Preoperative localization of parathyroid glands

J. Ruf; E. Lopez Hänninen; Th. Steinmüller; T. Rohlfing; H. Bertram; M. Gutberlet; A.-J. Lemke; R. Felix; H. Amthauer

doi:10.1055/s-0038-1625596

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2004; 43(03): 85-90
DOI: 10.1055/s-0038-1625596

Original Article

Schattauer GmbH

Preoperative localization of parathyroid glands

Use of MRI, scintigraphy, and image fusionPräoperative Lokalisationsdiagnostik von NebenschilddrüsenNutzen der MRT, Szintigraphie und Bildfusion

J. Ruf

¹Department of Radiology and Nuclear Medicine

,

E. Lopez Hänninen

¹Department of Radiology and Nuclear Medicine

,

Th. Steinmüller

²Visceral and Transplant Surgery, Charité, Universitätsmedizin Berlin, Campus Virchow Clinic, Germany

,

T. Rohlfing

³Image Guidance Laboratories, Department of Neurosurgery, Stanford University, USA

,

H. Bertram

¹Department of Radiology and Nuclear Medicine

,

M. Gutberlet

¹Department of Radiology and Nuclear Medicine

,

A.-J. Lemke

¹Department of Radiology and Nuclear Medicine

,

R. Felix

¹Department of Radiology and Nuclear Medicine

,

H. Amthauer

¹Department of Radiology and Nuclear Medicine

› Author Affiliations

Abstract

Summary

Aim: Minimally invasive resection of hyperfunctional parathyroid glands is an alternative to open surgery. However, it requires a precise preoperative localization. This study evaluated the diagnostic use of magnetic resonance (MR) imaging, parathyroid scintigraphy, and consecutive image fusion. Patients, methods: 17 patients (9 women, 8 men; age: 29-72 years; mean: 51.2 years) with primary hyperparathyroidism were included. Examination by MRI used unenhanced T1- and T2-weighted sequences as well as contrast-enhanced T1-weighted sequences. ^99mTc-MIBI scintigraphy consisted of planar and SPECT (single photon emission tomography) imaging techniques. In order to improve the anatomical localization of a scintigraphic focus, SPECT-data were fused with the corresponding MR-data using a modified version of the Express 5.0 software (Advanced Visual Systems, Waltham, MA). Results of image fusion were then compared to histopathology. Results: In 14/17 patients, a single parathyroid adenoma was found. There were 3 cases with hyperplastic glands. MRI detected 10 (71%), scintigraphy 12 (86%) adenomas. Both modalities detected 1/3 patients with hyperplasia. Image fusion improved the anatomical assignment of the 13 scintigraphic foci in five patients and was helpful in the interpretation of inconclusive MR-findings in two patients. Conclusions: Both MRI and ^99mTc-MIBI scintigraphy sensitively detect parathyroid adenomas but are less reliable in case of hyperplastic glands. In case of a scintigraphic focus, image fusion considerably improves its topographic assignment. Furthermore, it facilitates the evaluation of inconclusive MRI findings.

Zusammenfassung

Ziel: Die minimal-invasive Resektion hypersezernierender Nebenschilddrüsen ist eine Alternative zur offenen Chirurgie, bedarf jedoch einer präzisen präoperativen Lokalisationsdiagnostik. Diese Studie evaluierte den Nutzen von Magnetresonanztomographie (MRT), Nebenschilddrüsenszintigraphie und konsekutiver Bild-fusion. Patienten, Methoden: 17 Patienten (9 Frauen, 8 Männer, Alter: 29-72 Jahre; Mittel: 51,2 Jahre) mit primärem Hyperparathyreoidismus wurden in diese Studie eingeschlossen. Die MRT-Untersuchung umfasste T2- und T1-gewichtete Sequenzen. Die ^99mTc-MIBISzintigraphie wurde in planarer und SPECT(single photon emission tomography)-Technik durchgeführt. Zur Verbesserung der anatomischen Zuordnung eines szintigraphischen Fokus, wurden die SPECT-Daten mit dem korrespondierenden MRT-Datensatz fusioniert. Hierfür wurde eine modifizierte Version der Software Express 5.0 (Advanced Visual Systems, Waltham, MA) verwendet. Die Ergebnisse der Bildfusion wurden mit den histopathologischen Befunden verglichen. Ergebnisse: Bei 14 Patienten wurde ein singuläres Nebenschilddrüsenadenom nachgewiesen. Bei 3 Patienten wurden hyper-plastische Drüsen entdeckt. Die MRT entdeckte 10 (71%) und die Szintigraphie 12 (86%) der Adenome. Beide Verfahren detektierten hyperplastische Drüsen in einem von drei Fällen. Die Bildfusion verbesserte die anatomische Zuordnung der 13 szintigraphischen Foki bei 5 Patienten und war bei 2 Patienten für die Interpretation uneindeutiger MRT-Befunde von Nutzen. Schlussfolgerung: Während Adenome der Nebenschilddrüse sowohl mit der MRT als auch mit der ^99mTc-MIBISzintigraphie zuverlässig nachgewiesen werden, ist die Detektion hyperplastischer Drüsen mit beiden Verfahren weniger sensitiv. Im Falle eines szintigraphischen Fokus verbessert die Bildfusion in hohem Maße seine topographische Zuordnung. Darüber hinaus erleichtert sie die Interpretation nicht eindeutiger MRT-Befunde.

Keywords

Parathyroid gland - adenoma - scintigraphy - magnetic resonance imaging - image fusion

Schlüsselwörter

Nebenschilddrüsenadenom - Bildfusion

Full Text

References

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