Präoperative Bildgebung bei primärem Hyperparathyreoidismus

Zusammenfassung

Mit der Änderung der chirurgischen Taktik bei Patienten mit primärem Hyperparathyreoidismus zugunsten einer minimalinvasiven Vorgehensweise gewinnt die präoperative Darstellung von pathologisch veränderten Nebenschilddrüsen an Bedeutung. Neben anatomischen Lokalisationsmethoden bietet die Nebenschilddrüsenszintigrafie die Möglichkeit, morphologisch schwer erkennbare Strukturen zu detektieren, da die Lokalisation hier primär auf funktionellen Eigenschaften des Zielgewebes beruht. Ziel der Arbeit ist es, einen aktuellen Überblick über die Möglichkeiten der Nebenschilddrüsenlokalisationsdiagnostik zu geben. Insbesondere werden die diagnostischen Möglichkeiten bei kombinierter Verwendung von synergistischen Verfahren im Sinne einer anatomisch-funktionellen Bildgebung dargestellt. In Conclusio empfehlen wir vor einer minmalinvasiven Intervention zur Sanierung eines Hyperparathyreoidismus die kombinierte sonografisch-szintigrafische Nebenschilddrüsenlokalisationsdiagnostik, bestehend aus sequenzieller ^{99 m}Tc-Sestamibi-Szintigrafie inklusive SPECT plus Schilddrüsenszintigrafie und hochauflösender zervikaler Sonografie.

Abstract

In patients with primary hyperparathyroidism (pHPT) considered for surgery there has been increasing stress laid upon minimally invasive procedures in recent years. Precise localization prior to surgery is crucial in this context. Besides high-resolution ultrasonography, functional imaging using ^{99 m}Tc-Sestamibi is gaining importance as scintigraphic localization primarily relays on functional features than on morphologic appearance. The purpose of this review is to summarize the accuracy of different diagnostic imaging methods in pHPT with respect to synergistic anatomic and functional imaging. In conclusion we recommend prior to minimally invasive treatment of hyperparathyroidism combined localization studies, consisting of sequential ^{99 m}Tc-Sestamibi scintigraphy, additional SPECT plus thyroid gland scintigraphy, plus high-resolution cervical ultrasonography.

Primärer Hyperparathyreoidismus - Lokalisationsdiagnostik - ^{99 m}Tc-Sestamibi-Szintigrafie - Ultraschall - minimalinvasive Chirurgie

hyperparathyroidism - ^{99 m}Tc-Sestamibi scintigraphy - ultrasound - minimal-invasive surgery

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