Sánchez CNRJ, García OJR, Luis Felipe Alva LLF

Language: Spanish
References: 11
Page: 137-146
PDF size: 146.77 Kb.

ABSTRACT

Introduction: The parathyroid hormone is essential for the control of calcium metabolism and it is secreted by the Parathyroid Glands. Its supersecretion can result in a Symptomatic Hypercalcaemia. The primary hyperparathyroidism is a common endocrinopathy, especially in older women. Its treatment is controversial because many patients are asymptomatic and, because of this, not everyone will develop symptoms and/or complications of hyperparathyroidism.
Objective: To define the additional value that tridimensional imaging (SPECT) provides to the Gammagram of parathyroid glands with conventional technique (plain images) to locate parathyroid adenomas, taking the hystopathologic analysis as reference.
Methodology: The Nuclear Medicine files were reviewed and extract the gammagraphic studies taken and directed to locate parathyroid adenomas and that they had the inclusion of both techniques (Plain images + SPECT). The studies of 38 patients that had been referred by their attendant doctor to our area with clinic and paraclinic (only in a few cases) diagnostic suspicion of primary hyperthyroidism to have a parathyroid gland Gammagram with 99mTc-MIBI were reviewed.
Results: In all 38 patients, the images by SPECT technique accomplished to show abnormal findings in 22/38(58%) of them. On the other hand, plain images could show abnormalities in 14/38(37%) of them. From the 22 patients proved by SPECT technique, only 14 (63.6%) of them were shown on plain images and the rest couldn’t be shown. The rest of the studies didn’t show evident changes and were interpreted as normal and/or negative.
Conclusion: Experimented endocrinology surgeons are able to cure primary hyperparathyroidism secondary to a parathyroid adenoma, by bilateral examination of the neck in most patients (over 95% of the cases) without taking any imaging study. However, morbility and failed surgery percent can be high in less experimented hands.

REFERENCES

1. Ell PJ, Gambhir SS. Nuclear medicine in clinical diagnosis and treatment. 3rd Ed. 2004.

2. Smith JR, Oates ME. Radionuclide imaging of the parathyroid glands: Patterns, pearls and pitfall. Radiographics 2004; 24: 1101-15.

3. Scientific Exhibit. Parathyroid Imaging with Tc-99m SESTAMIBI planar and SPECT scintigraphy: Radiographics 1999; 19: 601-14.

4. Gayed IW, Kim EE, Broussard WF, et al. The value of 99mTc-Sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med 2005; 46: 248-52.

5. Clark PB, Case D, Watson NE, Morton KA, Perrier ND. Enhanced scintigraphic protocol required for optimal preoperative localization before targeted minimal invasive parathyroidectomy. Clin Nucl Med 2003; 28: 955-60.

6. Lorberboym M, Minski I, Macadziob S, Nikolov G, Schachter P. Incremental diagnostic value of preoperative 99m-Tc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003; 44: 904-8.

7. Billotey C, Sarfati E, Aurengo A, et al. Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 1996; 37: 1773-8.

8. Staudenherz A, Abela C, Niederle B, et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid disease. Eur J Nucl Med 1997; 24: 143-9.

9. Ning ZW, Wang O, Xu JY, et al. Assesment of preoperative localization techniques for patients with primary hyperparathyroidism. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2003; 25: 280-4.

10. Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med 1998; 39: 320-4.

11. Sandler P. Diagnostic nuclear medicine.