Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

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“…The mean volume of detected abnormal glands has been reported as 3.5 cm 3 , while the mean volume of missed glands is 1.4 cm 3 [85, 86]. …”

Section: Diagnosis and Imagingmentioning

confidence: 99%

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

et al. 2016

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“…It is particularly helpful in the identification and characterisation of single-gland disease (adenoma or rare carcinoma) although it may also detect multigland parathyroid disease (usually hyperplasia) allowing for the appropriate surgical approach 4 6 7 51 106–108 111 112 114 115. In patients with a predisposition for multigland disease (eg, those with MEN), parathyroid imaging is perhaps most useful in the localisation of recurrent disease as their initial surgery usually entails a four gland parathyroid exploration with resection of most of the parathyroid tissue 116 117.…”

Section: Radiological Investigationsmentioning

confidence: 99%

Clinicopathological correlates of hyperparathyroidism

2015

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Hyperparathyroidism is a common endocrine disorder with potential complications on the skeletal, renal, neurocognitive and cardiovascular systems. While most cases (95%) occur sporadically, about 5% are associated with a hereditary syndrome: multiple endocrine neoplasia syndromes (MEN-1, MEN-2A, MEN-4), hyperparathyroidism-jaw tumour syndrome (HPT-JT), familial hypocalciuric hypercalcaemia (FHH-1, FHH-2, FHH-3), familial hypercalciuric hypercalcaemia, neonatal severe hyperparathyroidism and isolated familial hyperparathyroidism. Recently, molecular mechanisms underlying possible tumour suppressor genes (MEN1, CDC73/HRPT2, CDKIs, APC, SFRPs, GSK3β, RASSF1A, HIC1, RIZ1, WT1, CaSR, GNA11, AP2S1) and proto-oncogenes (CCND1/PRAD1, RET, ZFX, CTNNB1, EZH2) have been uncovered in the pathogenesis of hyperparathyroidism. While bi-allelic inactivation of CDC73/HRPT2 seems unique to parathyroid malignancy, aberrant activation of cyclin D1 and Wnt/β-catenin signalling has been reported in benign and malignant parathyroid tumours. Clinicopathological correlates of primary hyperparathyroidism include parathyroid adenoma (80–85%), hyperplasia (10–15%) and carcinoma (<1–5%). Secondary hyperparathyroidism generally presents with diffuse parathyroid hyperplasia, whereas tertiary hyperparathyroidism reflects the emergence of autonomous parathyroid hormone (PTH)-producing neoplasm(s) from secondary parathyroid hyperplasia. Surgical resection of abnormal parathyroid tissue remains the only curative treatment in primary hyperparathyroidism, and parathyroidectomy specimens are frequently encountered in this setting. Clinical and biochemical features, including intraoperative PTH levels, number, weight and size of the affected parathyroid gland(s), are crucial parameters to consider when rendering an accurate diagnosis of parathyroid proliferations. This review provides an update on the expanding knowledge of hyperparathyroidism and highlights the clinicopathological correlations of this prevalent disease.

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“…Egy közelmúltban megjelent multicentrikus tanulmányban Jimenez-Heffernan és mtsai [2] igazolták, hogy a SPECT/CT vizsgálat több nyirokcsomót mutat ki és biztosabban ítéli meg a nyirokdrenázs útját, mint a konvencionális planáris vizsgálat (1. ábra). Wong és mtsai [3] metaanalízis-vizsgálatukban beszámoltak arról, hogy a 99m Tc-MIBI fúziós SPECT/CT képalkotással pontosabban detektálhatók a hiperfunkcionáló parathyreoidea-…”

Section: Hibrid Képalkotás a Klinikumbanunclassified

Hibrid képalkotás: klinikai evidenciák, lehetőségek

Trencsényi¹,

Barna²,

Garai³

2015

Orvosi Hetilap

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Napjainkban a radiológia és nukleáris medicina modern képalkotó berendezéseit ötvöző hibrid képalkotás fontos szerepet tölt be mind a transzlációs kutatási folyamatokban, mind pedig a klinikai diagnosztikában. A rutin képalkotó diagnosztikai eljárások közül a komputertomográffal vagy mágneses magrezonanciás képalkotással kombinált pozitronemissziós tomográfi a, illetve egyfotonos emissziós komputertomográfi ás vizsgálat jelenleg a legfejlettebb technikák közé tartozik, amelynek segítségével a funkcionális és a morfológiai képeket azonos pozícióban tudjuk egymásra vetíteni. A hibrid képalkotó berendezések a nagy érzékenységüknek, jó felbontásuknak köszönhetően hasznos információt nyújtanak a szervezetben zajló patológiás folyamatokról. Segítségükkel megismerhetők olyan biokémiai és patobiokémiai folyamatok, amelyek elengedhetetlenek a betegségek megértéséhez, kezeléséhez vagy egy új, gyógy-szerjelölt molekula megismeréséhez. A klinikai és preklinikai in vivo nem invazív molekuláris képalkotó rendszerek segítségével a gyógyszerfejlesztés folyamata lerövidíthető, költségei csökkenthetők. Orv. Hetil., 2015, 156(52), 2110-2115. Kulcsszavak: CT, hibrid képalkotás, MRI, PET, SPECT, transzlációs medicina Hybrid imaging: clinical evidence, opportunitiesNowadays the hybrid imaging technologies which combine the modern equipments of radiology and nuclear medicine play an important role in both the translational research process and clinical diagnostics. Among the routine diagnostic imaging procedures positron emission tomography and single photon emission computed tomography combined with computed tomography or magnetic resonance imaging currently belong to the most advanced techniques allowing that functional and morphological images can be superimposed on each other in the same position. The hybrid imaging equipments provide useful information about the pathological processes in the body due to their high sensibility and resolution. Furthermore, with the help of these imaging modalities we can get acquainted with the biochemical and pathobiochemical processes that are essential for understanding and treating diseases, or getting acquainted with the behaviour of a new drug candidate. With the help of the clinical and preclinical non-invasive in vivo molecular imaging systems the drug developing process can be shortened and its costs can be reduced. Rövidítések CT = komputertomográfi a; MRI = mágneses magrezonanciás képalkotás; PET = pozitronemissziós tomográfi a; SPECT = single photon (egyfotonos) emissziós komputertomográfi a Hibrid képalkotás a klinikumbanA hibrid technológiák előnye, hogy az egymás utáni pozitronemissziós tomográfi a (PET), single photon (egyfotonos) emissziós komputertomográfi a (SPECT), komputertomográfi a (CT), mágneses magrezonanciás (MR) leképezések pontos regisztrációja történik. Így a külön-böző információtartalommal rendelkező képek egymás utáni értékelése és együttes értelmezése nemcsak megkönnyíti a leletezés folyamatát, hanem nagymértékben fokozza a diagnosztikai megbízhatóságot is.Hibrid te...

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Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT

Cited by 127 publications

References 53 publications

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Clinicopathological correlates of hyperparathyroidism

Hibrid képalkotás: klinikai evidenciák, lehetőségek

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