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Journal of Nuclear Medicine

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OtherClinical Investigations

Radioguided Surgery of Primary Hyperparathyroidism Using the Low-Dose 99mTc-Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS)

Domenico Rubello, Maria Rosa Pelizzo, Giuseppe Boni, Riccardo Schiavo, Luca Vaggelli, Giuseppe Villa, Sergio Sandrucci, Andrea Piotto, Gianpiero Manca, Pierluigi Marini and Giuliano Mariani
Journal of Nuclear Medicine February 2005, 46 (2) 220-226;
Domenico Rubello
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Maria Rosa Pelizzo
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Giuseppe Boni
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Riccardo Schiavo
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Luca Vaggelli
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Giuseppe Villa
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Sergio Sandrucci
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Andrea Piotto
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Gianpiero Manca
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Pierluigi Marini
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Giuliano Mariani
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    FIGURE 1.

    Distribution of patients according to main factors affecting choice of surgical approach. BNE = bilateral neck exploration; T = thyroid; PT = parathyroid; MIBI = 99mTc-sestamibi.

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    TABLE 1

    Preoperative Imaging Modalities Used on 384 Patients with Primary Hyperparathyroidism

    ModalityPatients
    n%
    Double-tracer 99mTc-pertechnetate/99mTc-sestamibi subtraction scanning (planar) and ultrasonography24062.5
    Double-tracer 99mTc-pertechnetate/99mTc-sestamibi subtraction scanning (planar + SPECT) and ultrasonography5313.8
    Total double-tracer subtraction scanning and ultrasonography29376.3
    Single-tracer 99mTc-sestamibi dual-phase scanning (planar) and ultrasonography379.6
    Single-tracer 99mTc-sestamibi dual-phase scanning (planar + SPECT) and ultrasonography5414.1
    Total single-tracer dual-phase scanning and ultrasonography*9123.7
    CT†369.3
    MRI†5313.8
    • ↵* All patients imaged by dual-phase 99mTc-sestamibi scintigraphy also underwent 99mTc-pertechnetate scanning for evaluation of possible concomitant thyroid nodule disease.

    • ↵† CT and MRI were performed after scintigraphic and ultrasound examination, mainly on patients with ectopic PAs or previous neck surgery.

    • Selective venous blood sampling for assay of parathyroid hormone levels was performed on only 1 patient; arteriography, on none.

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    TABLE 2

    MIRS Protocol of the Present Study

    StepDescription
    AAntecubital venous blood sampling both before surgery and 10 min after PA removal, for IQPTH.
    BIntravenous injection of 99mTc-sestamibi (37–110 MBq, or 1–3 mCi: 37 MBq in 79% of patients, 74 MBq in 13%, and 110 MBq in 8%) in operating theater 10–30 min before surgery.
    CBefore surgical incision, external γ-probe scanning to identify area with maximum count activity (cutaneous projection of PA).
    DSurgical access either in midline of neck (approximately 1 cm above sternal notch) or in lateral neck (anterior border of sternocleidomastoid muscle), depending on each surgeon’s experience and convenience.
    ERepeated insertion of γ-probe through a 2- to 2.5-cm skin incision, guiding surgeon to area with maximum count activity, corresponding to PA (ligature of middle thyroid vein and inferior thyroid artery was necessary in some patients with PA deep in neck).
    Fγ-Probe measurement of radioactivity count rate on PA, thyroid gland, and background.
    Gγ-Probe measurement of radioactivity count rate on ex vivo PA to evaluate success of parathyroid tissue removal.
    Hγ-Probe scanning of surgical bed to evaluate completeness of parathyroid tissue removal.
    ICalculation of γ-probe count-rate ratios for various tissues.
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Journal of Nuclear Medicine: 46 (2)
Journal of Nuclear Medicine
Vol. 46, Issue 2
February 1, 2005
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Radioguided Surgery of Primary Hyperparathyroidism Using the Low-Dose 99mTc-Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS)
Domenico Rubello, Maria Rosa Pelizzo, Giuseppe Boni, Riccardo Schiavo, Luca Vaggelli, Giuseppe Villa, Sergio Sandrucci, Andrea Piotto, Gianpiero Manca, Pierluigi Marini, Giuliano Mariani
Journal of Nuclear Medicine Feb 2005, 46 (2) 220-226;

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Radioguided Surgery of Primary Hyperparathyroidism Using the Low-Dose 99mTc-Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS)
Domenico Rubello, Maria Rosa Pelizzo, Giuseppe Boni, Riccardo Schiavo, Luca Vaggelli, Giuseppe Villa, Sergio Sandrucci, Andrea Piotto, Gianpiero Manca, Pierluigi Marini, Giuliano Mariani
Journal of Nuclear Medicine Feb 2005, 46 (2) 220-226;
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