Preoperative Technetium Tc 99m Sestamibi SPECT Imaging in the Management of Primary Hyperparathyroidism in Patients With Concomitant Multinodular Goiter

Abstract

Preoperative parathyroid and thyroid imaging using technetium Tc 99m sestamibi scintigraphysingle-photon emission computed tomography (Tc 99m MIBI SPECT) and technetium Tc 99m sodium pertechnetate, respectively, in patients with parathyroid adenomas and concomitant multinodular goiters enables the selection of those suitable for minimally invasive radioguided surgery. Design: One hundred thirty patients with primary hyperparathyroidism were treated surgically during a 30month period. Forty-one of these 130 patients had an associated multinodular goiter. All patients underwent planar and SPECT parathyroid scintigraphy using Tc 99m MIBI, and thyroid scintigraphy with technetium Tc 99m pertechnetate 2 to 5 days before surgery. On the morning of surgery each patient was reinjected with Tc 99m MIBI for intraoperative localization and validation. Minimally invasive radio-guided parathyroidectomy was performed using a handheld gamma-detection device with a thyroid probe. Removed glands were submitted for histopathologic examination for comparison with the scintigraphic results. Quantitative analysis of parathyroid activity was performed. Results: Minimally invasive, radioguided parathyroidectomy was successfully performed in 21 (51%) of 41 patients who had a concomitant multinodular goiter. The remaining 20 patients underwent standard neck explor

Intraoperative real-time 99mTc-sestamibi scintigraphy with miniature gamma camera allows minimally invasive parathyroidectomy without ioPTH determination in primary hyperparathyroidism

“…Most authors agree to define 99m Tc-sestamibi scintigraphy as the most powerful preoperative diagnostic tool in PHPT, and it has undoubtfully been responsible for the changes in therapeutic strategies [7]. Even more, the accuracy of 99m Tc-sestamibi scintigraphy can be increased with the addition of some techniques, and ultrasound, the double tracer subtraction technique with 99m Tc-pertechnectate, and the single photon emission technique (SPECT) are the most frequently reported [8][9][10].…”

Accuracy of parathyroid imaging: comparison of planar scintigraphy, spect, spect/ct and c-11 methionine pet for the detection of parathyroid adenomas and glandular hyperplasia

“…The overall accuracy of dual-phase scintigraphy combined with ultrasonography has been found to be superior to that of other scintigraphic or radiological techniques (10,11). Studies comparing planar imaging and single photon emission computed tomography (SPECT) have shown significantly increased sensitivity for Tc-99m sestamibi SPECT, thus supporting its routine use prior to surgery (12)(13)(14).…”

Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter

“…The technical aspects of SPECT appear to be superior in comparison to planar imaging. 12,26,37 There are, however, reports that the proof of a parathyroid adenoma with concomitant large nodular goiter was not possible with SPECT. 12 Furthermore, Norman et al, who mainly used planar imaging as their method of proof, reported a sensitivity of 100% to be achieved.…”

“…12,26,37 There are, however, reports that the proof of a parathyroid adenoma with concomitant large nodular goiter was not possible with SPECT. 12 Furthermore, Norman et al, who mainly used planar imaging as their method of proof, reported a sensitivity of 100% to be achieved. 14 Several studies have shown that a combination of ultrasound and MIBI nuclear scan improved the sensitivity of locating adenoma.…”

“…9 Several centers perform parathyroidectomies for the treatment of pHPT via radio guidance. [10][11][12][13][14] Concomitant nodular goiters may cause problems with the diagnostics for the location. 10,15,16 There may be false-positive results because 99m Tc-MIBI accumulates preferentially in the mitochondria-rich thyroidal nodes.…”