Editorial
What is the role of preoperative scintigraphic imaging and the intraoperative gamma probe in secondary hyperparathyroidism? David Fustera, Sergi Vidal-Sicarta, Jose´-Vicente Torregrosab, Pilar Paredesa, Domenico Rubelloc and Francesca Ponsa Nuclear Medicine Communications 2014, 35:443–445 a
b
Nuclear Medicine Department, Renal Transplant Unit, Hospital Clinic, Barcelona, Spain and cDepartment of Imaging, Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Nuclear Medicine & PET/CT Centre, Santa Maria della Misericordia Hospital, Rovigo, Italy
& PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy Tel: + 39 0425 39 4428; fax: + 39 0425 39 4434; e-mail: [email protected] Received 23 December 2013 Accepted 12 January 2014
Correspondence to Domenico Rubello, MD, Department of Imaging, Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Nuclear Medicine
Preoperative parathyroid scintigraphy has a valuable role in identifying hyperfunctioning autonomous parathyroid tissue and is widely used to localize pathological glands. In primary hyperparathyroidism, which usually appears as a solitary adenoma, preoperative imaging can help the surgeon identify and precisely remove the parathyroid gland, especially in the case of minimally invasive surgical procedures. Nuclear medicine techniques have been shown to be most useful in identifying unsuspected ectopic [1] or supernumerary glands [2–4] and in reoperation after a previous failed surgical attempt [5]. EANM parathyroid guidelines indicate that the functional information that can be obtained by nuclear medicine parathyroid scintigraphy increases the diagnostic capability over conventional imaging. Double-tracer subtraction parathyroid scintigraphy has better sensitivity and is more likely to distinguish thyroid nodules that take up sestamibi from parathyroid tumours. Single-photon emission computed tomography (SPECT)/computed tomography (CT) images are strongly recommended to better define the position of an ectopic focus; however, SPECT and SPECT/CT imaging cannot replace the standard planar and ‘pinhole’ protocols [6]. Tardin et al. [7] evaluated the role of dual-phase 99m Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy in the diagnosis and treatment of primary hyperparathyroidism caused by ectopic adenomas in 105 consecutive patients with histopathological confirmation and at least 1-year follow-up, recording a 100% success rate for radioguided parathyroidectomy without evidence of persistent or recurrent hyperparathyroidism. Radioguided surgery has also proved to be helpful for patients with recurrent hyperparathyroidism from forearm graft hyperplasia, especially when the parathyroid fragment is unmarked [8]. Hyperparathyroidism patients may have concomitant thyroid pathology, and at times thyroid nodules can be problematic as they may present as falsepositive findings in parathyroid scintigraphy and can sometimes interfere with radioguided surgery, making it c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 0143-3636
difficult to differentiate from hyperactive parathyroid tissue. However, a study of 87 patients diagnosed with primary hyperparathyroidism who underwent radioguided surgery (divided into two groups depending on the presence or absence of concomitant thyroid pathology) concluded that patients with concomitant thyroid pathology should not be automatically excluded from minimally invasive surgery [9]. Secondary hyperparathyroidism, however, is a process generally characterized by multiglandular hyperplasia, and the possible benefits of preoperative noninvasive imaging tools in this setting are still under debate [10–13]. In the hands of a skilled surgeon, results in secondary hyperparathyroidism patients with no previous history of neck surgery are generally excellent, with minimal morbidity in either total or subtotal parathyroidectomy. Some authors are against preoperative parathyroid scintigraphy on the grounds that the low sensitivity of 99m Tc-MIBI to detect hyperplastic glands rather than adenomas brings no significant additional value [14]. Nevertheless, the rate of persistent or recurrent disease in this setting is currently between 10 and 30%, principally because of incomplete localization of the hyperplastic glands, which would suggest that more caution is warranted when ruling out a role for preoperative imaging. In a study on the follow-up of 51 haemodialysis patients who had undergone subtotal parathyroid surgery, our group found a high number of recurrences. Interestingly, in eight out of the nine recurrences, the preserved gland had shown 99m Tc-MIBI uptake in the scan performed before surgical intervention [15]. The interest in radioguided surgery will probably increase with the introduction of minimally invasive surgical techniques in this setting. The era of focused exploration or minimally invasive radioguided parathyroidectomy began nearly two decades ago, with the introduction of preoperative 99mTc-MIBI scintigraphy to identify and locate the parathyroid adenoma [16]. The 20% rule proposed by Norman established a guideline – measuring radioactivity in the minimally DOI: 10.1097/MNM.0000000000000090
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
444 Nuclear Medicine Communications 2014, Vol 35 No 5
invasive radioguided parathyroidectomy technique in order to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20% of the excision site/background radioactivity, the 20% rule was satisfied. A study by Quillo et al. [17] reviewed 216 primary hyperparathyroidism patients meeting these criteria and their results supported the 20% rule in almost 100% of patients, successfully locating and confirming an overactive gland without the need for intraoperative parathyroid hormone monitoring or tissue analysis. Nichol et al. [18] analysed 33 consecutive patients with secondary or tertiary hyperparathyroidism who underwent radioguided parathyroidectomy. All parathyroid glands were localized during the operation and all hyperplastic glands had ex-vivo counts greater than 20% of the background. When compared with 66 historical control participants who had undergone surgery without radioguidance, those with radioguided parathyroidectomy had decreased operative times and lengths of stay (P < 0.001), and analysis of frozen sections could be omitted. The authors concluded that radioguided parathyroidectomy appears to be a useful adjunct in the treatment of secondary and tertiary hyperparathyroidism [18]. Rubello et al. [19] implemented a low-dose 99m Tc-MIBI protocol (37 MBq) in a minimally invasive radioguided parathyroidectomy to evaluate successful removal of parathyroid tissue. A parathyroid/thyroid ratio higher than 1.5 was strongly suggestive of a parathyroid adenoma and an empty parathyroid bed-to-thyroid ratio approaching 1 was highly indicative of complete removal of abnormal parathyroid tissue [19]. Furthermore, Chen et al. [20] showed that radioguided techniques are equally effective in patients with negative (nonlocalizing) 99mTcMIBI scans undergoing parathyroidectomy for primary hyperparathyroidism, suggesting that the gamma probe has an important role for localization of parathyroid glands in patients with negative preoperative 99mTc-MIBI scans. An interesting report in the literature supports the use of radioguided surgery with 99mTc-MIBI in renal hyperparathyroidism using sensitization with intravenous low-dose dobutamine in a patient with negative parathyroid scintigraphy [21]. Nevertheless, Chen et al. [22] demonstrated that ex-vivo counts were highest in single-gland adenomas and lowest in hyperplastic parathyroid glands; however, all hyperplastic parathyroid glands still registered ex-vivo counts greater than 20% of postexcision background counts. The study by Friedman et al. [23] corroborates this impression as they differentiated ex-vivo radioactivity percentages of hyperactive parathyroid tissue from any other tissue, but could not differentiate adenomas from hyperplasia. Despite this, Rubello et al. [19] still recommend the use of the intraoperative quick parathyroid hormone assay at the time of radioguided parathyroidectomy following the low-dose 99mTc-MIBI technique to ensure complete removal of additional foci of hyperfunctioning parathyroid tissue secondary to the persistence of previously unrecognized hyperplastic parathyroid glands.
From a practical point of view, our own experience leads us to recognize the difficulty in ascertaining the diffuse uptake of those hyperplastic glands. Intraoperatively, the parathyroid/background or parathyroid/thyroid rate is rarely higher than 1.5–2.0, which introduces some uncertainty into the procedure (based on a previous dose of 370 MBq). In some cases it may be advisable to use intraoperative devices like portable gamma cameras or freehand SPECT. The group of Ortega et al. [24] performed planar imaging with 99mTc-MIBI before surgical incision with a portable gamma camera for intraoperative localization of the gland. The portable gamma camera images provided the same information as the preoperative images and consistently showed the location of parathyroid adenomas during surgery [24]. Free-hand SPECT enables intraoperative three-dimensional reconstruction of radioactivity distribution based on hand-held gamma probe detectors. This device uses a gamma probe and a threedimensional tracking system. An optical infrared camera ensures localization of the patient and gamma probe in space. Synchronized readings of the gamma detector and the navigation system provide a reconstruction in the same coordinate system as well as registration-free navigation. In the coming years, free-hand PET may provide intraoperative functional imaging techniques that can be complemented with preoperative and intraoperative MRI to allow for better planning, navigation, and guidance. Development should be followed up [25]. The routine use of parathyroid scintigraphy as a preoperative tool in secondary hyperparathyroidism would probably reduce the operative time and increase the success rate of surgical treatment while lowering the possibility of recurrence, especially in ectopic, supernumerary, and forearm autotransplanted glands. The addition of the intraoperative localization of parathyroid hyperplastic glands is not without technical difficulties due to the low parathyroid/thyroid background uptake but may still be feasible and should be taken into account when minimally invasive surgery is the treatment of choice for secondary hyperparathyroidism.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1 2 3 4
5
Kettle AG, O’Doherty MJ. Parathyroid imaging: how good is it and how should it be done? Semin Nucl Med 2006; 36:206–211. O’Doherty MJ, Kettle AG. Parathyroid imaging: preoperative localization. Nucl Med Commun 2003; 24:125–131. Coakley AJ. Parathyroid imaging. Nucl Med Commun 1995; 16:522–533. Feingold DL, Alexander HR, Chen CC, Libutti SK, Shawker TH, Simonds WF, et al. Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas. Surgery 2000; 128:1103–1109. Takeyama H, Tabei I, Ogi S, Yokoyama K, Yamamoto H, Okido I, et al. Usefulness of intraoperative 99mTc-MIBI-guided detection for recurrent sites in secondary hyperparathyroidism: a case–controlled study. Int J Surg 2008; 6:184–188.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Gamma imaging in secondary HPT Fuster et al. 445
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9
10
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12
13
14
15
Hindie´ E, Ugur O, Fuster D, O’Doherty M, Grassetto G, Uren˜a P, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 2009; 36:1201–1216. Tardin L, Prats E, Andre´s A, Razola P, Deus J, Gastaminza R, et al. Ectopic parathyroid adenoma: scintigraphic detection and radioguided surgery. Rev Esp Med Nucl 2011; 30:19–23. Sippel R, Bianco J, Chen H. Radioguided parathyroidectomy for recurrent hyperparathyroidism caused by forearm graft hyperplasia. J Bone Miner Res 2003; 18:939–942. Garcı´a-Talavera P, Gonza´lez C, Garcı´a-Talavera JR, Martı´n E, Martı´n M, Go´mez A. Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology. Eur J Nucl Med Mol Imaging 2010; 37:2060–2067. Weber CJ, Vansant J, Alazraki N, Christy J, Watts N, Phillips LS, et al. Value of technetium 99mTc sestamibi I-123 imaging in reoperative parathyroid surgery. Surgery 1993; 114:1011–1018. Kasai ET, da Silva JW, Mandarim de Lacerda CA, Boasquevisque E. Parathyroid glands: combination of sestamibi-(99m)Tc scintigraphy and ultrasonography for demonstration of hyperplasic parathyroid glands. Rev Esp Med Nucl 2008; 27:8–12. Lomonte C, Buonvino N, Selvaggiolo M, Dassira M, Grasso G, Vernaglione L, et al. Sestamibi scintigraphy, topography, and histopathology of parathyroid glands in secondary hyperparathyroidism. Am J Kidney Dis 2006; 48: 638–644. Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (doublephase study). J Nucl Med 1992; 33:1801–1807. Olaizola I, Zingraff J, Heuguerot C, Fajardo L, Le´ger A, Lo´pez J, et al. [(99m)Tc]-sestamibi parathyroid scintigraphy in chronic haemodialysis patients: static and dynamic explorations. Nephrol Dial Transplant 2000; 15:1201–1206. Torregrosa JV, Fuster D, Ybarra J, Ortı´n J, Moreno A, Valveny N. Predicting the effect of intravenous calcitriol on parathyroid gland activity using double-
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18
19
20
21
22
23
24
25
phase technetium Tc 99m-sestamibi scintigraphy. Am J Kidney Dis 2004; 44:476–480. Proye CAG, Carnaille B, Bizard JP, Quievreux JL, Lecomte-Houcke M. Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited – where are we in the early 1990s – a plea against unilateral parathyroid exploration. Surgery 1992; 112:1118–1122. Quillo AR, Bumpous JM, Goldstein RE, Fleming MM, Flynn MB. Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid? Am Surg 2011; 77:484–487. Nichol PF, Mack E, Bianco J, Hayman A, Starling JR, Chen H. Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism. Surgery 2003; 134:713–717. Rubello D, Casara D, Giannini S, Piotto A, De carlo E, Muzzio PC, et al. Importance of radio-guided minimally invasive parathyroidectomy using hand-held gamma probe and low 99mTc-MIBI dose: technical considerations and long-term clinical results. Q J Nucl Med 2003; 47:224–232. Chen H, Sippel RS, Schaefer S. The effectiveness of radioguided parathyroidectomy in patients with negative technetium Tc 99msestamibi scans. Arch Surg 2009; 144:643–648. Quagliata A, Lo´pez JJ, Juri C, Alonso O. Value of radioguided surgery with dobutamine 99mTc-MIBI in persistent secondary hyperparathyroidism. Rev Esp Med Nucl 2006; 25:387–390. Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg 2003; 238:332–337. Friedman M, Gurpinar B, Schalch P, Joseph NJ. Guidelines for radioguided parathyroid surgery. Arch Otolaryngol Head Neck Surg 2007; 133:1235–1239. Ortega J, Ferrer-Rebolleda J, Cassinello N, Lledo S. Potential role of a new hand-held miniature gamma camera in performing minimally invasive parathyroidectomy. Eur J Nucl Med Mol Imaging 2007; 34:165–169. Matthies P, Okur A, Wendler T, Navab N, Friebe M. Combination of intraoperative freehand SPECT imaging with MR images for guidance and navigation. Conf Proc IEEE Eng Med Biol Soc 2013;3383–3386.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
What is the role of preoperative scintigraphic imaging and the intraoperative gamma probe in secondary hyperparathyroidism? David Fustera, Sergi Vidal-Sicarta, Jose´-Vicente Torregrosab, Pilar Paredesa, Domenico Rubelloc and Francesca Ponsa Nuclear Medicine Communications 2014, 35:443–445 a
b
Nuclear Medicine Department, Renal Transplant Unit, Hospital Clinic, Barcelona, Spain and cDepartment of Imaging, Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Nuclear Medicine & PET/CT Centre, Santa Maria della Misericordia Hospital, Rovigo, Italy
& PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy Tel: + 39 0425 39 4428; fax: + 39 0425 39 4434; e-mail: [email protected] Received 23 December 2013 Accepted 12 January 2014
Correspondence to Domenico Rubello, MD, Department of Imaging, Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Nuclear Medicine
Preoperative parathyroid scintigraphy has a valuable role in identifying hyperfunctioning autonomous parathyroid tissue and is widely used to localize pathological glands. In primary hyperparathyroidism, which usually appears as a solitary adenoma, preoperative imaging can help the surgeon identify and precisely remove the parathyroid gland, especially in the case of minimally invasive surgical procedures. Nuclear medicine techniques have been shown to be most useful in identifying unsuspected ectopic [1] or supernumerary glands [2–4] and in reoperation after a previous failed surgical attempt [5]. EANM parathyroid guidelines indicate that the functional information that can be obtained by nuclear medicine parathyroid scintigraphy increases the diagnostic capability over conventional imaging. Double-tracer subtraction parathyroid scintigraphy has better sensitivity and is more likely to distinguish thyroid nodules that take up sestamibi from parathyroid tumours. Single-photon emission computed tomography (SPECT)/computed tomography (CT) images are strongly recommended to better define the position of an ectopic focus; however, SPECT and SPECT/CT imaging cannot replace the standard planar and ‘pinhole’ protocols [6]. Tardin et al. [7] evaluated the role of dual-phase 99m Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy in the diagnosis and treatment of primary hyperparathyroidism caused by ectopic adenomas in 105 consecutive patients with histopathological confirmation and at least 1-year follow-up, recording a 100% success rate for radioguided parathyroidectomy without evidence of persistent or recurrent hyperparathyroidism. Radioguided surgery has also proved to be helpful for patients with recurrent hyperparathyroidism from forearm graft hyperplasia, especially when the parathyroid fragment is unmarked [8]. Hyperparathyroidism patients may have concomitant thyroid pathology, and at times thyroid nodules can be problematic as they may present as falsepositive findings in parathyroid scintigraphy and can sometimes interfere with radioguided surgery, making it c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 0143-3636
difficult to differentiate from hyperactive parathyroid tissue. However, a study of 87 patients diagnosed with primary hyperparathyroidism who underwent radioguided surgery (divided into two groups depending on the presence or absence of concomitant thyroid pathology) concluded that patients with concomitant thyroid pathology should not be automatically excluded from minimally invasive surgery [9]. Secondary hyperparathyroidism, however, is a process generally characterized by multiglandular hyperplasia, and the possible benefits of preoperative noninvasive imaging tools in this setting are still under debate [10–13]. In the hands of a skilled surgeon, results in secondary hyperparathyroidism patients with no previous history of neck surgery are generally excellent, with minimal morbidity in either total or subtotal parathyroidectomy. Some authors are against preoperative parathyroid scintigraphy on the grounds that the low sensitivity of 99m Tc-MIBI to detect hyperplastic glands rather than adenomas brings no significant additional value [14]. Nevertheless, the rate of persistent or recurrent disease in this setting is currently between 10 and 30%, principally because of incomplete localization of the hyperplastic glands, which would suggest that more caution is warranted when ruling out a role for preoperative imaging. In a study on the follow-up of 51 haemodialysis patients who had undergone subtotal parathyroid surgery, our group found a high number of recurrences. Interestingly, in eight out of the nine recurrences, the preserved gland had shown 99m Tc-MIBI uptake in the scan performed before surgical intervention [15]. The interest in radioguided surgery will probably increase with the introduction of minimally invasive surgical techniques in this setting. The era of focused exploration or minimally invasive radioguided parathyroidectomy began nearly two decades ago, with the introduction of preoperative 99mTc-MIBI scintigraphy to identify and locate the parathyroid adenoma [16]. The 20% rule proposed by Norman established a guideline – measuring radioactivity in the minimally DOI: 10.1097/MNM.0000000000000090
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
444 Nuclear Medicine Communications 2014, Vol 35 No 5
invasive radioguided parathyroidectomy technique in order to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20% of the excision site/background radioactivity, the 20% rule was satisfied. A study by Quillo et al. [17] reviewed 216 primary hyperparathyroidism patients meeting these criteria and their results supported the 20% rule in almost 100% of patients, successfully locating and confirming an overactive gland without the need for intraoperative parathyroid hormone monitoring or tissue analysis. Nichol et al. [18] analysed 33 consecutive patients with secondary or tertiary hyperparathyroidism who underwent radioguided parathyroidectomy. All parathyroid glands were localized during the operation and all hyperplastic glands had ex-vivo counts greater than 20% of the background. When compared with 66 historical control participants who had undergone surgery without radioguidance, those with radioguided parathyroidectomy had decreased operative times and lengths of stay (P < 0.001), and analysis of frozen sections could be omitted. The authors concluded that radioguided parathyroidectomy appears to be a useful adjunct in the treatment of secondary and tertiary hyperparathyroidism [18]. Rubello et al. [19] implemented a low-dose 99m Tc-MIBI protocol (37 MBq) in a minimally invasive radioguided parathyroidectomy to evaluate successful removal of parathyroid tissue. A parathyroid/thyroid ratio higher than 1.5 was strongly suggestive of a parathyroid adenoma and an empty parathyroid bed-to-thyroid ratio approaching 1 was highly indicative of complete removal of abnormal parathyroid tissue [19]. Furthermore, Chen et al. [20] showed that radioguided techniques are equally effective in patients with negative (nonlocalizing) 99mTcMIBI scans undergoing parathyroidectomy for primary hyperparathyroidism, suggesting that the gamma probe has an important role for localization of parathyroid glands in patients with negative preoperative 99mTc-MIBI scans. An interesting report in the literature supports the use of radioguided surgery with 99mTc-MIBI in renal hyperparathyroidism using sensitization with intravenous low-dose dobutamine in a patient with negative parathyroid scintigraphy [21]. Nevertheless, Chen et al. [22] demonstrated that ex-vivo counts were highest in single-gland adenomas and lowest in hyperplastic parathyroid glands; however, all hyperplastic parathyroid glands still registered ex-vivo counts greater than 20% of postexcision background counts. The study by Friedman et al. [23] corroborates this impression as they differentiated ex-vivo radioactivity percentages of hyperactive parathyroid tissue from any other tissue, but could not differentiate adenomas from hyperplasia. Despite this, Rubello et al. [19] still recommend the use of the intraoperative quick parathyroid hormone assay at the time of radioguided parathyroidectomy following the low-dose 99mTc-MIBI technique to ensure complete removal of additional foci of hyperfunctioning parathyroid tissue secondary to the persistence of previously unrecognized hyperplastic parathyroid glands.
From a practical point of view, our own experience leads us to recognize the difficulty in ascertaining the diffuse uptake of those hyperplastic glands. Intraoperatively, the parathyroid/background or parathyroid/thyroid rate is rarely higher than 1.5–2.0, which introduces some uncertainty into the procedure (based on a previous dose of 370 MBq). In some cases it may be advisable to use intraoperative devices like portable gamma cameras or freehand SPECT. The group of Ortega et al. [24] performed planar imaging with 99mTc-MIBI before surgical incision with a portable gamma camera for intraoperative localization of the gland. The portable gamma camera images provided the same information as the preoperative images and consistently showed the location of parathyroid adenomas during surgery [24]. Free-hand SPECT enables intraoperative three-dimensional reconstruction of radioactivity distribution based on hand-held gamma probe detectors. This device uses a gamma probe and a threedimensional tracking system. An optical infrared camera ensures localization of the patient and gamma probe in space. Synchronized readings of the gamma detector and the navigation system provide a reconstruction in the same coordinate system as well as registration-free navigation. In the coming years, free-hand PET may provide intraoperative functional imaging techniques that can be complemented with preoperative and intraoperative MRI to allow for better planning, navigation, and guidance. Development should be followed up [25]. The routine use of parathyroid scintigraphy as a preoperative tool in secondary hyperparathyroidism would probably reduce the operative time and increase the success rate of surgical treatment while lowering the possibility of recurrence, especially in ectopic, supernumerary, and forearm autotransplanted glands. The addition of the intraoperative localization of parathyroid hyperplastic glands is not without technical difficulties due to the low parathyroid/thyroid background uptake but may still be feasible and should be taken into account when minimally invasive surgery is the treatment of choice for secondary hyperparathyroidism.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1 2 3 4
5
Kettle AG, O’Doherty MJ. Parathyroid imaging: how good is it and how should it be done? Semin Nucl Med 2006; 36:206–211. O’Doherty MJ, Kettle AG. Parathyroid imaging: preoperative localization. Nucl Med Commun 2003; 24:125–131. Coakley AJ. Parathyroid imaging. Nucl Med Commun 1995; 16:522–533. Feingold DL, Alexander HR, Chen CC, Libutti SK, Shawker TH, Simonds WF, et al. Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas. Surgery 2000; 128:1103–1109. Takeyama H, Tabei I, Ogi S, Yokoyama K, Yamamoto H, Okido I, et al. Usefulness of intraoperative 99mTc-MIBI-guided detection for recurrent sites in secondary hyperparathyroidism: a case–controlled study. Int J Surg 2008; 6:184–188.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Gamma imaging in secondary HPT Fuster et al. 445
6
7
8
9
10
11
12
13
14
15
Hindie´ E, Ugur O, Fuster D, O’Doherty M, Grassetto G, Uren˜a P, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 2009; 36:1201–1216. Tardin L, Prats E, Andre´s A, Razola P, Deus J, Gastaminza R, et al. Ectopic parathyroid adenoma: scintigraphic detection and radioguided surgery. Rev Esp Med Nucl 2011; 30:19–23. Sippel R, Bianco J, Chen H. Radioguided parathyroidectomy for recurrent hyperparathyroidism caused by forearm graft hyperplasia. J Bone Miner Res 2003; 18:939–942. Garcı´a-Talavera P, Gonza´lez C, Garcı´a-Talavera JR, Martı´n E, Martı´n M, Go´mez A. Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology. Eur J Nucl Med Mol Imaging 2010; 37:2060–2067. Weber CJ, Vansant J, Alazraki N, Christy J, Watts N, Phillips LS, et al. Value of technetium 99mTc sestamibi I-123 imaging in reoperative parathyroid surgery. Surgery 1993; 114:1011–1018. Kasai ET, da Silva JW, Mandarim de Lacerda CA, Boasquevisque E. Parathyroid glands: combination of sestamibi-(99m)Tc scintigraphy and ultrasonography for demonstration of hyperplasic parathyroid glands. Rev Esp Med Nucl 2008; 27:8–12. Lomonte C, Buonvino N, Selvaggiolo M, Dassira M, Grasso G, Vernaglione L, et al. Sestamibi scintigraphy, topography, and histopathology of parathyroid glands in secondary hyperparathyroidism. Am J Kidney Dis 2006; 48: 638–644. Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (doublephase study). J Nucl Med 1992; 33:1801–1807. Olaizola I, Zingraff J, Heuguerot C, Fajardo L, Le´ger A, Lo´pez J, et al. [(99m)Tc]-sestamibi parathyroid scintigraphy in chronic haemodialysis patients: static and dynamic explorations. Nephrol Dial Transplant 2000; 15:1201–1206. Torregrosa JV, Fuster D, Ybarra J, Ortı´n J, Moreno A, Valveny N. Predicting the effect of intravenous calcitriol on parathyroid gland activity using double-
16
17
18
19
20
21
22
23
24
25
phase technetium Tc 99m-sestamibi scintigraphy. Am J Kidney Dis 2004; 44:476–480. Proye CAG, Carnaille B, Bizard JP, Quievreux JL, Lecomte-Houcke M. Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited – where are we in the early 1990s – a plea against unilateral parathyroid exploration. Surgery 1992; 112:1118–1122. Quillo AR, Bumpous JM, Goldstein RE, Fleming MM, Flynn MB. Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid? Am Surg 2011; 77:484–487. Nichol PF, Mack E, Bianco J, Hayman A, Starling JR, Chen H. Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism. Surgery 2003; 134:713–717. Rubello D, Casara D, Giannini S, Piotto A, De carlo E, Muzzio PC, et al. Importance of radio-guided minimally invasive parathyroidectomy using hand-held gamma probe and low 99mTc-MIBI dose: technical considerations and long-term clinical results. Q J Nucl Med 2003; 47:224–232. Chen H, Sippel RS, Schaefer S. The effectiveness of radioguided parathyroidectomy in patients with negative technetium Tc 99msestamibi scans. Arch Surg 2009; 144:643–648. Quagliata A, Lo´pez JJ, Juri C, Alonso O. Value of radioguided surgery with dobutamine 99mTc-MIBI in persistent secondary hyperparathyroidism. Rev Esp Med Nucl 2006; 25:387–390. Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg 2003; 238:332–337. Friedman M, Gurpinar B, Schalch P, Joseph NJ. Guidelines for radioguided parathyroid surgery. Arch Otolaryngol Head Neck Surg 2007; 133:1235–1239. Ortega J, Ferrer-Rebolleda J, Cassinello N, Lledo S. Potential role of a new hand-held miniature gamma camera in performing minimally invasive parathyroidectomy. Eur J Nucl Med Mol Imaging 2007; 34:165–169. Matthies P, Okur A, Wendler T, Navab N, Friebe M. Combination of intraoperative freehand SPECT imaging with MR images for guidance and navigation. Conf Proc IEEE Eng Med Biol Soc 2013;3383–3386.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
