The role of combined techniques of scintigraphy and SPECT/CT in the diagnosis of primary hyperparathyroidism

Stanciu, Mihaela; Boicean, Loredana Camelia; Popa, Florina Ligia

doi:10.1097/md.0000000000014154

Cited by 12 publications

(3 citation statements)

References 11 publications

(19 reference statements)

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“…Most of the investigated patients have an increased body mass index. The obtained results support the concept of sarcopenic obesity from the literature [ 22 , 23 , 24 , 25 , 26 ]. Thus, the excess representation of adipose tissue can influence functionality.…”

Section: Discussionsupporting

confidence: 88%

The Impact of Complex Rehabilitation Treatment on Sarcopenia—Pathology with an Endocrine Morphological Substrate and Musculoskeletal Implications

et al. 2023

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The pathogenesis of sarcopenia is multifactorial, including changes in the endocrine system. Easy-to-perform screening tests can guide the diagnosis of sarcopenia and the rehabilitation therapeutic conduct, which can act on many physiopathological links. This study was conducted over a period of 5 months, from April to August 2022, and included 84 patients hospitalized for a period of 10 days in the Balneal and Rehabilitation Sanatorium Techirghiol for complex physiotherapy, which included balneotherapy. In dynamics, both at admission and discharge, specific screening tests for sarcopenia (SARC-F questionnaire, grip strength, testing muscle strength at the level of the quadriceps, sit-to-stand tests (the time required for five consecutive rises and the number of rises performed in 30 s)) and the Visual Analogue Scale (VAS) for pain were performed. The study was conducted according to the norms of deontology and medical ethics. Results: A significant proportion of patients had a positive result in at least one of the tests for the screening of sarcopenia syndrome. The most eloquent results were obtained from the statistical analysis of the following parameters evaluated at admission: the SARC-F questionnaire and the sit-to-stand test—the number of rises in 30 s. In terms of dynamics, after performing the complex rehabilitation treatment, the patients recorded improvements in the established screening tests and improvements in pain symptoms evaluated with the help of the VAS. Conclusions: Sarcopenia, a pathology developed with aging, is frequently encountered among adults. In the future, it is important to perform screening for sarcopenia in both endocrinology and medical rehabilitation clinics. Good management of sarcopenia can influence therapeutic conduct and can prevent complications, improving the functional capacity and the quality of life of the patients.

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Section: Discussionsupporting

confidence: 88%

The Impact of Complex Rehabilitation Treatment on Sarcopenia—Pathology with an Endocrine Morphological Substrate and Musculoskeletal Implications

et al. 2023

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“…Single-photon emission computed tomography/computed tomography (SPECT/CT) was found useful in different tumours that are either malignant or hormonally active, such as parathyroid tumours [ 56 , 57 , 58 ]. Kitajima et al [ 56 ] applied three-dimensional (3D) quantitative bone SPECT/CT to assess the evolution of a patient diagnosed with pulmonary cancer who was treated with pembrolizumab.…”

Section: Results: Sternal Metastases—a Multidisciplinary Perspective ...mentioning

confidence: 99%

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

Carsote,

Terzea,

Vasilescu

et al. 2023

Diagnostics

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We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as “sternal”, “manubrium”, and “metastasis” within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisional biopsy was used to address a 10 cm sternal tumour upon first admission on an apparently healthy male). The studies (n = 14) may be classified into one of three groups: studies addressing the incidence of bone metastases (including sternum) amid different primary cancers, such as prostate cancer (N = 122 with bone metastases, 83% of them with chest wall metastases), head and neck cancers (N = 3620, 0.8% with bone metastases, and 10.34% of this subgroup with sternum involvement); and glioblastoma (N = 92 with bone metastases, 37% of them with non-vertebral metastases, including the sternum); assessment cohorts, including breast cancer (N = 410; accuracy and sensitivity of PET/CT vs. bone scintigraphy is superior with concern to sternum spreading) and bone metastases of unknown origin (N = 83, including a subgroup with sternum metastases; some features of PET/CT help the differentiation with multiple myeloma); and cohorts with various therapeutic approaches, such as palliative arterial embolization (N = 10), thymic neuroendocrine neoplasia (1/5 detected with sternum metastases), survival rates for sternum metastases vs. non-sternum chest wall involvement (N = 87), oligo-metastatic (sternal) breast cancer (3 studies, N = 16 for all of them), oligo-metastatic head and neck cancer (N = 81), conformal radiotherapy (N = 24,215, including an analysis on sternum spreading), and EBRT followed by MR-HIFU (N = 6). Core data coming from the isolated case reports (N = 34) showed a female to male ratio of 1.6; the females’ ages were between 34 and 80 (mean of 57.28) and the males’ ages varied between 33 and 79 (average of 58.78) years. The originating tumour profile revealed that the most frequent types were mammary (N = 8, all females) and thyroid (N = 9, both women and men), followed by bladder (N = 3), lung (N = 2), and kidney (N = 2). There was also one case for each of the following: adenoid cystic carcinoma of the jaw, malignant melanoma, caecum MiNEN, a brain and an extracranial meningioma, tongue carcinoma, cholangiocarcinoma, osteosarcoma, and hepatocellular carcinoma. To our knowledge, this is the most complex and the largest analysis of prior published data within the time frame of our methods. These data open up new perspectives of this intricate, dynamic, and challenging domain of sternum metastases. Awareness is a mandatory factor since the patients may have a complex multidisciplinary medical and/or surgical background or they are admitted for the first time with this condition; thus, the convolute puzzle will start from this newly detected sternal lump. Abbreviations: N = number of patients; n = number of studies; PET/CT = positron emission tomography/computed tomography; EVRT = external beam radiotherapy; MR-HIFU = magnetic resonance-guided high-intensity focused ultrasound; MiNEN = mixed neuroendocrine-non-neuroendocrine tumour.

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“…Recently, 11C-methionine, 11C-choline or 18F-fluorocholine PET/CT showed encouraging outcomes, especially in patients who underwent unsuccessful parathyroidectomy or had negative or discordant imaging results pre-surgery, with these patients being alternatively candidates to SPECT/CT, as well [44][45][46][47]. Head-to-head studies (versus 99m-Tc sestamibi SPECT/CT) showed comparable results despite using a different tracer for parathyroid glands [48] or even an improvement in detection rate, for instance, from 88% for 99m-Tc-sestamibi SPECT/CT to 98% according to one recent study [49] or a sensitivity of 99% for 18F-fluorocholine PET/CT versus 75% for ultrasound versus 65% for 99m-Tc sestamibi scintigraphy versus 89.9% for ultrasound combined with this type of scintigraphy according to another cohort from 2022 [50].…”

Section: Concordance Of Pre-operatory Localisation Studies In Phpmentioning

confidence: 99%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95–99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.

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The role of combined techniques of scintigraphy and SPECT/CT in the diagnosis of primary hyperparathyroidism

Cited by 12 publications

References 11 publications

The Impact of Complex Rehabilitation Treatment on Sarcopenia—Pathology with an Endocrine Morphological Substrate and Musculoskeletal Implications

The Impact of Complex Rehabilitation Treatment on Sarcopenia—Pathology with an Endocrine Morphological Substrate and Musculoskeletal Implications

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

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