Der Nuklearmediziner 2003; 26(1): 13-20
DOI: 10.1055/s-2003-38784
Endokrine und exokrine Drüsen

© Georg Thieme Verlag Stuttgart · New York

Nuklearmedizinische Diagnostik des primären Hyperparathyreoidismus (pHPT)

Nuclear Medicine in the Diagnosis of Primary HyperparathyroidismM. Luster1 , S. Timm2
  • 1Klinik für Nuklearmedizin der Universität Würzburg
  • 2Chirurgische Universitätsklinik Würzburg
Further Information

Publication History

Publication Date:
17 April 2003 (online)

Zusammenfassung

Die nuklearmedizinische Nebenschilddrüsendiagnostik hat in jüngerer Vergangenheit zunehmende Bedeutung erlangt. Durch die Einführung minimal invasiver Operationstechniken ist eine präoperative Bildgebung für die Planung des Eingriffs Voraussetzung. Die Sestamibi-Szintigraphie hat in diesem Zusammenhang in zahlreichen Studien eine Überlegenheit gegenüber anderen Verfahren im Hinblick auf die Sensitivität bei der Detektion von Läsionen, insbesondere beim primären Hyperparathyreoidismus, gezeigt. Demzufolge wird dieses Untersuchungsverfahren nicht nur wie bisher vor Rezidiveingriffen oder bei persistierender Erkrankung, sondern auch erfolgreich vor Erstoperationen eingesetzt. Die vermehrte Nutzung der SPECT-Technik konnte in den letzten Jahren zu einer weiteren Steigerung der Detektionsrate beitragen und sollte großzügig Verwendung finden.

Abstract

Nuclear medicine recently has gained importance in the diagnosis of primary hyperparathyroidism. Stimulated by the introduction of minimal invasive surgery preoperative imaging is mandatory for the planning of the surgical approach. Sestamibi scintigraphy has proven its superiority in sensitivity concerning the lesion detection especially in primary hyperparathyroidism as compared to other imaging modalities. Therefore this test is not only used for the diagnosis of relapsing or persistent disease but also successfully implemented in the initial work-up. The wider use of SPECT contributed significantly to a further increase of the detection rate and is recommended as a standard procedure.

Literatur

  • 1 Bergenfelz A, Isaksson A, Lindblom P. et al . Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery.  Br J Surg. 1998;  85 1129-1132
  • 2 Bilezikian J P, Silverberg S J, Gartenberg F. Clinical presentation of primary hyperparathyroidism. In: Bilezikian JP, Marcus R, Levine MA, eds.: The Parathyroids. New York: Raven 1994; 457-470
  • 3 Boggs J E, Irvin G L, Molinari S. et al . Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy.  Surgery. 1996;  120 954-958
  • 4 Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau C J, Maheux P. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content.  J Nucl Med. 1998;  39 1441-1444
  • 5 Carty S E, Worsey J, Virji M A, Brown M L, Watson C G. Concise parathyroidectomy: the impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay.  Surgery. 1997;  122 1107-1114
  • 6 Chapuis Y, Fulla Y, Bonnichon P. et al . Values of ultrasonografy, sestamibi scintigrafy, and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism.  World J Surg. 1996;  20 835-839
  • 7 Chen C C, Skarulis M C, Fraker D L, Alexander R, Marx S J, Spiegel A M. Technetium-99m-sestamibi imaging before reoperation for primary hyperparathyroidism.  J Nucl Med.. 1995;  36 186-2191
  • 8 Chen C C, Holder L E, Scovill W A, Tehan A M, Gann D S. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT.  J Nucl. Med.1997;  38 834-839
  • 9 Chen E M, Mishkin F S. Parathyroid hyperplasia may be missed by double-phase Tc-99m sestamibi scintigraphy alone.  Clin Nucl Med. 1997;  22 222-226.
  • 10 Coakley A J, Kettle A G, Wells C P, O’Doherty M J, Collins R E. 99mTc-Sestamibi: a new agent for parathyroid imaging.  Nucl Med Commun. 1989;  10 791-794
  • 11 Denham D W, Norman J. Cost-effectiveness of properative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon's choice of operative procedure.  J Am Coll Surg. 1998;  186 293-304
  • 12 Fjeld J G, Erichsen K, Pfeffer P F, Clausen O P, Rootwelt K. Technetium-99m-tetrofosmin for parathyroid scintigraphy: a comparison with sestamibi.  J Nucl Med. 1997;  38 831-834
  • 13 Frilling A, Görges R, Clauer U. et al . Minimal-invasive Parathyreoidekromie in Lokalanaesthesie in Verbindung mit Ultrasonographie, Sestamibi-Szintigrafie und intraoperativer Parathormonmessung.  Chirurg. 2000;  71 1474-1479
  • 14 Fujii H, Kubo A. Parathyroid imaging with technetium-99m sestamibi.  Biomed Pharmacother. 2000;  54 (Suppl 1) 12s-16s
  • 15 Gallowitsch H J, Mikosch P, Kresnik E, Unterweger O, Lind P. Comparison between 99mTc-tetrofosmin/pertechnetate subtraction scintigraphy and 99mTc-tetrofosmin SPECT for preoperative localization of parathyroid adenoma in an endemic goiter area.  Invest Radiol. 2000;  35 453-459
  • 16 Gallowitsch H J, Mikosch P, Kresnik E, Gomez I, Lind P. Technetium 99mtetrofosmin parathyroid imaging. Results with double-phase study and SPECT in primary and secondary hyperparathyroidism.  Invest Radiol. 1997;  32 459-465
  • 17 Giordano A, Rubello D, Casara D. New trends in parathyroid scintigraphy.  Eur J Nucl Med. 2001;  28 1409-1420
  • 18 Gordon B M, Gordon L, Hoang K. et al . Parathyroid imaging with 99m Tc-sestamibi.  Am J Roentgenol. 1996;  167 1563-1568
  • 19 Greenspan B S, Brown M L, Dillehay G L, McBiles M, Sandler M P, Seabold J E, Sisson J C. Procedure guideline for parathyroid scintigraphy. Society of Nuclear Medicine.  J Nucl Med. 1998;  39 1111-1114
  • 20 Heller K, Attie J, Dunber S. Parathyroid localization: inability to predict multiple gland involvement.  Am J Surg. 1993;  166 357-359
  • 21 Hindie E, Melliere D, Jeanguillaume C, Perlemuter L, Chehade F, Galle P. Parathyroid imaging using simultaneous double-window recording of technetium-99m-sestamibi and iodine-123.  J Nucl Med. 1998;  39 1100-1105
  • 22 Hindie E, Urena P, Jeanguillaume C, Melliere D, Berthelot J M, Menoyo-Calonge V, Chiappini-Briffa D, Janin A, Galle P. Preoperative imaging of parathyroid glands with technetium- 99m-labelled sestamibi and iodine-123 subtraction scanning in secondary hyperparathyroidism.  Lancet. 1999;  353 2200-2204
  • 23 Kao A, Shiau Y C, Tsai S C, Wang J J, Ho S T. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression.  Eur J Nucl Med Mol Imaging. 2002;  29 1012-1015
  • 24 Klieger P, O'Mara R. The diagnostic utility of dual phase Tc-99m sestamibi parathyroid imaging.  Clin Nucl Med. 1998;  23 208-211
  • 25 Krausz Y, Lebensart P D, Klein M. et al . Preoperative localisation of parathyroid adenoma in patients with concomitant thyroid nodular disease.  World J Surg. 2000;  24 (12) 1573-8
  • 26 Krubsack A J, Wilson S D, Lawson T L, Kneeland J B, Thorsen M K, Collier B D, Hellman R S, Isitman A T. Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors.  Surgery. 1989;  106 639-644
  • 27 Lee V S, Wilkinson Jr R H, Leight Jr G S, Coogan A C, Coleman R E. Hyperparathyroidism in high-risk surgical patients: evaluation with double-phase technetium-99m sestamibi imaging.  Radiology. 1995;  197 627-633
  • 28 Leslie W D, Dupont J O, Bybel B, Riese K T. Parathyroid (99m) Tc-sestamibi scintigraphy: dual-tracer subtraction is superior to double-phase washout.  Eur J Nucl Med Mol Imaging.. 2002;  29 1566-1570
  • 29 Ljungall S, Hellmann P, Rastad I. et al . Primary hyperparathyroidism, epidemiology, diagnosis and clinical picture.  World J Surg. 1991;  15 681-687
  • 30 McBiles M, Lambert A T, Cote M G, Kim S Y. Sestamibi parathyroid imaging.  Semin Nucl Med. 1995;  25 221-234
  • 31 Miedlich S, Koch C A, Paschke R. Primärer Hyperparathyreoidismus: Heute ein meist asymptomatisches Krankheitsbild.  Dtsch Arztebl. 2002;  49 2812-2817
  • 32 Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Preoperative localization of parathyroid adenomas using 99mTc-MIBI scintigraphy.  Am J Med. 2000;  108 733-736
  • 33 Moka D, Eschner W, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Iterative Rekonstruktion von SPECT: Verbesserung der diagnostischen Sensitivität bei der MIBI-Nebenschilddrüsenszintigraphie.  Nuklearmedizin. 2000;  39 A 49
  • 34 Molinari A S, Irvin G L, Deriso G T. et al . Incidence of multiglandular disease in primary hyperparathyroidism determined by parathyroid hormone secretion.  Surgery. 1996;  120 934-937
  • 35 Neumann D R, Esselstyn C B, Maclntyre W J, Go R T, Obuchowski N A, Chen E Q, Licata A A. Comparison of FDG-PET and sestamibi-SPECT in primary hyperparathyroidism.  J Nucl Med. 1996;  37 1809-1815
  • 36 Nguyen B D. Parathyroid imaging with Tc-99m sestamibi planar and SPECT scintigraphy.  Radiographics. 1999;  19 601-614
  • 37 Bilezikian J P, Potts Jr J T, Ghada El-Hajj Fuleihan, Kleerekoper M, Neer R, Peacock M, Rastad J, Silverberg S J, Udelsman R, Wells S A. Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century.  J Clin Endocrinol Metabol. 2002;  87(12) 5353-5361
  • 38 Norman J, Chheda H, Farrell C. Minimally invasive parathyroidecomy for primary hyperparathyroidism: Decreasing operative time and potential complications while improving cosmetic results.  Am Surg. 1998;  64 391-396
  • 39 Perez-Monte J E, Brown M L, Shah A N, Ranger N T, Watson C G, Carty S E, Clarke M R. Parathyroid adenomas: accurate detection and localization with Tc-99m sestamibi SPECT.  Radiology. 1996;  201 85-91
  • 40 Nowak B, Sabri O, Hoff C, Reinartz P, Kleinhans E, Zimny M. Various dynamics of Tc-99m-tetrofosmin and Tc-99m-MIBI in a parathyroid adenoma.  Nuklearmedizin. 1999;  38 160-163
  • 41 O’Doherty M J, Kettle A G, Wells P, Collins R E, Coakley A J. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies.  J Nucl Med. 1992;  33 313-318
  • 42 Prager G, Czerny C, Kurtaran A. et al . Der Stellenwert präoperativer Lokalisationsmethoden beim primären Hyperparathyreoidismus.  Chirurg. 1999;  70 1082-1088
  • 43 Prager G, Czerny C, Kurtaran A. et al . Minimally invasive open parathyreoidectomy in an endemic goiter area.  Arch Surg. 2001;  136 810-816
  • 44 Rink T, Schroth H J, Holle L H, Garth H. Limited sensitivity of parathyroid imaging with (99m)Tc-sestamibi/(123)I subtraction in an endemic goiter area.  J Nucl Med. 2002;  43 1175-1180
  • 45 Sandrock D. Leitlinie für die Nebenschilddrüsenszintigraphie.  Nuklearmedizin. 1999;  38 223-225
  • 46 Silverberg S J, Shane E, Jacobs T P, Siris E, Bilezikian J P. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery.  N Engl J Med. 1999;  341 1249-1255
  • 47 Soffermann R, Narhan M, Fairbank J. Preoperative technetium Tc99m sestamibi imaging. Paving the way to minimal access parathyroid surgery.  Arch Otolaryngol Head Neck Surg. 1996;  122 369-374
  • 48 Staudenherz A, Abela C, Niederle B, Steiner E, Helbich T, Puig S, Kaserer K, Becherer A, Leitha T, Kletter K. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases.  Eur J Nucl Med. 1997;  24 143-149
  • 49 Staudenherz A, Kletter K, Leitha T H. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma.  J Nucl Med. 1995;  36 1928-1929
  • 50 Stirat G M. Preoperative scanning in secondary hyperparathyroidism.  Lancet. 1999;  353 2174-2175 Commentary
  • 51 Taillefer R, Boucher Y, Potvin C, Lambert R. 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. 1992;  33 1801-1807
  • 52 Takebayashi S, Hidai H, Chiba T, Takagi Y, Nagatani Y, Matsubara S. Hyperfunctional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings.  J Nucl Med. 1999;  40 1792-1797
  • 53 Timm S, Hamelmann W, Luster M, Reiners C, Geling M, Thiede A, Timmermann W. Selection criteria for single sided or minimally invasive parathyroidectomy for patients with primary hyperparathyroidism.  Zentralbl f Chir. 2002;  127 443-447
  • 54 Udelsmann R. Parathyroid imaging: The myth and the reality.  Radiology. 1996;  201 317-318
  • 55 Wermers R A, Khosla S, Atkinson E J, Hodgson S F, O'Fallon W M, Melton L J. The rise and fall of primary hyperparathyroidism: a population-based study in Rochester, Minnesota, 1965 -1992.  Ann Int Med. 1997;  126 433-440

Dr. Markus Luster

Klinik für Nuklearmedizin der Universität Würzburg

Josef-Schneider-Str. 2

97080 Würzburg

+49/9 31/2 01-3 58 74

Email: luster@nuklearmedizin.uni-wuerzburg.de

    >