Localization of parathyroid disease with ‘sequential multiphase and dual-tracer’ technique and comparison with neck ultrasound

Abstract

SMADT results in better localization of varying parathyroid pathologies and complements the role of US in patients with multigland disease and nodular thyroid.

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

“…Hybrid SPECT‐CT had the highest PPV of the analyzed imaging modalities at 0.98 but the relative differences in PPV between imaging modalities was not statistically significant in our pooled analysis. One advantage of SPECT‐CT is the additional detail of soft tissue and vascular neck anatomy, which may be helpful for the qualitative generalizable localizing of ectopic adenomas, although this has not been quantitatively supported in the literature we identified . Opinions vary as to whether SPECT‐CT should be routine for patients with hyperparathyroidism and potential thyroid disease, particularly given the additional costs and radiation exposure .…”

“…Hybrid SPECT‐CT was evaluated in 4 studies . Based on 2 studies, this modality had a pooled sensitivity of 0.81 (95% CI 0.71‐0.91) and PPV of 0.98 (95% CI 0.95‐1.02).…”

“…Thirteen studies were prospective [10][11][12][16][17][18][19][20][21][22][23][24][25] and 15 were retrospective. 4,5,[26][27][28][29][30][31][32][33][34][35][36][37][38] Levels of evidence analysis were determined to be level III (cohort studies) and V (case series). The main concerns regarding study quality were: minor variations in patient inclusion criteria, potential bias in patient selection inherent to retrospective studies, and heterogeneity in the reporting of data and summary statistics.…”

New scintigraphic methods for parathyroid imaging

“…Pre-operative imaging consists of a combination of planar scintigraphy with parallel-hole or pinhole collimator scintigraphy with single (or dual) isotope dynamic 99m Tc-sestamibi(/ 99m TcO 4 ) scintigraphy with SPECT/CT and ultrasonography, which provide up to now the best accuracy and is critical for successful minimal invasive surgery aiming to lower morbidity and complication rate [1][2][3][4][5]. Lately, there have been advances in nuclear medicine methods for parathyroid imaging, which will focus thereafter on:…”

“…Jusqu'à maintenant, l'imagerie préopératoire par scintigraphie dynamique avec collimateurs à trous parallèles ou pinhole sur simple ou double isotope 9m Tc-sestamibi(/ 99m TcO4) avec tomographie par émission monophotonique couplée à la tomodensitométrie (TEMP/TDM) en combinaison avec l'échographie fournissaient la meilleure approche et permettaient de diminuer le taux de complications et de morbidités dans la chirurgie minimale invasive [1][2][3][4][5]. Récemment, certains progrès ont eu lieu en médecine nucléaire pour l'imagerie des glandes parathyroïdes, selon les méthodes détaillées ci-après et qui peuvent être divisées en :…”