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Virtual neck exploration in patients with hyperparathyroidism and former cervical operations

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Abstract

Background

In surgery for primary hyperparathyroidism, preoperative localization together with intraoperative parathyroid hormone assay is important when minimal invasive operations of the parathyroid glands are intended. In cases of reoperation, correct localization of the abnormal parathyroid glands is extremely instrumental. Computed tomography (CT)–99mTc-sestamibi (MIBI)–single photon emission computed tomography (SPECT) image fusion allows for a virtual exploration of the neck by showing the suspected gland three-dimensionally with all the anatomic landmarks in correct position. The aim of this study was to evaluate whether CT–MIBI–SPECT image fusion is superior to MIBI–SPECT alone in detecting abnormal parathyroid glands in patients with previous neck surgery.

Patients and methods

In a prospective study, CT–MIBI–SPECT image fusion for preoperative localization was performed in 28 patients with hyperparathyroidism and previous neck surgery. Twenty-one patients had thyroidectomy and seven patients had surgery for hyperparathyroidism. The results of MIBI–SPECT alone and CT–MIBI–SPECT image fusion were compared in these patients. The outcome and the exact predicted position, not just the predicted side, were correlated with intraoperative findings.

Results

CT–MIBI–SPECT image fusion was able to predict the exact position of the abnormal gland in 24 of 28 patients (86%), whereas MIBI–SPECT alone was successful in 12 of 28 cases (43%, p < 0.004) only. CT–MIBI–SPECT image fusion detected all three pathologic glands in their ectopic position. With MIBI–SPECT alone, just one ectopic pathologic gland was found.

Conclusion

This study provides evidence that CT–MIBI–SPECT image fusion is superior to MIBI–SPECT alone in preoperative localization of enlarged parathyroid glands in patients with hyperparathyroidism and previous neck surgery. This should be kept in mind if the results are compared to earlier studies concerning CT–MIBI–SPECT image fusion.

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References

  1. Doppman JL (1968) Reoperative parathyroid surgery: localization procedures. Parathyroid surgery. Prog Surg 18:1171

    Google Scholar 

  2. Liew V, Gough IR, Nolan G, Fryar B (2004) Re-operation for hyperparathyroidism. ANZ J Surg 74:732–740. doi:10.1111/j.1445-1433.2004.03142.x

    Article  PubMed  Google Scholar 

  3. Arnalsteen L, Quievreux JL, Huglo D, Pattou F, Carnaille B, Proye C (2004) Reoperation for persistent or recurrent hyperparathyroidism. Seventy-seven cases among 1888 operated cases. Ann Chir 129:224–231. doi:10.1016/j.anchir.2004.03.007

    Article  PubMed  CAS  Google Scholar 

  4. Mariette C, Pellissier L, Combemale F, Quievreux JL, Carnaille B, Proye C (1998) Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg 383:174–179

    PubMed  CAS  Google Scholar 

  5. Karakas E, Zielke A, Dietz C, Rothmund M (2005) Reoperation beim primären Hyperparathyreoidismus. Chirurg 76:207–216. doi:10.1007/s00104-004-0994-6

    Article  PubMed  CAS  Google Scholar 

  6. Profanter C, Wetscher GJ, Gabriel M, Sauper T, Rieger M, Kovacs P et al (2004) CT–MIBI image fusion: a new preoperative localization technique for primary, recurrent and persistent hyperparathyroidism. Surgery 135:157–162. doi:10.1016/S0039-6060(03)00396-9

    Article  PubMed  Google Scholar 

  7. Profanter C, Prommegger R, Gabriel M, Moncayo R, Wetscher GJ, Lang TH et al (2004) CT–MIBI image fusion for preoperative localization in primary hyperparathyroidism. Am J Surg 187:383–387. doi:10.1016/j.amjsurg.2003.12.012

    Article  PubMed  Google Scholar 

  8. Bale RJ, Vogele M, Freysinger W, Gunkel AR, Martin A, Bumm K et al (1997) Minimally invasive head holder to improve the performance of frameless stereotactic surgery. Laryngoscope 107:373–377. doi:10.1097/00005537-199703000-00018

    Article  PubMed  CAS  Google Scholar 

  9. Sweeney R, Bale R, Vogele M, Nevinny-Stickel M, Bluhm A, Auer T et al (1998) Repositioning accuracy: comparison of non-invasive head holder with thermoplastic mask for fractionated radiotherapy and a case report. Int J Radiat Oncol Biol Phys 41:475–483. doi:10.1016/S0360-3016(98)00064-9

    PubMed  CAS  Google Scholar 

  10. Joseph K, Welcke U, Hoffken H, Koppelberg T, Rothmund M (1994) Scintigraphy of parathyroid adenoma with 99mTc-sestamibi in an endemic goiter area. Nucl Med (Stuttg) 33:93–98

    CAS  Google Scholar 

  11. O’Doherty MJ, Kettle AG, Wells P, Collins RE, Coakley AJ (1992) Parathyroid imaging with technetium 99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 33:313–318

    PubMed  CAS  Google Scholar 

  12. Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD et al (2006) Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 140:932–941. doi:10.1016/j.surg.2006.07.028

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Anichstrasse 35, 6020, Innsbruck, Austria

    Gerd Wimmer, Tonja Sauper, Michael Sieb, Christoph Profanter, Raimund Margreiter & Rupert Prommegger

  2. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

    Reto Bale & Peter Kovacs

  3. Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria

    Michael Gabriel & Daniel Putzer

Authors
  1. Gerd Wimmer
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  2. Reto Bale
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  3. Peter Kovacs
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  4. Michael Gabriel
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  5. Daniel Putzer
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  6. Tonja Sauper
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  7. Michael Sieb
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  8. Christoph Profanter
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  9. Raimund Margreiter
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  10. Rupert Prommegger
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Corresponding author

Correspondence to Rupert Prommegger.

Additional information

Best of Endocrine Surgery in Europe 2008.

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Wimmer, G., Bale, R., Kovacs, P. et al. Virtual neck exploration in patients with hyperparathyroidism and former cervical operations. Langenbecks Arch Surg 393, 687–692 (2008). https://doi.org/10.1007/s00423-008-0359-6

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  • DOI: https://doi.org/10.1007/s00423-008-0359-6

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