Computed axial tomography–MIBI image fusion for preoperative localization in primary hyperparathyroidism

doi:10.1016/j.amjsurg.2003.12.012

The American Journal of Surgery

Volume 187, Issue 3, March 2004, Pages 383-387

https://doi.org/10.1016/j.amjsurg.2003.12.012 Get rights and content

Abstract

Background

An imaging-guided unilateral surgical approach in patients with primary hyperparathyroidism (HPTH) requires reliable preoperative localization procedures. Using present imaging techniques, 60% to 80% of patients with primary HPTH can be treated successfully with limited surgery. Thus, further improvement of diagnostic accuracy is required. Computed axial tomography (CAT)–MIBI image fusion was introduced as a new technique for localizing enlarged parathyroid glands. We describe the new method and present its first results.

Methods

Six consecutive patients with primary HPTH underwent CAT–MIBI image fusion for preoperative parathyroid localization. CAT and technetium-99m–sestamibi scan were performed separately. The patient's head and neck were fixed with the noninvasive Vogele-Bale-Hohner Head Holder (VBH HeadFIX; Medical Intelligence, Schwabmünchen, Germany) and the BodyFIX (Medical Intelligence) vacuum cushion. Radiographic and scintigraphic markers were mounted at the head holder and the patient. CAT and MIBI images were fused by overlaying radiographic markers using a commercial software and workstation.

Results

In 5 patients, localization and dimension of the solitary adenomas were exactly predicted. In 1 patient with multiglandular disease (3 enlarged glands), CAT–MIBI image fusion was not able to predict multiple gland involvement. However, in a retrospective analysis of the localization study, the other two enlarged parathyroid glands could be correctly identified regarding their site and size.

Conclusions

First results of CAT–MIBI image fusion are promising. The new technique provides a higher image resolution and better delimitation of enlarged parathyroid glands and adjacent anatomic structures than conventional scintigraphic methods.

Section snippets

Methods

Six consecutive patients with biochemically confirmed primary HPTH underwent preoperative CAT–MIBI image fusion for localizing enlarged parathyroid glands. All patients were female, and the medium age was 65 years (range 52 to 75). Intraoperative findings were compared with preoperative imaging results of CAT–MIBI image fusion and conventional MIBI–single-photon emission computed tomography (SPECT) alone. The MIBI–SPECT images were analyzed by one of the investigators (R.M.) who was blinded to

Results

Four patients had undergone previous neck operations. Three patients had undergone bilateral thyroid resection several years before the study, and one patient had undergone two previous thyroid operations. The former thyroid operations were performed because of benign multinodular goiters. In the previously operated patients, a short Kocher's incision (2 to 4 cm) was used to allow for transmembraneous positioning of a needle probe for recurrent laryngeal nerve monitoring. All of these patients

Comments

The best surgical strategy for patients with primary HPTH undergoing their first cervical surgery remains a matter of discussion [1], [2], [14], [15]. In patients with previous neck surgery, the value of preoperative localization studies is generally accepted [16]. Numerous investigators still favor the bilateral approach, whereas the number of proponents of an imaging-guided approach is increasing per the recent literature [1–4,14,15,17]. The main argument against unilateral or minimally

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Scientific paperComputed axial tomography–MIBI image fusion for preoperative localization in primary hyperparathyroidism

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Comments

Surgery

Surgery

Surgery

Surgery

Am J Surg

Surgery

Am J Surg

Unilateral surgery for primary hyperparathyroidism on the basis of technetium Tc 99m sestamibi and iodine 123 subtraction scanning

Arch Surg

Scientific paper
Computed axial tomography–MIBI image fusion for preoperative localization in primary hyperparathyroidism