Skip to main content

Technetium-99m-MIBI SPECT/CT in Primary Hyperparathyroidism

World Journal of Surgery volume 30, pages 76–83 (2006)Cite this article

Abstract

The novel trend toward focused parathyroidectomy requires precise preoperative localization of the parathyroid adenoma in patients with primary hyperparathyroidism (PHPT). The present study evaluated the impact of hybrid single photon emission computed tomography/computed tomography (SPECT/CT), using 99mTc-sestamibi (MIBI), on the surgical management of these patients. In a retrospective study of 36 patients with PHPT, SPECT/CT was undertaken when planar 99mTc-MIBI scintigraphy was negative or when an ill-defined focus in the neck or an ectopic site on planar views was visualized. Imaging data were compared with intraoperative findings, and the incremental value of SPECT/CT to lesion localization and surgical procedure was assessed. Three patients with both negative planar and SPECT/CT studies subsequently underwent bilateral neck exploration, with multiglandular hyperplasia diagnosed in two patients and a parathyroid adenoma in one. Of 33 patients with a positive MIBI study, parathyroid adenoma was confined to the neck in 23 patients and to the lower neck-mediastinum in 10. SPECT/CT facilitated the surgical exploration of all 10 ectopic parathyroid adenomas and 4 of 23 cervical parathyroid adenomas, the latter four either at reexploration or in patients with nonvisualization of the thyroid after thyroidectomy. SPECT/CT contributed to the localization of parathyroid adenomas in patients with PHPT and to planning the surgical exploration in 14 of 36 (39%) patients, predominantly those with ectopic parathyroid adenomas or who had distorted neck anatomy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1
Figure 2

References

  1. Clark OH. How should patients with primary hyperparathyroidism be treated? J Clin Endocrinol Metab 2003;88:3011–3014

    PubMed  Article  Google Scholar 

  2. Bergenfelz A, Lindblom P, Tibblin S, et al. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002;236:543–551

    PubMed  Article  Google Scholar 

  3. Krausz Y, Lebensart PD, Klein M, et al. Pre-operative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease. World J Surg 2000;24:1573–1578

    PubMed  Article  CAS  Google Scholar 

  4. van Vroonhoven TJ, van Dalen A. Successful minimally invasive surgery in primary hyperparathyroidism after combined preoperative ultrasound and computed tomography imaging. J Intern Med 1998;243:581–587

    PubMed  Google Scholar 

  5. Ohshima A, Simizu S, Okido M, et al. Endoscopic neck surgery: current status for thyroid and parathyroid diseases. Biomed Pharmacother 2002;56(Suppl. 1):48s–52s

    PubMed  Google Scholar 

  6. McBiles M, Lambert AT, Cote MG, et al. Sestamibi parathyroid imaging. Semin Nucl Med 1995;25:221–234

    PubMed  CAS  Google Scholar 

  7. Mariani G, Gulec SA, Rubello D, et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 2003;44:1443–1458

    PubMed  Google Scholar 

  8. Casara D, Rubello D, Cauzzo C, et al. 99mTc-MIBI radio-guided minimally invasive parathyroidectomy: experience with patients with normal thyroids and nodular goiters. Thyroid 2002;12:53–61

    PubMed  Article  Google Scholar 

  9. Perrier ND, Ituarte PH, Morita E, et al. Parathyroid surgery: separating promise from reality. J Clin Endocrinol Metab. 2002;87:1024–1029

    PubMed  Article  CAS  Google Scholar 

  10. Casara D, Rubello D, Pelizzo MR, et al. Clinical role of 99mTcO4/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism. Eur J Nucl Med 2001;28:1351–1359

    PubMed  Article  CAS  Google Scholar 

  11. Lumachi F, Ermani M, Basso S, et al. Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection. Endocr Relat Cancer 2001;8:63–69

    PubMed  Article  CAS  Google Scholar 

  12. Rubello D, Casara D, Pelizzo MR. Symposium on parathyroid localization. optimization of peroperative procedures. Nucl Med Commun 2003;24:133–140

    PubMed  Article  CAS  Google Scholar 

  13. Arici C, Cheah WK, Ituarte PH, et al. Can localization studies be used to direct focused parathyroid operations? Surgery 2001;129:720–729

    PubMed  Article  CAS  Google Scholar 

  14. Van Dalen A, Smit CP, van Vroonhoven TJ, et al. Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology 2001;220:631–639

    PubMed  Google Scholar 

  15. Profanter C, Prommegger R, Gabriel M, et al. Computed axial tomography-MIBI image fusion for preoperative localization in primary hyperparathyroidism. Am J Surg 2004;187:383–387

    PubMed  Article  Google Scholar 

  16. Profanter C, Wetscher GJ, Gabriel M, et al. CT-MIBI image fusion: a new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism. Surgery 2004;135:157–162

    PubMed  Article  Google Scholar 

  17. Even-Sapir E, Keidar Z, Sachs J, et al. The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasms. J Nucl Med 2001;42:998–1004

    PubMed  CAS  Google Scholar 

  18. Kaczirek K, Prager G, Kienast O, et al. Combined transmission and (99m)Tc-sestamibi emission tomography for localization of mediastinal parathyroid glands. Nuklearmedizin 2003;42:220–223

    PubMed  CAS  Google Scholar 

  19. Lorberboym M, Minski I, Macadziob S, et al. Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003;44:904–908

    PubMed  Google Scholar 

  20. Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128:29–35

    PubMed  Article  CAS  Google Scholar 

  21. Sfakianakis GN, Irvin GL 3rd, Foss J, et al. Efficient parathyroidectomy guided by SPECT-MIBI and hormonal measurements. J Nucl Med 1996;37:798–804

    PubMed  CAS  Google Scholar 

  22. Perez-Monte JE, Brown ML, Shah AN, et al. Parathyroid adenomas: accurate detection and localization with Tc-99m-sestamibi SPECT. Radiology 1996;201:85–91

    PubMed  CAS  Google Scholar 

  23. Billotey C, Sarfati E, Aurengo A, et al. Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 1996;37:1773–1778

    PubMed  CAS  Google Scholar 

  24. Nudelman IL, Deutsch AA, Reiss R. Primary hyperparathyroidism due to mediastinal parathyroid adenoma. Int Surg 1987;72:104–108

    PubMed  CAS  Google Scholar 

  25. Loevner LA. Imaging of the parathyroid glands. Semin Ultrasound CT MR 1996;17:563–575

    PubMed  CAS  Google Scholar 

  26. Price DC. Radioisotopic evaluation of the thyroid and the parathyroids. Radiol Clin North Am 1993;31:991–1015

    PubMed  CAS  Google Scholar 

  27. Freitas JE, Freitas AE. Thyroid and parathyroid imaging. Semin Nucl Med 1994;24:234–245

    PubMed  CAS  Google Scholar 

  28. Wang C. Parathyroid re-exploration: a clinical and pathological study of 112 cases. Ann Surg 1977;186:140–145

    PubMed  CAS  Google Scholar 

  29. Medrano C, Hazelrigg SR, Landreneau RJ, et al. Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 2000;69:221–223

    PubMed  Article  CAS  Google Scholar 

  30. Doherty GM, Doppman JL, Miller DL, et al. Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. Ann Surg 1992;215:101–106

    PubMed  CAS  Google Scholar 

  31. Norton JA, Schneider PD, Brennan MF. Median sternotomy in reoperations for primary hyperparathyroidism. World J Surg 1985;9:807–813

    PubMed  Article  CAS  Google Scholar 

  32. Rubello D, Casara D, Fiore D, et al. An ectopic mediastinal parathyroid adenoma accurately located by a single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction scintigraphy and MIBI-SPECT-computed tomographic image fusion. Clin Nucl Med 2002;27:186–190

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors express their gratitude to Hava Lester, Ph.D. and to Benjamin Glaser, M.D. for their judicious remarks and great help in editing this manuscript.

Author information

Affiliations

  1. Department of Medical Biophysics and Nuclear Medicine, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel

    Yodphat Krausz MD & Roland Chisin MD

  2. Department of Nuclear Medicine, Rambam Medical Center, PO Box 9602, Bat-Galim, Haifa, 31096, Israel

    Lise Bettman MSc, Galina Yosilevsky PhD, Zohar Keidar MD, PhD, Rachel Bar-Shalom MD & Ora Israel MD

  3. Department of Diagnostic Imaging, Rambam Medical Center, PO Box 9602, Bat-Galim, Haifa, 31096, Israel

    Luda Guralnik MD

  4. Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv, Israel

    Einat Even-Sapir MD, PhD

  5. Faculty of Medicine, Israel Institute of Technology-Technion, PO Box 9649, Bat-Galim, Haifa, 31096, Israel

    Zohar Keidar MD, PhD & Ora Israel MD

Authors
  1. Yodphat Krausz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lise Bettman MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luda Guralnik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Galina Yosilevsky PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zohar Keidar MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rachel Bar-Shalom MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Einat Even-Sapir MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roland Chisin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ora Israel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yodphat Krausz MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Krausz, Y., Bettman, L., Guralnik, L. et al. Technetium-99m-MIBI SPECT/CT in Primary Hyperparathyroidism. World J. Surg. 30, 76–83 (2006). https://doi.org/10.1007/s00268-005-7849-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-7849-2

Keywords

  • Adenoma
  • Primary Hyperparathyroidism
  • Parathyroid Adenoma
  • Bilateral Neck Exploration
  • MIBI Uptake