Pre-operative Sestamibi–Technetium Subtraction Scintigraphy in Primary Hyperparathyroidism: Experience with 156 Consecutive Patients

Jones, J.Mark; Russell, C. F. J.; Ferguson, W.R.; Laird, J. D.

doi:10.1053/crad.2001.0701

Cited by 59 publications

(50 citation statements)

References 13 publications

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“…A prior meta-analysis of 20,225 cases of primary hyperparathyroidism demonstrated radionuclide scintigraphy having a sensitivity of 88% for detecting solitary adenomas, 19 though the sensitivity decreased to between 51% and 69% for adenomas of Յ500 mg. 20,21 Similarly, sonography is reported to have sensitivities for lateralization ranging from 61% to 88%. Many consider sonography to be the first-line imaging study, due to its ability to localize enlarged parathyroid glands while concurrently determining the presence of relevant thyroid disease.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Griffith¹,

Chaudhary

Mahmood

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Minimally invasive parathyroidectomy requires accurate preoperative localization of suspected adenomas, and multiphase CT allows adenoma characterization while providing detailed anatomic information. The purpose of this study was to assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Griffith¹,

Chaudhary

Mahmood

et al. 2015

AJNR Am J Neuroradiol

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“…However, because of their wide availability, ultrasound and technetium-99m-2-methoxyisobutylisonitrile (Tc-MIBI or sestamibi) scans have become the most commonly ordered preoperative localizing study, with sensitivity rates reported between 80 and 100% (1). But their usefulness is diminished by their inability to consistently identify smaller glands, with sensitivity rates around 50% (10). Because of the two-dimensional nature of the sestamibi scan, along with its inability to localize normal-sized glands and its occasional lack of uptake even in enlarged glands, additional tests including computed tomography or nuclear magnetic resonance may be useful.…”

Section: Discussionmentioning

confidence: 99%

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

Prosst

Schroeter

Gahlen

2004

European Journal of Endocrinology

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Objective: Identification of parathyroid glands is often a challenge even for experienced surgeons. The feasibility and efficacy of fluorescence diagnosis for localization of parathyroids has already been proven in an experimental setting. In preparation for a clinical application of this technique in patients undergoing surgery for hyperparathyroidism, we evaluated the kinetics of fluorescence diagnosis. Design and methods: Fifty rats were randomized into eight groups with different photosensitization parameters using the photosensitizer aminolevulinic acid (ALA): a peritoneal lavage was performed with either 1.5 or 3.0% ALA solution and the induced photosensitization times varied from 0.5, 1 and 2 to 4 h. Under special fluorescence illumination, D-light, the exposed operative site with thyroid, parathyroid glands and neck muscles was examined. The identified parathyroid glands were studied according to fluorescence intensity by spectrometric measurement and compared with surrounding tissue.Results: Photosensitizer accumulation in parathyroid glands, indirectly measured by spectrometry, was up to 3.2 times higher than in thyroid and 2.6 times higher than in muscle tissue (2 h photosensitization with 3.0% ALA). Using 1.5% ALA, the optimum fluorescence intensity and ratio/contrast was slightly lower (parathyroid-to-thyroid ratio £ 3.0, parathyroid-to-muscle ratio £ 1.9) but was reached earlier (1 h) and hence considered as the parameter of choice for a clinical application. Conclusions: In future clinical application, intraoperative fluorescence diagnosis is expected to increase the ease of identification of atypically located or supernumeric glands. In combination with preoperative diagnostics, this may result in reduced operation time and avoidance of persistent hypercalcaemia.European Journal of Endocrinology 150 743-747

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“…Outcome of surgery The disappointing low predictive value of the Tc99m-MIBI-SPECT imaging technique in patients with persistent PHPT is believed to be due to the usually small size of residual parathyroid glands and to their frequent hyperplastic nature (1,6,(35)(36)(37)(38). Our findings suggest that the sensitivity of SVS is also decreased in the case of pathological parathyroid glands smaller than 1.5 cm compared with glands O1.5 cm (55 vs 89%) and in the case of hyperplastic compared with adenomatous residual glands (64 vs 100%), hyperplastic glands being smaller than adenomatous ones (1.45 vs 2.3 cm; PZ0.21).…”

Section: Outcome Of Localization Studiesmentioning

confidence: 99%

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

Witteveen¹,

Kievit²,

Erkel³

et al. 2010

European Journal of Endocrinology

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Introduction: Localization studies are mandatory prior to revision surgery in patients with persistent hyperparathyroidism in order to improve surgical outcome and reduce the risk of lengthy explorations. However, in this case, noninvasive localization studies are reported to have a poor sensitivity. The aim of our study is to determine the accuracy of selective venous sampling (SVS) for parathyroid hormone (PTH) in localizing residual hyperactive parathyroid glands in patients with persistent or recurrent hyperparathyroidism. Patients and methods: We retrospectively evaluated the localizing accuracy of 20 PTH SVS performed prior to revision surgery in 18 patients with persistent or recurrent primary hyperparathyroidism (nZ11) or autonomous (tertiary) hyperparathyroidism (nZ7). Tc99m-methoxy-isobutyle-isonitrile (MIBI)-single photon emission computed tomography (SPECT) was also performed in all patients prior to revision surgery. Operative and pathological data were obtained from hospital records. Results: The SVS was able to accurately localize 15 of the 20 pathological glands removed at revision surgery, representing a sensitivity of 75%. This sensitivity is significantly higher than that of Tc99m-MIBI-SPECT, which was only 30% (PZ0.012).Conclusion: Our findings demonstrate that SVS is a valuable localization study in patients with persistent or recurrent hyperparathyroidism, with a sensitivity significantly higher than that of Tc99m-MIBI-SPECT. Our data suggest that SVS represents a useful addition to the preoperative workup of these patients prior to revision surgery.

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Pre-operative Sestamibi–Technetium Subtraction Scintigraphy in Primary Hyperparathyroidism: Experience with 156 Consecutive Patients

Cited by 59 publications

References 13 publications

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

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