandular disease of any type. CT scan alone found all glands in 36.7% (11/30) and MIBI-SPECT alone in 13.3% (4/30) of patients.…”

Section: Pre-operative Imagingmentioning

confidence: 99%

The surgical management of renal hyperparathyroidism

Madorin

Owen

Fraser

et al. 2011

Eur Arch Otorhinolaryngol

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Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. Patients present with various bone disorders, cardiovascular disease, and typical laboratory abnormalities. Medical treatment consists of controlling hyperphosphatemia, vitamin D/analog and calcium administration, and calcimimetic agents. Improved medical therapies have led to a decrease in the use of parathyroidectomy (PTX). The surgical indications include parathyroid hormone (PTH) levels >800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Transplant recipients often show decreased PTH, calcium and phosphorus levels, but some will have persistent HPT. Evidence suggests that PTX may cause deterioration in renal graft function in the short-term calling into the question the indications for PTX in these patients. Pre-operative imaging is only occasionally helpful except in re-operative PTX. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages and disadvantages which are discussed. Intraoperative PTH monitoring has a high positive predictive value of cure but a poor negative predictive value and therefore is of limited utility. Hypocalcemia is the most common complication requiring aggressive calcium administration. Benefits of surgery may include improved survival, bone mineral density and alleviation of symptoms.

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CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism

Cited by 43 publications

References 19 publications

Endocrine Scintigraphy with Hybrid SPECT/CT

Endocrine Scintigraphy with Hybrid SPECT/CT

SPECT/CT in hyperparathyroidism

The surgical management of renal hyperparathyroidism

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