SNM Practice Guideline for Parathyroid Scintigraphy 4.0

Greenspan, Bennett S.; Dillehay, Gary; Intenzo, Charles; Lavely, William C.; O’Doherty, Michael; Palestro, Christopher J.; Scheve, William; Stabin, Michael G.; Sylvestros, Delynn; Tülchinsky, Mark

doi:10.2967/jnmt.112.105122

Cited by 142 publications

(136 citation statements)

References 24 publications

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“…Planar imaging can be done using the dual tracer (DT) protocol where the image using Tc-99m sestamibi which localizes in both the thyroid and hyperfunctioning parathyroid lesions is compared with an image using Tc-99m pertechnetate or I-123 sodium iodide which localizes solely in the thyroid. The dual phase (DP) protocol compares two or more Tc-99m sestamibi images obtained at Original different time points and diagnosis is based on the observation that Tc-99m sestamibi washes out of the thyroid more rapidly than from hyperfunctioning parathyroid lesions [15]. Tomographic imaging including single photon emission computed tomography (SPECT) and single photon emission computed tomography/computed tomography (SPECT/CT) has been suggested to provide improved diagnostic accuracy over planar imaging [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

et al. 2018

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“…At present, 99m Tc-sestaMIBI (MIBI) parathyroid scintigraphy is recognized as the imaging procedure of choice in this field and it is especially indicated in patients with pHPT at their first operation who are scheduled to undergo a minimally invasive parathyroidectomy [6,7]. In such patients, it is suggested to use the technique in combination with high-resolution neck ultrasound (US) in order to further increase the sensitivity and accuracy of detection and localization of parathyroid adenomas located in the neck.…”

Section: Role and Indicationsmentioning

confidence: 99%

“…Moreover, the addition of US is particularly indicated in patients with concomitant thyroid nodules for better differentiating these from parathyroid lesions. Thin-section computed tomography (CT) and MRI may also be useful as additional imaging modalities in the presence of ectopic mediastinal parathyroid adenomas since they allow detailed anatomical localization [6,7].…”

Section: Role and Indicationsmentioning

confidence: 99%

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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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“…Scintigraphy for the localization of parathyroid adenomas has evolved over time. Currently, a dual-phase imaging method is employed where both early (20-minute), and delayed (2-hour), images are obtained following the administration of 99m Tc-Sestamibi (16). Activity tends to wash out more slowly from parathyroid adenomas than from thyroid tissue, which consequently become more conspicuous on delayed imaging.…”

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confidence: 99%

Hypercalcemic Crisis Secondary to A Parathyroid Hormone-Secreting, Intrathymic, Cystic, Parathyroid Adenoma

Diab

Awad

Purgina

et al. 2018

AACE Clinical Case Reports

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Objective: To report a rare case of a male patient with primary hyperparathyroidism due to a parathyroid hormone (PTH)-secreting, intrathymic, cystic, parathyroid adenoma.Methods: The pertinent clinical features, laboratory data, radiologic and pathologic findings are reported, along with a brief literature review.Results: A 69-year-old male was followed for asymptomatic hypercalcemia secondary to primary hyperparathyroidism since 2013. He was also incidentally found to have an anterior mediastinal mass on a chest X-ray which remained stable on annual follow-up. He was monitored regularly with serial calcium and renal function tests, with no indication for surgical intervention. Dual-phase 99m TcSestamibi scan did not localize a culprit parathyroid gland in the neck or upper chest. He presented in 2015 with renal failure and hypovolemic shock secondary to severe hypercalcemia (calcium 17.20 mg/dL, PTH 3,452 pg/mL) requiring intensive care unit admission. Treatment with aggressive hydration, diuresis and pamidronate failed to lower calcium levels. Patient underwent emergent surgical exploration with combined resection of 2 enlarged, eutopic parathyroid glands suspicious for adenoma and the cystic mediastinal mass. PTH levels from fluid within the cystic mediastinal mass were elevated at 1,290,000 pg/mL. Immediate postoperative PTH and calcium levels dropped to 58 pg/mL and 10.80 mg/dL, respectively. Pathology of the mediastinal mass was consistent with ectopic, intrathymic, parathyroid adenoma.Conclusion: Anterior mediastinal mass in the setting of hypercalcemia should be considered as a possible source of ectopic PTH production in the setting of an otherwise negative 99m Tc-Sestamibi parathyroid scan. Definitive treatment by resection of the mass is potentially curative.

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SNM Practice Guideline for Parathyroid Scintigraphy 4.0

Cited by 142 publications

References 24 publications

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

SPECT/CT in hyperparathyroidism

Hypercalcemic Crisis Secondary to A Parathyroid Hormone-Secreting, Intrathymic, Cystic, Parathyroid Adenoma

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