Virtual Neck Exploration

Prommegger, Rupert; Wimmer, Gerd; Profanter, Christoph; Sauper, Tonja; Sieb, Michael; Kovács, Péter; Bale, Reto; Putzer, Daniel; Gabriel, Michael; Margreiter, Raimund

doi:10.1097/sla.0b013e3181bd906b

Cited by 46 publications

(11 citation statements)

References 28 publications

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“…In a retrospective study using dual phase MIBI and SPECT/CT in 94 patients the sensitivity of SPECT/CT was reported as 92%, which is similar to our findings (15). In another study with 116 patients, the sensitivity for SPECT/CT was slightly lower than our results with 88%, and the sensitivity for SPECT was similar to our findings with 59% (16). …”

Section: Discussionsupporting

confidence: 87%

Improved Benefit of SPECT/CT Compared to SPECT Alone for the Accurate Localization of Endocrine and Neuroendocrine Tumors

Bural

Muthukrishnan²,

Oborski³

et al. 2012

MIRT

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Objective: To assess the clinical utility of SPECT/ CT in subjects with endocrine and neuroendocrine tumors compared to SPECT alone.Material and Methods: 48 subjects (31 women;17 men; mean age 54±11) with clinical suspicion or diagnosis of endocrine and neuroendocrine tumor had 50 SPECT/CT scans (32 Tc-99m MIBI, 5 post treatment I-131, 8 In-111 Pentetreotide, and 5 I-123 MIBG). SPECT alone findings were compared to SPECT/CT and to pathology or radiological follow up.Results: From the 32 Tc-99m MIBI scans, SPECT accurately localized the lesion in 22 positive subjects while SPECT/CT did in 31 subjects. Parathyroid lesions not seen on SPECT alone were smaller than 10 mm. In five post treatment I-131 scans, SPECT alone neither characterized, nor localized any lesions accurately. SPECT/CT revealed 3 benign etiologies, a metastatic lymph node, and one equivocal lesion. In 8 In-111 Pentetreotide scans, SPECT alone could not localize primary or metastatic lesions in 6 subjects all of which were localized with SPECT/CT. In five I-123 MIBG scans, SPECT alone could not detect a 1.1 cm adrenal lesion or correctly characterize normal physiologic adrenal uptake in consecutive scans of the same patient with prior history of adrenelectomy, all of which were correctly localized and characterized with SPECT/CT.Conclusion: SPECT/CT is superior to SPECT alone in the assessment of endocrine and neuroendocrine tumors. It is better in lesion localization and lesion characterization leading to a decrease in the number of equivocal findings. SPECT/CT should be included in the clinical work up of all patients with diagnosis or suspicion of endocrine and neuroendocrine tumors.Conflict of interest:None declared.

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Section: Discussionsupporting

confidence: 87%

Improved Benefit of SPECT/CT Compared to SPECT Alone for the Accurate Localization of Endocrine and Neuroendocrine Tumors

Bural

Muthukrishnan²,

Oborski³

et al. 2012

MIRT

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“…Aside from its ability to localize the pathological gland(s), accurate imaging provides valuable anatomical information for the surgeon. 99 Tc-sestamibi single photon emission computed tomography (SPECT-CT) has become one of the mainstays in first-line parathyroid imaging based on robust evidence demonstrating its ability to predict the location of an adenoma [6]. However, a recent meta-analysis showed that its sensitivity is only 63–84 % (depending on protocol), which leaves a substantial amount of cases with equivocal imaging results [7].…”

Section: Introductionmentioning

confidence: 99%

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Kluijfhout

Pasternak

Drake

et al. 2016

Langenbecks Arch Surg

109

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Purpose The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers. Methods A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance. Conclusions The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPVand may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.

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“…In another report of 116 patients with single-gland disease, sensitivity for SPECT/CT was 88%, for CT 70%, and for SPECT 59%. Specificity for SPECT/CT was 99%, for SPECT 95%, and for CT 94% [33]. Both studies concluded that SPECT/CT fusion was superior to the individual CT or SPECT images alone in localizing parathyroid adenomas.…”

Section: Preoperative Parathyroid Localizationmentioning

confidence: 99%

“…In investigating the role of SPECT/CT in the general oncologic patients, the functional and anatomic imaging obtained from SPECT and CT has been shown to be synergistic versus complementary, and can significantly contribute to more accurate localization of parathyroid and other cancers [37]. While the SPECT/CT can be technically challenging to perform and potentially increase patient radiation doses, the benefits of its improved sensitivity and specificity can decrease need for future confirmatory imaging studies [33, 35]. …”

Section: Preoperative Parathyroid Localizationmentioning

confidence: 99%

Role of SPECT and SPECT/CT in the Surgical Treatment of Primary Hyperparathyroidism

Taubman

Goldfarb

Lew

2011

International Journal of Molecular Imaging

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Primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient population. This condition is usually the result of a single hyperfunctioning parathyroid gland. Targeted parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IPM) through a small cervical incision has replaced traditional bilateral neck exploration (BNE) as the initial approach in the surgical treatment of primary hyperparathyroidism at many medical centers worldwide. Preoperative sestamibi-technetium 99m scintigraphy serves as an important prerequisite for successful targeted parathyroidectomy. Single-photon emission computed tomography (SPECT) and CT fusion, however, is a recent imaging technique that provides a three-dimensional functional image with advanced contrast resolution to greatly improve preoperative localization of parathyroid tumors.

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Virtual Neck Exploration

Abstract: This study provides evidence that CT-MIBI-SPECT image fusion is superior to CT or MIBI-SPECT alone for preoperative localization of enlarged parathyroid glands in patients with single-gland primary hyperparathyroidism.

Cited by 46 publications

References 28 publications

Improved Benefit of SPECT/CT Compared to SPECT Alone for the Accurate Localization of Endocrine and Neuroendocrine Tumors

Improved Benefit of SPECT/CT Compared to SPECT Alone for the Accurate Localization of Endocrine and Neuroendocrine Tumors

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Role of SPECT and SPECT/CT in the Surgical Treatment of Primary Hyperparathyroidism

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