Imaging for primary hyperparathyroidism — what beginners should know

Ahuja, Anil T.; Wong, Kwan-Yee K.; Ching, A. S. C.; Fung, Mmh; Lau, James; Yuen, Edmund H.Y.; King, Ann D.

doi:10.1016/j.crad.2004.04.005

Cited by 58 publications

(62 citation statements)

References 48 publications

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“…The sensitivity of US for detecting a single parathyroid adenoma was very high [2]. However, as shown in the present series, US has several weak points for detecting or accurately indicating the responsible lesion(s) [8,9]. 99m Tc-MIBI, a lipophilic cationic molecule which was initially used for cardiac imaging, was found to show the uptake in the mitochondria and cytoplasm of parathyroid tissue.…”

Section: Discussionmentioning

confidence: 90%

“…However, parathyroid US is dependent on the experience of the operator [8] and has a suboptimal detection rate for multinodular thyroid disease and silent areas, such as the mediastinum, tracheoesophageal groove, and retroesophageal region [9]. Therefore, the practical choice for localization analysis in pHPT is a combination of 99m Tc-MIBI scintigraphy and US [10].…”

mentioning

confidence: 99%

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Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

et al. 2014

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Primary hyPerParathyroidism (pHPT) is a disease for which the diagnosis and treatment have become relatively straightforward. The criteria for diagnosis have become standardized with either elevated blood calcium levels, the presence of kidney stones, or decreased bone densitometry. The primary causes of pHPT are classically said to be 80%-85% due to adenoma, 10% -15% due to hyperplasia, and ~1% due to carcinoma, respectively. Majority of responsible lesion of pHPT is, thus, a single adenoma. The standard of care of pHPT is a surgical excision of the responsible lesion(s). Therefore, accurate localiza- abstract. We evaluated the efficacy of technetium-sestamibi ( 99m Tc-MIBI) SPECT/CT for planning parathyroidectomy in cases with primary hyperparathyroidism (pHPT), comparing with planar scintigraphy and ultrasound (US), in an aim to establish the proper surgical strategy according to the preoperative imaging studies. A retrospective review of consecutive 75 pHPT patients who had been operated on was conducted. The results of preoperative imaging modalities and the operative finding were analyzed. Seven cases were found to have multiple hyperplastic glands, and no responsible gland was found in three cases. Four cases underwent only US scan for preoperative imaging. Remaining 61 cases were found to have single adenoma, and were included in the evaluation of localization imaging. US scan, 99m Tc-MIBI planar scan and 99m Tc-MIBI SPECT/CT showed accurate localization in 77.0% (47/61), 75.4% (46/61) and 88.5% (46/52) of the evaluable cases, respectively. US and 99m Tc-MIBI planar scan demonstrated consistent result in 42 cases (68.9%), and those cases showed accurate localization in 90.5% (38/42). When both US and 99m Tc-MIBI SPECT/CT was consistent, all 37 lesions had been correctly indicated. No clinico-pathological features were suggested to influence in demonstrating the localization, other than only 99m Tc-MIBI SPECT/CT exhibited 100% sensitivity in ectopic glands. Combination of US and 99m Tc-MIBI SPECT/CT certainly contributes to the planning of minimally invasive operation in cases with pHPT by indicating correct localization of single adenoma.Key words: Primary hyperparathyroidism, Technetium-sestamibi ( 99m Tc-MIBI), SPECT/CT tion analysis is important.The imaging techniques that have been used to identify the location of responsible lesion(s) are technetium-thallium subtraction scan, technetium-sestamibi ( 99m Tc-MIBI) scan, ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) [1], venous sampling of parathyroid hormone, and angiography. To date, the best results have been found using either US or technetium imaging.The sensitivity of US for detecting a single parathyroid adenoma was 57 to 87 % [2][3][4][5][6][7]. However, parathyroid US is dependent on the experience of the operator [8] and has a suboptimal detection rate for multinodular thyroid disease and silent areas, such as the mediastinum, tracheoesophageal groove, and retroesophageal region [9]. Therefore, the practical choic...

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Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

et al. 2014

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“…Higher calcium levels greater than 14mg/dl and intact PTH levels on average 5-10 times upper limit of the normal range are diagnostic of parathyroid cancer [12]. Anatomic imaging including ultrasound, Tc-99m-sestamibi SPECT and TC scan are useful localizing studies, in patients suffering primary hyperparathyroidism [2,6]. Block resection of all involved tissue, central neck dissection and lobectomy of thyroid is the appropriate initial surgical treatment in all suspected cases of parathyroid carcinoma [13].…”

Section: Discussionmentioning

confidence: 99%

“…Less common causes include parathyroid hyperplasia of all four glands, represented by only 10% of sporadic PHPT, and multiple adenomas, which constitute only 4% [6]. Rare causes of pancreatitis include parathyroid cancers and cysts, but is less than 3% of all cases [6]. Here, we present a case of acute pancreatitis caused by parathyroid carcinoma in a 45 years old female.…”

Section: Introductionmentioning

confidence: 96%

“…A single parathyroid adenoma accounts for 85% of all sporadic primary hyperparathyroidism. Less common causes include parathyroid hyperplasia of all four glands, represented by only 10% of sporadic PHPT, and multiple adenomas, which constitute only 4% [6]. Rare causes of pancreatitis include parathyroid cancers and cysts, but is less than 3% of all cases [6].…”

Section: Introductionmentioning

confidence: 99%

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Parathyroid Carcinoma Presenting as an Acute Pancreatitis

Cadena¹,

Romero‐Rojas²

2017

IJRRT

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Parathyroid carcinoma is the cause of only 1% of hyperparathyroidism cases. The incidence of acute pancreatitis in patients with hyperparathyroidism was reported to be only 1.5%. The occurrence of pancreatitis in patients with parathyroid carcinoma is unusual, ranging from 0% to 15%. Here, we report a very rare case of parathyroid carcinoma presenting as an acute pancreatitis in a 45 years old woman, who was suspected for hypercalcemia and higher levels of intact parathyroid hormone. The parathyroid carcinoma was verified with ultrasound, CT Scan, and single-photon emission computed tomography. The pathological anatomy report showed a minimally invasive parathyroid carcinoma. Following surgery, the patient was free after almost a 4 years follow up.

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Investigations

Stack¹,

Randolph²

2010

A Practical Manual of Thyroid and Parathyroid Disease

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Imaging for primary hyperparathyroidism — what beginners should know

Cited by 58 publications

References 48 publications

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

Parathyroid Carcinoma Presenting as an Acute Pancreatitis

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