Parathyroid Localization by Computed Tomographic Scanning

Friedman, Michael; Mafee, Mahmood F.; Shelton, Vicki K.; Berlinger, Frederick G.; Skolnik, Emanuel M.

doi:10.1001/archotol.1983.00800160029007

Cited by 10 publications

(2 citation statements)

References 5 publications

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“…A wide variety of imaging techniques has been proposed to localize parathyroid adenomata and hyperplasia. Currently, vigorous debate centers on techniques that are readily available, noninvasive, and hold promise as practical methods for parathyroid localization: thallium-technetium scintigraphy (TTS) [5][6][7][8][9][10][11][12][13], computed tomography (CT) [14][15][16][17][18][19][20][21][22][23][24], and sonography (US) [25][26][27][28][29][30][31][32][33][34][35]. We compared these 3 imaging modalities prospectively, using as the standard for comparison the surgical, pathologic, and clinical findings.…”

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confidence: 99%

Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors

et al. 1986

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Controversy exists concerning the advantages and appropriateness of current imaging modalities of the localization of parathyroid tumors. We conducted a prospective, blinded study to compare the efficacy of 3 different imaging modalities in 40 patients with primary hyperparathyroidism (HPT). Patients with HPT were examined preoperatively by computer‐assisted thallium‐201/technetium‐99m scintigraphy (TTS), high‐resolution (GE 9800) computed tomography (CT), and high‐resolution (7.5 MHz) real‐time sonography (US). Each study was performed and interpreted independently. These patients then had a neck exploration and parathyroidectomy which allowed for clinical correlation of pathologic findings with the imaging results. Overall sensitivities of the 3 imaging modalities were TTS‐72%, CT‐72%, and US‐57%, with specificities of TTS‐93%, CT‐92%, and US‐96%. For lesions located below the thyroid (thymic tongue and mediastinum), sensitivities were TTS‐86%, CT‐29%, and US‐20%, all with specificities of 100%. In those HPT patients presenting with prior failed neck explorations, parathyroid tumors were detected with sensitivities of TTS‐88%, CT‐57%, and US‐67%, with specificities of 100%, 71%, and 100%, respectively. TTS with subsequent CT appears to be an optimal imaging strategy for HPT patients with prior failed neck explorations or suspected lesions below the thyroid. Since surgeons experienced in parathyroid surgery have a cure rate of 93% or greater in HPT patients without prior neck exploration, these imaging modalities may not be cost‐effective and thus not indicated for these patients.

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Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors

et al. 1986

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“…Computed tomography. The accuracy of computed tomography (CT) in detecting parathyroid adenomas is primarily dependent on the size of the tumor [72,73]. Contrast enhancement appears to occur in 25% of parathyroid tumors, and large tumors are more likely to enhance than are small tumors [74].…”

Section: Imaging Of Hyperparathyroidismmentioning

confidence: 99%

Diagnostic advances in APUDomas and other endocrine tumors: Imaging and localization

McLeod

Few

Shapiro

1993

Seminars in Surgical Oncology

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The different diagnostic imaging modalities available for determining the location of the various APUDomas are discussed with reference to their advantages and disadvantages. The ability to image these lesions, and to be confident in their role in the underlying pathophysiology, and clinical neuroendocrine syndrome causing symptomatology and illness, has proved to be the key to successful treatment. In many instances it is not the diagnosis that is in question, but it is the extent of disease, the location of the lesion, or whether the anatomical abnormality under study is responsible for the complicating symptoms being considered, that are the crucial questions. The ability to locate APUDomas by a variety of direct and indirect imaging or regionalizing modalities, represent a magnificent advance in the management of these tumors. It should, however, be kept in mind that no one modality or diagnostic method can uniformly be relied upon. It is evident that a multimodal, interactive medical team approach is essential to the successful overall management of patients afflicted with these fascinating tumors.

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The Pitfalls of Technetium Tc 99m/Thallium 201 Parathyroid Scanning

Voorman

Petti²,

Schulz³

et al. 1988

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\Technetium Tc 99m/thallium 201 parathyroid scanning has been proved to be effective by multiple researchers. A review of 54 patients who underwent scanning and operations at an institution showed the scans to be accurate in 83%.There were 15% false-negative and 2% false-positive scans. The pitfalls of parathyroid scanning can be related to false\x=req-\ positives and false-negatives.(Arch Otolaryngol Head Neck Surg 1988;114:993-995) Head and neck surgeons have long sought a means to localize pre¬ operatively abnormal parathyroid glands. Many techniques have been tried and compared.110 Surgical explo¬ ration without localizing studies should be successful in 95% of the cases of primary hyperparathyroidism." However, some surgeons are now using parathyroid scanning in all cases to shorten surgery time.12 In 1985, we reported our initial results of parathyroid scanning.10 We have now reviewed all our surgical cases since we began parathyroid scanning. Our updated results and pitfalls of para¬ thyroid scanning are discussed. PATIENTS AND METHODSWe reviewed all patients who had sur¬ gery for hyperparathyroidism. All patients had parathyroid scans, and all patients with clinical hyperparathyroidism were

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Parathyroid Localization by Computed Tomographic Scanning

Cited by 10 publications

References 5 publications

Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors

Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors

Diagnostic advances in APUDomas and other endocrine tumors: Imaging and localization

The Pitfalls of Technetium Tc 99m/Thallium 201 Parathyroid Scanning

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