Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck

Aschenbach, René; Tuda, Sigemiti; Lamster, E.; Meyer, Axel; Roediger, H.; Stier, A.; Conrad, Elke; Basche, S; Klisch, Joachim; Vogl, T. J.

doi:10.1016/j.ejrad.2012.05.023

Cited by 24 publications

(31 citation statements)

References 18 publications

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“…Sonography of the thyroid gland still did not reveal any further lesions, but the volume of the "cyst" had increased to 13.9 mL. For further clarification, dynamic magnetic resonance angiography of the neck was performed, knowing its high diagnostic accuracy in this field [4]. The examination revealed a small focal arterial hypervascularization at the ventral part of the lesions capsule, which is frequently seen in parathyroidal adenomas (Fig.…”

Section: Case Presentationmentioning

confidence: 98%

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Case report of a cystic parathyroidal adenoma with rapid growth induced by cinacalcet

et al. 2020

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Background: Primary hyperparathyroidism is a rare condition of disease which can seldomly present as giant retrotrhyroideal cysts, complicating the localization of the adenoma to resect. Case presentation: A 56-year old female presented with hypercalcaemia of 3.38 mmol/L (2.2-2.65 mmol/L) and a history of breast cancer. A fast growing cystic parathyroidal adenoma was diagnosed by a multimodal approach including comprehensive diagnostic imaging (ultrasonography, scintigraphies, dynamic MRI) and cytopathological investigations after ultrasonography-guided puncture. The patient was cured by surgical extraction of the whole adenoma. In retrospect, the rapid growth was most likely induced by cinacalcet (initially 30 mg/d, later 60 mg/d) therapy which the patient received for few months only. Primary hyperparathyroidism was ascertained because surgical removal of the solitary adenoma cured the patient. Furthermore, there was no relevant renal insufficiency or history of prolonged calcium-level deregulation. Conclusions: This phenomenon of cystic degeneration of parathyroidal adenoma under therapy with cinacalcet has previously been described in secondary hyperparathyroidism, but not in primary hyperparathyroidism and should be considered in diagnostic approach.

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Section: Case Presentationmentioning

confidence: 98%

“…3 Clinic of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany. 4 Department of Radiology, Jena University Hospital, Jena, Germany. 5 Institute of Pathology, Jena University Hospital, Jena, Germany.…”

Section: Acknowledgementsmentioning

confidence: 99%

Case report of a cystic parathyroidal adenoma with rapid growth induced by cinacalcet

et al. 2020

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“…Parathyroid adenomas appear hyperenhancing during the early arterial phase, while thyroid tissue enhances during subsequent phases. In a study of 30 patients with hyperparathyroidism and prior neck surgery, MRI with dynamic MRA had sensitivity for localization of 93% [53].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…It also requires experience to interpret accurately, underscoring the importance of seeking a high-volume radiologist. It is quite limited in both its anatomic resolution and its ability to localize small parathyroid glands or multigland disease (in which glands tend to be only mildly enlarged) [14,28,[53][54][55]. ere are several factors that may explain why the accuracy of preoperative sestamibi scintigraphy decreases in the setting of persistent or recurrent disease.…”

Section: Sestamibi Scintigraphymentioning

confidence: 99%

“…Although this increase was shown in a sample consisting of both initial and reoperative patients, it is reasonable to conclude that MRI provides an added benefit in the reoperative setting, where the accuracy of ultrasound and sestamibi scintigraphy markedly suffer. While the use of dynamic MRI does not confer a significant benefit over conventional MRI in the reoperative setting, the addition of dynamic MRA might, as it enables the detection of smaller adenomas than conventional MRI alone [53]. Yet, these strengths must be weighed against both the drawbacks of the modality and the limitations in evidence supporting it.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

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Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Parikh

Grogan

Morón

2020

International Journal of Endocrinology

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The localization of persistent or recurrent disease in reoperative patients with primary hyperparathyroidism presents challenges for radiologists and surgeons alike. In this article, we summarize the relevant imaging modalities, compare their accuracy in identifying reoperative disease, and outline their advantages and disadvantages. Accurate localization by preoperative imaging is a predictor of operative success, whereas negative or discordant preoperative imaging is a risk factor for operative failure. Ultrasound is a common first-line modality because it is inexpensive, accessible, and radiation-free. However, it is highly operator-dependent and less accurate in the reoperative setting than in the primary setting. Sestamibi scintigraphy is superior to ultrasound in localizing reoperative disease but requires radiation, prolonged imaging times, and reader experience for accurate interpretation. Like ultrasound, sestamibi scintigraphy is less accurate in the reoperative setting because reoperative patients can exhibit distorted anatomy, altered perfusion of remaining glands, and interference of radiotracer uptake. Meanwhile, four-dimensional computed tomography (4DCT) is superior to ultrasound and sestamibi scintigraphy in localizing reoperative disease but requires the use of radiation and intravenous contrast. Both 4DCT and magnetic resonance imaging (MRI) do not significantly differ in accuracy between unexplored and reoperative patients. However, MRI is more costly, inaccessible, and time-consuming than 4DCT and is inappropriate as a first-line modality. Hybrid imaging with positron emission tomography and computed tomography (PET/CT) may be a promising second-line modality in the reoperative setting, particularly when first-line modalities are discordant or inconclusive. Lastly, selective venous sampling should be reserved for challenging cases in which noninvasive modalities are negative or discordant. In the challenging population of reoperative patients with PHPT, a multimodality approach that utilizes the expertise of high-volume centers can accurately localize persistent or recurrent disease and enable curative parathyroidectomy.

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Preoperative Imaging Techniques in Primary Hyperparathyroidism

Bunch

Kelly

2018

JAMA Otolaryngol Head Neck Surg

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Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck

Cited by 24 publications

References 18 publications

Case report of a cystic parathyroidal adenoma with rapid growth induced by cinacalcet

Case report of a cystic parathyroidal adenoma with rapid growth induced by cinacalcet

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Preoperative Imaging Techniques in Primary Hyperparathyroidism

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