Original CommunicationsTechnetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas*
Section snippets
Patients and methods
The total patient population of 92 was made up of 34 men and 58 women, mean age 60 ± 13 years, with established diagnosis of primary hyperparathyroidism. The diagnosis was based on elevated levels of serum calcium (2.98 ± 0.24 mmol/L; normal range, 2.20-2.65 mmol/L) and parathormone (PTH, 314 ± 133 ng/L; normal range, 12-72 ng/L), a further inclusion criterion being a nondiagnostic ultrasound (7.5 MHz linear array). After the MIBI study, the patients were scheduled to undergo bilateral surgical
Results
All patients underwent a bilateral neck exploration (the average operation time alone was 50 minutes). In 4 patients, a mediastinal exploration (sternotomy) was necessary. Twelve patients were operated on additionally for a benign goiter. The mean hospital stay of the in-patients was about 4 days; the average hospital operation costs amounted to approximately $1000.
All abnormal serum parameters returned to normal values after the operation (calcium, 2.32 ± 0.14 mmol/L and parathormone 44 ± 22
Discussion
Parathyroidectomy with bilateral exploration can become a lengthy, large-scale operation and must be performed by an experienced endocrine surgeon to be successful. Bilateral exploration of the neck exposes the patient to a greater risk of recurrent laryngeal nerve injuries13 and increases the likelihood of hypoparathyroidism.14 The latter can be caused by unintentional intraoperative damage of the filamentous blood vessels supplying the normal parathyroid glands. Multiple adenomas (Fig 2, A ),
Conclusions
Although exact prior localization can render extensive bilateral exploration unnecessary in patients with a solitary adenoma,33 preoperative scintigraphic screening cannot yet be recommended for all patients with primary hyperparathyroidism, since cost-benefit analyses have still not revealed any clear advantages of this approach,13, 21, 23, 34 especially when the operation is performed by an experienced endocrine surgeon. Nevertheless, the preoperative localization of abnormal glands by using
References (34)
- et al.
Operative experience of U.S. general surgery residents in thyroid and parathyroid disease
Surgery
(1995) - et al.
Sestamibi parathyroid imaging
Sem Nucl Med
(1995) - et al.
Outpatient thyroid and parathyroid surgery: a prospective study of feasibility, safety, and costs
Surgery
(1995) - et al.
Analysis of savings in operative time for primary hyperparathyroidism using localization with technetium 99m sestamibi scan
Am J Surg
(1995) - et al.
Parathyroid localization: inability to predict multiple gland involvement
Am J Surg
(1993) - et al.
Impact of complementary parathyroid scintigraphy and ultrasonography on the surgical management of hyperparathyroidism
Surgery
(1996) - et al.
Correct preoperative localization: does it permit a change in operative strategy for primary hyperparathyroidism?
Surgery
(1995) - et al.
Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community
N Engl J Med
(1980) - et al.
Cervical exploration for primary hyperthyroidism
J Surg Oncol
(1993) - et al.
Reoperation for persistent or recurrent primary hyperparathyroidism
Arch Surg
(1996)
Unilateral parathyroidectomy: the role of thallium-technetium subtraction scans
Otolaryngol Head Neck Surg
Advantages of SPECT in technetium-99m sestamibi parathyroid scintigraphy
J Nucl Med
Technetium-99m sestamibi parathyroid localization is accurate enough for scan-directed unilateral neck exploration
Br J Surg
Management of hyperparathyroidism in an endemic goiter area
World J Surg
Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT
Radiology
Efficient parathyroidectomy guided by SPECT-MIBI and hormonal measurement
J Nucl Med
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
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Reprint requests: Detlef Moka, MD, Department of Nuclear Medicine, University of Cologne, Josef Stelzmannstr 9, D-50924 Köln, Germany.