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==Other Imaging Findings== | ==Other Imaging Findings== | ||
Other imaging modalities are used for preoperative localization of hyper-functioning parathyroid glands. The includes both non-invasive and invasive modalities. | |||
* | ===Non-invasive modalities=== | ||
** | *Technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi or MIBI) scintigraphy is the most popular investigation for preoperative localization of hyper-functioning parathyroid glands.<ref name="pmid16150247">{{cite journal| author=Palestro CJ, Tomas MB, Tronco GG| title=Radionuclide imaging of the parathyroid glands. | journal=Semin Nucl Med | year= 2005 | volume= 35 | issue= 4 | pages= 266-76 | pmid=16150247 | doi=10.1053/j.semnuclmed.2005.06.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16150247 }} </ref> | ||
**[ | *Most of the sestamibi is retained in mitochondria of thyroid and abnormal parathyroid tissue and is a function of mitochondrial activity.<ref name="pmid11742331">{{cite journal| author=Hetrakul N, Civelek AC, Stagg CA, Udelsman R| title=In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. | journal=Surgery | year= 2001 | volume= 130 | issue= 6 | pages= 1011-8 | pmid=11742331 | doi=10.1067/msy.2001.118371 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11742331 }} </ref> | ||
*The basis of this "single-isotope, double-phase technique" is that sestamibi washes out of the thyroid more rapidly than from abnormal parathyroid tissue.<ref name="pmid1328564">{{cite journal| author=Taillefer R, Boucher Y, Potvin C, Lambert R| title=Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study) | journal=J Nucl Med | year= 1992 | volume= 33 | issue= 10 | pages= 1801-7 | pmid=1328564 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1328564 }} </ref> | |||
*Multiple planar images are obtained, typically one shortly after injection of 99mTc-sestamibi and another after two hours to identify the foci of retained sestamibi showing hyper-functioning parathyroid tissue. | |||
*As all parathyroid lesions does not retain sestamibi nor all thyroid tissue washes out quickly, subtraction imaging may be beneficial.<ref name="pmid8288719">{{cite journal| author=Thulé P, Thakore K, Vansant J, McGarity W, Weber C, Phillips LS| title=Preoperative localization of parathyroid tissue with technetium-99m sestamibi 123I subtraction scanning. | journal=J Clin Endocrinol Metab | year= 1994 | volume= 78 | issue= 1 | pages= 77-82 | pmid=8288719 | doi=10.1210/jcem.78.1.8288719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8288719 }} </ref> | |||
*Subtraction technique uses dual contrast Tc-99m sestamibi along with iodine-123 or 99m-technicium pertechnetate which is taken by thyroid tissue only. Iodine-123/99m-technicium pertechnetate images of thyroid are later digitally subtracted from Tc-99m sestamibi images leading to visualization of parathyroid tissue only.<ref name="pmid25722888">{{cite journal| author=Ryhänen EM, Schildt J, Heiskanen I, Väisänen M, Ahonen A, Löyttyniemi E et al.| title=(99m)Technetium Sestamibi-(123)Iodine Scintigraphy Is More Accurate Than (99m)Technetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism. | journal=Int J Mol Imaging | year= 2015 | volume= 2015 | issue= | pages= 391625 | pmid=25722888 | doi=10.1155/2015/391625 | pmc=4333274 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25722888 }} </ref> | |||
*Presence of solid thyroid nodule is the most common cause of false positive results. Other causes of false positive results may include thyroid carcinoma, lymphoma, and lymphadenopathy. | |||
*The sensitivity of sestamibi scintigraphy can be increased by using it concomitantly with neck ultrasound and/or SPECT. <ref name="pmid18794320">{{cite journal| author=Eslamy HK, Ziessman HA| title=Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. | journal=Radiographics | year= 2008 | volume= 28 | issue= 5 | pages= 1461-76 | pmid=18794320 | doi=10.1148/rg.285075055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18794320 }} </ref><ref name="pmid12153604">{{cite journal| author=Haber RS, Kim CK, Inabnet WB| title=Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy. | journal=Clin Endocrinol (Oxf) | year= 2002 | volume= 57 | issue= 2 | pages= 241-9 | pmid=12153604 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12153604 }} </ref> | |||
*The sensitivity of sestamibi scintigraphy is 80% - 90%.<ref name="pmid8678959">{{cite journal |vauthors=Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, Richard B |title=Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism |journal=World J Surg |volume=20 |issue=7 |pages=835–9; discussion 839–40 |year=1996 |pmid=8678959 |doi= |url=}}</ref><ref name="pmid17685957">{{cite journal |vauthors=Prasannan S, Davies G, Bochner M, Kollias J, Malycha P |title=Minimally invasive parathyroidectomy using surgeon-performed ultrasound and sestamibi |journal=ANZ J Surg |volume=77 |issue=9 |pages=774–7 |year=2007 |pmid=17685957 |doi=10.1111/j.1445-2197.2007.04227.x |url=}}</ref><ref name="pmid20625763">{{cite journal |vauthors=Gómez-Ramírez J, Sancho-Insenser JJ, Pereira JA, Jimeno J, Munné A, Sitges-Serra A |title=Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism |journal=Langenbecks Arch Surg |volume=395 |issue=7 |pages=929–33 |year=2010 |pmid=20625763 |doi=10.1007/s00423-010-0680-8 |url=}}</ref> | |||
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[[image:Parathyroid subtraction.jpg|center|thumb|450px|Dual tracer Tc-99m sestamibi scintigraphy - A nuclear medicine parathyroid scan demonstrates a parathyroid adenoma adjacent to the left inferior pole of the thyroid gland. The above study was performed with Technetium-Sestamibi (1st column) and Iodine-123 (2nd column) simultaneous imaging and the subtraction technique (3rd column). -- [https://commons.wikimedia.org/wiki/File%3AParathyroid_subtraction.jpg Source:Myohan at en.wikipedia, via Wikimedia Commons]]] | |||
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[[image:Sestamibi scan gif.gif|center|thumb|600px|Tc-99m sestamibi scan - Parathyroid adenomas typically retain activity on late scans after wash-out in the thyroid has occurred. - [https://radiopaedia.org/cases/16675 Source:Case courtesy of Dr Roberto Schubert, Radiopaedia.org, rID: 16675]]] | |||
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==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Imaging modalities may be helpful in preoperative localization of hyper-functioning parathyroid glands. These imaging modalities include Tc-99m sestamibi scintigraphy, single positron emission computed tomography, positron emission tomography. Some invasive modalities used for preoperative localization of hyper-functioning parathyroid glands include selective arteriography and angiography. Dual energy X-ray absorptiometry is helpful in detecting low bone mineral density caused by hyperparathyroidism.
Other Imaging Findings
Other imaging modalities are used for preoperative localization of hyper-functioning parathyroid glands. The includes both non-invasive and invasive modalities.
Non-invasive modalities
- Technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi or MIBI) scintigraphy is the most popular investigation for preoperative localization of hyper-functioning parathyroid glands.[1]
- Most of the sestamibi is retained in mitochondria of thyroid and abnormal parathyroid tissue and is a function of mitochondrial activity.[2]
- The basis of this "single-isotope, double-phase technique" is that sestamibi washes out of the thyroid more rapidly than from abnormal parathyroid tissue.[3]
- Multiple planar images are obtained, typically one shortly after injection of 99mTc-sestamibi and another after two hours to identify the foci of retained sestamibi showing hyper-functioning parathyroid tissue.
- As all parathyroid lesions does not retain sestamibi nor all thyroid tissue washes out quickly, subtraction imaging may be beneficial.[4]
- Subtraction technique uses dual contrast Tc-99m sestamibi along with iodine-123 or 99m-technicium pertechnetate which is taken by thyroid tissue only. Iodine-123/99m-technicium pertechnetate images of thyroid are later digitally subtracted from Tc-99m sestamibi images leading to visualization of parathyroid tissue only.[5]
- Presence of solid thyroid nodule is the most common cause of false positive results. Other causes of false positive results may include thyroid carcinoma, lymphoma, and lymphadenopathy.
- The sensitivity of sestamibi scintigraphy can be increased by using it concomitantly with neck ultrasound and/or SPECT. [6][7]
- The sensitivity of sestamibi scintigraphy is 80% - 90%.[8][9][10]
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References
- ↑ Palestro CJ, Tomas MB, Tronco GG (2005). "Radionuclide imaging of the parathyroid glands". Semin Nucl Med. 35 (4): 266–76. doi:10.1053/j.semnuclmed.2005.06.001. PMID 16150247.
- ↑ Hetrakul N, Civelek AC, Stagg CA, Udelsman R (2001). "In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria". Surgery. 130 (6): 1011–8. doi:10.1067/msy.2001.118371. PMID 11742331.
- ↑ Taillefer R, Boucher Y, Potvin C, Lambert R (1992). "Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study)". J Nucl Med. 33 (10): 1801–7. PMID 1328564.
- ↑ Thulé P, Thakore K, Vansant J, McGarity W, Weber C, Phillips LS (1994). "Preoperative localization of parathyroid tissue with technetium-99m sestamibi 123I subtraction scanning". J Clin Endocrinol Metab. 78 (1): 77–82. doi:10.1210/jcem.78.1.8288719. PMID 8288719.
- ↑ Ryhänen EM, Schildt J, Heiskanen I, Väisänen M, Ahonen A, Löyttyniemi E; et al. (2015). "(99m)Technetium Sestamibi-(123)Iodine Scintigraphy Is More Accurate Than (99m)Technetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism". Int J Mol Imaging. 2015: 391625. doi:10.1155/2015/391625. PMC 4333274. PMID 25722888.
- ↑ Eslamy HK, Ziessman HA (2008). "Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT". Radiographics. 28 (5): 1461–76. doi:10.1148/rg.285075055. PMID 18794320.
- ↑ Haber RS, Kim CK, Inabnet WB (2002). "Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy". Clin Endocrinol (Oxf). 57 (2): 241–9. PMID 12153604.
- ↑ Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, Richard B (1996). "Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism". World J Surg. 20 (7): 835–9, discussion 839–40. PMID 8678959.
- ↑ Prasannan S, Davies G, Bochner M, Kollias J, Malycha P (2007). "Minimally invasive parathyroidectomy using surgeon-performed ultrasound and sestamibi". ANZ J Surg. 77 (9): 774–7. doi:10.1111/j.1445-2197.2007.04227.x. PMID 17685957.
- ↑ Gómez-Ramírez J, Sancho-Insenser JJ, Pereira JA, Jimeno J, Munné A, Sitges-Serra A (2010). "Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism". Langenbecks Arch Surg. 395 (7): 929–33. doi:10.1007/s00423-010-0680-8. PMID 20625763.