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Chandran M, Tse Tan SY. Disorders of bone and mineral metabolism in pregnancy and lactation: A case based clinical review. Osteoporos Sarcopenia 2025; 11:1-8. [PMID: 40256359 PMCID: PMC12009114 DOI: 10.1016/j.afos.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 03/01/2025] [Accepted: 03/08/2025] [Indexed: 04/22/2025] Open
Abstract
Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approximately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adaptations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during pregnancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalcemia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal complications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lactation requires a nuanced approach to meet the dual needs of the mother and fetus.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
| | - Sarah Ying Tse Tan
- Obesity and Metabolic Unit, Department of Endocrinology, Singapore General Hospital, Singapore
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Silberzweig AM, Xing M, Mundi N, Dowling E, Urken ML. An unusual case of retropharyngeal ectopic parathyroid adenoma. EAR, NOSE & THROAT JOURNAL 2025; 104:137-139. [PMID: 35538678 DOI: 10.1177/01455613221101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Monica Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Neil Mundi
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Eric Dowling
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Patel N, Gharai S, Brindle KA, Khati NJ. Imaging Spectrum of Extrathyroidal Neck Masses. Ultrasound Q 2025; 41:e00708. [PMID: 39919309 DOI: 10.1097/ruq.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
ABSTRACT Extrathyroidal masses in the anterolateral neck are frequently encountered in the adult population and may represent a diagnostic dilemma. These neck masses can result from a diverse array of pathologies including congenital, inflammatory, infectious, and neoplastic causes. Relevant medical history and physical examination are essential to complement the imaging findings. Ultrasound (US) plays an important role in the initial evaluation of neck masses due to its reliability, availability, safety and cost-effectiveness. It can confirm or exclude the presence of a mass and initially characterize it as solid or cystic. Sonographically assessing the relationship of a mass to adjacent cervical anatomy can facilitate a more targeted differential diagnosis. US also effectively guides fine needle aspirations and/or biopsies of accessible lesions. Multimodality imaging is reserved for problem-solving complex cases and presurgical planning. The anterolateral neck masses are categorized into midline/paramedian lesions, salivary gland pathologies, and other soft tissue lesions. Midline and paramedian lesions include thyroglossal duct pathologies, ectopic thyroid tissue, and parathyroid adenomas. Salivary gland pathologies include obstructive/inflammatory processes, benign and malignant neoplasms, and systemic diseases. This pictorial essay presents clinical features and sonographic characteristics of extrathyroidal masses in the anterolateral neck with a brief discussion of other imaging modalities.
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Affiliation(s)
- Naiya Patel
- Department of Radiology, The George Washington University Hospital, Washington, DC
| | - Sean Gharai
- Department of Radiology, The George Washington University Hospital, Washington, DC
| | - Kathleen A Brindle
- Department of Radiology, Musculoskeletal Section, The George Washington University Hospital, Washington, DC
| | - Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, Washington, DC
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Meomartino L, Rossi M, Selvatico G, Rossetto Giaccherino R, Pagano L. Thyroid nodule with cytological outcome of indeterminate lesion with low risk of malignancy found to be parathyroid adenoma. A case report and minireview of literature. Front Endocrinol (Lausanne) 2025; 16:1474440. [PMID: 40060374 PMCID: PMC11885119 DOI: 10.3389/fendo.2025.1474440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 01/31/2025] [Indexed: 05/13/2025] Open
Abstract
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder, typically caused by a single parathyroid adenoma. The diagnosis of PHPT is biochemical, and the localization of abnormal parathyroid glands is usually achieved through a combination of ultrasound and technetium-99m sestamibi (99mTc-MIBI) scans. In some cases, newer imaging modalities, such as positron emission tomography-computed tomography (PET-CT) with 18F-fluorocholine or 11C-methionine, are used as second-line methods. Consequently, parathyroid tissue (PTT) is not typically sampled by fine needle aspiration biopsy (FNAb). However, with an incidence ranging from 9% to 22%, the affected parathyroid gland may present in an ectopic location, with the thyroid gland being a possible site. In intra-thyroidal parathyroid adenomas (IPAs), the differential diagnosis with thyroid nodules can be challenging due to similar ultrasound features and the potential uptake of 99mTc-MIBI by some thyroid nodules. As a result, such lesions may sometimes undergo unintentional cytological examination, leading to the risk of misinterpretation as cytologically indeterminate thyroid lesions. This can result in both misdiagnosis and inappropriate surgical approach. For this reason, a routine evaluation of calcium-phosphorus metabolism could prove beneficial as part of the diagnostic workup for cytologically indeterminate thyroid nodules, especially when surgery is planned. To support this diagnostic approach, we present a mini-review of the literature on this topic, along with a case report of an IPA misinterpreted as an indeterminate thyroid lesion (TIR3A, according to the Italian Society for Anatomic Pathology and Cytology-Italian Thyroid Association 2014 classification system), diagnosed following the preoperative incidental detection of hypercalcemic PHPT.
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Affiliation(s)
- Letizia Meomartino
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University
of Turin, Turin, Italy
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Kesim S, Turoglu HT, Kotan T, Balaban Genc ZC, Niftaliyeva K, Toper H, Gogas Yavuz D, Ozguven S, Kaya H, Dede F, Ugurlu MU, Oksuzoglu K, Cagliyan F, Gulluoglu BM, Ones T, Erdil TY. Efficacy of additional lateral pinhole and SPECT/CT imaging in dual-phase Tc-99m MIBI parathyroid scintigraphy for localising parathyroid pathologies in patients with primary hyperparathyroidism: a single-institution experience. Nucl Med Commun 2025; 46:47-54. [PMID: 39512197 DOI: 10.1097/mnm.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
PURPOSE Parathyroid imaging with dual-phase technetium-99m methoxyisobutrylizonitrile (Tc-99m MIBI) scintigraphy serves as an important prerequisite for the identification of hyperfunctioning parathyroid gland(s) in patients with primary hyperparathyroidism (PHPT) for a successful targeted parathyroidectomy. This study aimed to evaluate the clinical value of additional lateral imaging and single-photon emission computed tomography/computed tomography (SPECT/CT) versus conventional planar imaging for locating parathyroid pathologies in patients with PHPT. MATERIALS AND METHODS A retrospective review was performed on 105 patients who underwent dual-phase Tc-99m MIBI scintigraphy and were surgically treated by parathyroidectomy. Dual-phase Tc-99m-MIBI planar scintigraphy with additional lateral pinhole views and SPECT/CT imaging was performed on a routine basis, as per departmental protocol. Comparison study between imaging modalities was done by patient-based analysis and scintigraphy results were compared with the clinical findings, biochemical markers, and histopathological findings. RESULTS Sensitivity and specificity for anterior planar dual-phase Tc-99m MIBI scintigraphy were 78.8 and 80%, respectively. In comparison, lateral pinhole scan and SPECT/CT alone were found to have sensitivities of 85.9 and 90.9%, respectively, with the same specificity. Sensitivity decreased in patients with normocalcaemia and multiglandular disease. The mean adenoma weight and size for true-positive studies were significantly higher than those for false-negative or false-positive studies. CONCLUSION SPECT/CT provided the highest diagnostic accuracy for preoperative identification of parathyroid lesions in PHPT patients. Lateral pinhole imaging offers comparable sensitivity and aids in adenoma localisation when SPECT/CT is unavailable.
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Affiliation(s)
| | | | | | | | | | | | - Dilek Gogas Yavuz
- Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
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Marchand JG, Ghander C, Bienvenu-Perrard M, Rouxel A, Buffet C, Russ G. Normal Parathyroid Glands Are Most Often Seen on Neck Ultrasound. Acad Radiol 2024; 31:3605-3611. [PMID: 38777720 DOI: 10.1016/j.acra.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE AND OBJECTIVES The dogma is that normal parathyroid glands (PTGs) are not visible on ultrasound (US). Recently, several studies have shown that PTGs present these US features: ovoid structure, homogeneous and hyperechoic. The primary objective was to assess the detection rate, standard size and locations of normal PTGs in a population of patients consulting for thyroid US exam. The secondary objective was to determine if the presence of a goiter or a thyroiditis could modify the visualization of normal PTGs. METHOD Single-center prospective study on 192 patients based on the typical US appearance previously described to identify one or more PTGs. RESULTS One or more PTGs were visualized in 75% of patients (144/192). They were visualized preferentially at the lower pole of the thyroid gland and in the infra-thyroid region (66%). The mean (± SD) size of normal PTGs was 5.68 mm (± 1,42 mm)×4.05 mm (± 1,03 mm)×2,68 mm (± 0,61 mm) and mean volume was 33.3 mm3 (± 17.75 mm3). The presence of a goiter made the search for PTGs more difficult whereas the presence of thyroiditis facilitated it. CONCLUSION The US detection rate of PTGs is high (75%). The identification of PTGs could be particularly useful in the preoperative assessment before total thyroidectomy or parathyroid surgery. It could reduce the risk of postoperative hypoparathyroidism and improve the accuracy of postoperative US surveillance of thyroid cancer. Better knowledge of the usual anatomical location of normal PTGs could also enable better detection of abnormal glands.
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Affiliation(s)
- J-G Marchand
- Thyroid and Endocrine Tumors Department. La Pitié-Salpêtrière Hospital. Sorbonne University, GRC N°16. 83 Bd de l'Hôpital, 75013, Paris, France; Centre of Pathology and Radiology, Paris, France.
| | - C Ghander
- Thyroid and Endocrine Tumors Department. La Pitié-Salpêtrière Hospital. Sorbonne University, GRC N°16. 83 Bd de l'Hôpital, 75013, Paris, France
| | - M Bienvenu-Perrard
- Centre of Pathology and Radiology, Paris, France; Nuclear medicine department. Cochin Hospital, Paris, France
| | - A Rouxel
- Centre of Pathology and Radiology, Paris, France; Nuclear medicine department. Avicenne Hospital, Bobigny, France
| | - C Buffet
- Thyroid and Endocrine Tumors Department. La Pitié-Salpêtrière Hospital. Sorbonne University, GRC N°16. 83 Bd de l'Hôpital, 75013, Paris, France
| | - G Russ
- Thyroid and Endocrine Tumors Department. La Pitié-Salpêtrière Hospital. Sorbonne University, GRC N°16. 83 Bd de l'Hôpital, 75013, Paris, France; Centre of Pathology and Radiology, Paris, France
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Luong D, Hawke K, De Waal E, Duke M, Wolski P. Diagnosing Primary Hyperparathyroidism in Pregnancy: A Case of Altered Parathyroid Hormone Degradation in Pregnancy. JCEM CASE REPORTS 2024; 2:luae159. [PMID: 39238943 PMCID: PMC11375578 DOI: 10.1210/jcemcr/luae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Indexed: 09/07/2024]
Abstract
Diagnosing primary hyperparathyroidism in pregnancy is difficult due to pregnancy-related changes in parathyroid hormone (PTH); calcium; 1,25 vitamin D; and renal calcium excretion. Parathyroid hormone-related peptide (PTHrP) produced by the placenta adds additional complexity. Our case is the first to demonstrate an increased rate of PTH degradation within a pregnant individual who returned unexpectedly low PTH levels. We describe a 27-year-old female patient who presented at 25 weeks gestation with pancreatitis and hypercalcemia. Primary hyperparathyroidism was suspected but variable PTH results led to uncertainty and an assay error was considered. PTH samples were collected in both serum-separating tubes (SST) and EDTA tubes and compared to controls (5 nonpregnant and 5 pregnant individuals). Samples were retested every 2 hours for a period of 10 hours. A rapid decline in the measured PTH was noted in the index case, an observation which differed from controls. We postulated that internal and/or external factors influenced the PTH measurement obtained from our patient. From our observations, rapid PTH degradation in pregnancy, and individual variation in PTH stability and laboratory processes, can influence PTH results and impact on interpreting hypercalcemia in pregnancy.
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Affiliation(s)
- Dianna Luong
- School of Medicine, University of Queensland, Herston QLD 4006, Australia
- Obstetric Medicine Department, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia
| | - Kate Hawke
- School of Medicine, University of Queensland, Herston QLD 4006, Australia
- Obstetric Medicine Department, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia
| | - Elzahn De Waal
- Chemical Pathology Department, Pathology Queensland, Herston QLD 4029, Australia
| | - Madeline Duke
- School of Medicine, University of Queensland, Herston QLD 4006, Australia
| | - Penny Wolski
- School of Medicine, University of Queensland, Herston QLD 4006, Australia
- Obstetric Medicine Department, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia
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Chakrabarty N, Mahajan A, Basu S, D’Cruz AK. Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review. Cancers (Basel) 2024; 16:2593. [PMID: 39061231 PMCID: PMC11274996 DOI: 10.3390/cancers16142593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/06/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Parathyroid pathologies are suspected based on the biochemical alterations and clinical manifestations, and the predominant roles of imaging in primary hyperparathyroidism are localisation of tumour within parathyroid glands, surgical planning, and to look for any ectopic parathyroid tissue in the setting of recurrent disease. This article provides a comprehensive review of embryology and anatomical variations of parathyroid glands and their clinical relevance, surgical anatomy of parathyroid glands, differentiation between multiglandular parathyroid disease, solitary adenoma, atypical parathyroid tumour, and parathyroid carcinoma. The roles, advantages and limitations of ultrasound, four-dimensional computed tomography (4DCT), radiolabelled technetium-99 (99mTc) sestamibi or dual tracer 99mTc pertechnetate and 99mTc-sestamibi with or without single photon emission computed tomography (SPECT) or SPECT/CT, dynamic enhanced magnetic resonance imaging (4DMRI), and fluoro-choline positron emission tomography (18F-FCH PET) or [11C] Methionine (11C -MET) PET in the management of parathyroid lesions have been extensively discussed in this article. The role of fluorodeoxyglucose PET (FDG-PET) has also been elucidated in this article. Management guidelines for parathyroid carcinoma proposed by the American Society of Clinical Oncology (ASCO) have also been described. An algorithm for management of parathyroid lesions has been provided at the end to serve as a quick reference guide for radiologists, clinicians and surgeons.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Anil K. D’Cruz
- Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India;
- Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
- Union International Cancer Control (UICC), 1202 Geneva, Switzerland
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9
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Shan H, Jiang Z, Xu J, Li J, Zhu X. Ectopic parathyroid adenoma on sternocleidomastoid muscle: a case report. Front Oncol 2024; 14:1410057. [PMID: 38957316 PMCID: PMC11217165 DOI: 10.3389/fonc.2024.1410057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
A 54-year-old woman was admitted to the hospital with a left neck mass. Enhanced CT and ultrasound examinations revealed a lesion in the left sternocleidomastoid muscle. The patient undergone right thyroid lobe resection 8 years ago. Interestingly, the lesion on the sternocleidomastoid muscle, along with the left lobe of the patient's thyroid, visually appears to form a displaced and complete thyroid in the early Tc-99m-MIBI parathyroid scintigraphy. Combined with Tc-99m-MIBI scintigraphy and abnormal PTH and blood calcium levels, the consideration was given to the lesion in the sternocleidomastoid muscle as an ectopic parathyroid adenoma. Subsequent surgical pathology confirmed this suspicion.
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Affiliation(s)
- HuiMin Shan
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - ZhenPeng Jiang
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Jin Xu
- Department of Pathology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - JingFa Li
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - XuSheng Zhu
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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Adarve Castro A, Domínguez Pinos D, Soria Utrilla V, O'Farrell Del Campo JA, Sendra Portero F, Ruiz-Gómez MJ. Update in imaging tests used for the localization of parathyroid pathology. RADIOLOGIA 2024; 66:236-247. [PMID: 38908885 DOI: 10.1016/j.rxeng.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/28/2023] [Indexed: 06/24/2024]
Abstract
Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET). There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.
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Affiliation(s)
- A Adarve Castro
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - D Domínguez Pinos
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Hospital Universitario Virgen de la Victoria, Málaga, Spain.
| | | | | | - F Sendra Portero
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - M J Ruiz-Gómez
- Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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Lunardi N, Jacob A, Elfenbein D, Schneider DF, Long K, Holoubek SA, MacKinney E, Chiu A, Sippel RS, Balentine CJ. Don't chase the adenoma: A probabilistic approach to imaging before parathyroidectomy. Surgery 2024; 175:1299-1304. [PMID: 38433078 DOI: 10.1016/j.surg.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of preoperative imaging varies substantially depending on the preoperative probability of having adenoma(s) and (2) that a selective imaging approach based on this probability could avoid unnecessary patient costs and radiation. METHODS We analyzed 3,577 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2001 to 2022. The predicted probability of patients having single or double adenoma versus hyperplasia was estimated using logistic regression. We then estimated the relationship between the predicted probability of single/double adenoma and the likelihood that sestamibi or 4-dimensional computed tomography was helpful for operative planning. Current Medicare costs and published data on radiation dosing were used to calculate costs and radiation exposure from non-helpful imaging. RESULTS The mean age was 62 ± 13 years; 78% were women. Adenomas were associated with higher mean calcium (11.2 ± 0.74 mg/dL) and parathyroid hormone levels (140.6 ± 94 pg/mL) than hyperplasia (9.8 ± 0.52 mg/dL and 81.4 ± 66 pg/mL). The probability that imaging helped with operative planning increased from 12% to 65%, as the predicted probability of adenoma increased from 30% to 90%. For every 10,000 patients, a selective approach to imaging that considered the preoperative probability of having adenomas could save patients up to $3.4 million and >239,000 millisieverts of radiation. CONCLUSION Rather than imaging all patients with primary hyperparathyroidism, a selective strategy that considers the probability of having adenomas could reduce costs and avoid excess radiation exposure.
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Affiliation(s)
- Nicole Lunardi
- Department of Surgery, University of Texas Southwestern, Dallas, TX; Department of Surgery, North Texas VA Health Care System, Dallas, TX
| | - Allison Jacob
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Dawn Elfenbein
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - David F Schneider
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Kristin Long
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Simon A Holoubek
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Erin MacKinney
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Alexander Chiu
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Rebecca S Sippel
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Courtney J Balentine
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI; Wisconsin Surgical Outcomes Research Program, Madison, WI.
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12
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Govind K, Paruk IM, Motala AA. Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa. BMC Endocr Disord 2024; 24:53. [PMID: 38664758 PMCID: PMC11044279 DOI: 10.1186/s12902-024-01583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003-2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH. METHODS A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded. RESULTS Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008). CONCLUSIONS The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.
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Affiliation(s)
- Kamal Govind
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.
| | - Imran M Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
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13
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Kim S, Shin JH, Hahn SY, Kim H, Kim MK. The Parathyroid Gland: An Overall Review of the Hidden Organ for Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:327-344. [PMID: 38617871 PMCID: PMC11009140 DOI: 10.3348/jksr.2022.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 08/08/2023] [Indexed: 04/16/2024]
Abstract
Parathyroid glands are small endocrine glands that regulate calcium metabolism by producing parathyroid hormone (PTH). These are located at the back of the thyroid gland. Typically, four glands comprise the parathyroid glands, although their numbers may vary among individuals. Parathyroid diseases are related to parathyroid gland dysfunction and can be caused by problems with the parathyroid gland itself or abnormal serum calcium levels arising from renal disease. In recent years, as comprehensive health checkups have become more common, abnormal serum calcium levels are often found incidentally in blood tests, after which several additional tests, including a PTH test, ultrasonography (US), technetium-99m sestamibi parathyroid scan, single-photon-emission CT (SPECT)/CT, four-dimensional CT (4D-CT), and PET/CT, are performed for further evaluation. However, the parathyroid gland remains an organ less familiar to radiologists. Therefore, the normal anatomy, pathophysiology, imaging, and clinical findings of the parathyroid gland and its associated diseases are discussed here.
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Greene C, Fujima N, Sakai O, Andreu-Arasa VC. Comparing accuracy of machine learning approaches to identifying parathyroid adenomas: Lessons and new directions. Am J Otolaryngol 2024; 45:104155. [PMID: 38141567 DOI: 10.1016/j.amjoto.2023.104155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/03/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE The purpose of this investigation is to understand the accuracy of machine learning techniques to detect biopsy-proven adenomas from similar appearing lymph nodes and factors that influence accuracy by comparing support vector machine (SVM) and bidirectional Long short-term memory (Bi-LSTM) analyses. This will provide greater insight into how these tools could integrate multidimensional data and aid the detection of parathyroid adenomas consistently and accurately. METHODS Ninety-nine patients were identified; 93 4D-CTs of patients with pathology-proven parathyroid adenomas were reviewed; 94 parathyroid adenomas and 112 lymph nodes were analyzed. A 2D slice through the lesions in each phase was used to perform sequence classification with ResNet50 as the pre-trained network to construct the Bi-LSTM model, and the mean enhancement curves were used to form an SVM model. The model characteristics and accuracy were calculated for the training and validation data sets. RESULTS On the training data, the area under the curve (AUC) of the Bi-LSTM was 0.99, while the SVM was 0.95 and statistically significant on the DeLong test. The overall accuracy of the Bi-LSTM on the validation data set was 92 %, while the SVM was 88 %. The accuracy for parathyroid adenomas specifically was 93 % for the Bi-LSTM and 83 % for the SVM model. CONCLUSION Enhancement characteristics are a distinguishing feature that accurately identifies parathyroid adenomas alone. The Bi-LSTM performs statistically better in identifying parathyroid adenomas than the SVM analysis when using both morphologic and enhancement information to distinguish between parathyroid adenomas and lymph nodes. SUMMARY STATEMENT The Bi-LSTM more accurately identifies parathyroid adenomas than the SVM analysis, which uses both morphologic and enhancement information to distinguish between parathyroid adenomas and lymph nodes, performs statistically better.
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Affiliation(s)
- Cynthia Greene
- Department of Radiology, Boston Medical Center, Boston University School of Medicine One Boton Medical Center Place, Boston, MA 02118, USA
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, 5 Chome Kita 14, Jonishhi, Sapporo, Hokkaido, Japan
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine One Boton Medical Center Place, Boston, MA 02118, USA
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine One Boton Medical Center Place, Boston, MA 02118, USA.
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15
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Ilgan S, Aydoğan Bİ, Emer Ö, Anıl C, Gürsoy A, Cesur M, Bilezikçi B. Sonographic Features of Atypical and Initially Missed Parathyroid Adenomas: Lessons Learned From a Single-Center Cohort. J Clin Endocrinol Metab 2024; 109:439-448. [PMID: 37668359 DOI: 10.1210/clinem/dgad527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
CONTEXT Awareness of typical and atypical ultrasonographic (US) features of parathyroid adenomas (PAs) is crucial since US is the most widely used first-line imaging modality. OBJECTIVE The purpose of this study was to describe the atypical features of PAs on US and other possible factors leading to a false negative examination in a large single-center cohort. MATERIALS AND METHODS The US records of 457 PAs in 445 patients with biochemically proven primary hyperparathyroidism (PHPT) were evaluated in a prospectively maintained database. Atypical size, composition, shape, echogenicity, location, and vascular pattern on US were noted. For patients who previously had at least one negative US examination in referring centers, the main possible reason was defined accordingly. RESULTS The study group included 359 female and 86 male patients with PHPT. Typical sonographic features were observed in 231 PAs (51%), whereas 226 (49%) had at least one atypical US feature. The most common atypical features were atypical size (29%), followed by atypical echogenicity (19%), shape (8%), location (7%), and composition (7%), respectively. There were 122 initially missed PAs in all groups. The most frequent main atypical US features leading to false negative examinations were atypical size (22.1%) and atypical location (18.8%). Inexperience was third most common reason (16.3%) for false negative US examinations. CONCLUSIONS Almost half of PAs have at least one atypical feature on US. Awareness of the high prevalence of atypical US features could increase the accuracy of US examination and potentially decrease demand for more expensive second-line imaging modalities.
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Affiliation(s)
- Seyfettin Ilgan
- Department of Nuclear Medicine, Ankara Güven Hospital, 06680 Ankara, Turkey
| | - Berna İmge Aydoğan
- Department of Endocrinology and Metabolism, Ankara Güven Hospital, 06680 Ankara, Turkey
| | - Özdeş Emer
- Department of Nuclear Medicine, Ankara Güven Hospital, 06680 Ankara, Turkey
| | - Cüneyd Anıl
- Department of Endocrinology and Metabolism, Ankara Güven Hospital, 06680 Ankara, Turkey
| | - Alptekin Gürsoy
- Department of Endocrinology and Metabolism, Ankara Güven Hospital, 06680 Ankara, Turkey
| | - Mustafa Cesur
- Department of Endocrinology and Metabolism, Ankara Güven Hospital, 06680 Ankara, Turkey
| | - Banu Bilezikçi
- Department of Pathology, Ankara Güven Hospital, 06680 Ankara, Turkey
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16
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Biryukova EV, Shinkin MV, Podachina SV, Feidorov IY, Mikheeva OM, Zvenigorodskaya LA, Malkina NA, Synkova DA. [A case of severe hyperparathyroidism in clinical practice. Case report]. TERAPEVT ARKH 2023; 95:1185-1191. [PMID: 38785059 DOI: 10.26442/00403660.2023.12.202483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 05/25/2024]
Abstract
Disorders of the mineral balance often determine the symptoms, the severity of the course and the prognosis of many diseases. Primary hyperparathyroidism (PHPT) is a common endocrine disease caused by increased secretion of parathyroid hormone as a result of primary damage to the parathyroid glands. Diagnosis of PHPT is often difficult. Clinical signs of PHPT appear months or years after the onset of the disease, however, the presence of hypercalcemia serves as an early indication of the disease of the thyroid gland. Often, patients are observed for a long time by related specialists (rheumatologists, traumatologists-orthopedists, oncologists), which gives rise to a lot of problems consisting in the lack of adequate treatment and its result, the progression of the disease, disability, and a decrease in the quality of life. Often, patients are observed for a long time by related specialists (rheumatologists, orthopedic traumatologists, oncologists) under the "masks" of various pathologies (osteoporosis, recurrent urolithiasis, etc.), which gives rise to a lot of problems, consisting in an erroneous diagnosis, lack of adequate treatment and its result, progression of the disease, disability, and a decrease in the quality of life. Late diagnosis of PHPT leads to the development of severe complications (osteoporetic fractures, renal failure) and an increased risk of premature death. A clinical case of late diagnosis of PHPT at the stage of pronounced bone complications of the disease, which proceeded under the guise of osteoarthritis, is considered. According to the results of laboratory and instrumental studies, the following were revealed: hypercalcemia, a significant increase in the concentration of PTH, adenoma of the left lower parathyroid gland, hyperparathyroid osteodystrophy, and a decrease in bone mineral density. Surgical treatment was performed - selective parathyroidectomy with the development of hypocalcemia in the early postoperative period, which was stopped by taking calcium supplements and active vitamin D metabolites and is designed to help practitioners of various specialties to understand the issues of diagnosis of PHPT and effective care for patients.
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Affiliation(s)
- E V Biryukova
- Russian University of Medicine
- Loginov Moscow Clinical Scientific Center
| | | | - S V Podachina
- Russian University of Medicine
- Loginov Moscow Clinical Scientific Center
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17
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Yazgi D, Richa C, Salenave S, Kamenicky P, Bourouina A, Clavier L, Dupeux M, Papon JF, Young J, Chanson P, Maione L. Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100751. [PMID: 37915399 PMCID: PMC10616552 DOI: 10.1016/j.lanepe.2023.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
Background Neck ultrasound (US) is a widely used and accessible operator-dependent technique that helps characterize thyroid nodules and pathologic parathyroid glands (PPGs). However, thyroid nodules may sometimes be confused with PPGs. PARATH-US study aims at identifying US characteristics to differentiate PPGs from thyroid nodules, as there is no study, at present, which directly compares the US features of these two common neoplasms. Methods PARATH-US is a single-center study that was conducted at a tertiary referral center, including consecutive lesions from patients undergoing neck US examination from 2016 to 2022. Findings 176 PPGs (158 patients: serum calcium levels 2.91 [IQR 2.74-3.05] mmol/L, PTH levels 173 [112-296] ng/L) were compared to 232 size- and volume-matched thyroid nodules (204 age- and sex-matched patients). The morphologic patterns, echoic content and vascular status were all different between PPGs and thyroid neoplasms (p < 0.01 for all comparisons). The combined parameters maximally discriminated PPGs from thyroid nodules (OR, 7.6; 95% CI: 3.4, 17.1, p < 0.0001). When applying risk stratification systems developed for thyroid malignancies, 58-63% of PPGs were classified as high-risk lesions. Parathyroid adenomas had larger sizes and volumes than hyperplasias (p = 0.013 and p = 0.029). Serum calcium and PTH levels were significantly correlated with PPG size and volume (p < 0.0001 for all comparisons). Interpretation We demonstrate the presence of distinct US characteristics in PPGs, which help differentiate them from thyroid nodules. When mistaken for thyroid nodules, PPGs bear high-risk US features. When dealing with high-risk cervical lesions detected on US, a PPG should be suspected, and an assessment of calcium levels recommended to avoid unnecessary invasive procedures. Funding CYTO-TRAIN, C2022DOSRH053, funded by the French Regional Health Agency.
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Affiliation(s)
- Dolly Yazgi
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Carine Richa
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Sylvie Salenave
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Amel Bourouina
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | | | - Margot Dupeux
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre Service d’Anatomie et Cytologie Pathologiques, Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie et Chirurgie Cervico-Maxillo Faciale, Le Kremlin-Bicêtre, France
| | - Jacques Young
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
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18
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Mannoh EA, Baregamian N, Thomas G, Solόrzano CC, Mahadevan-Jansen A. Comparing laser speckle contrast imaging and indocyanine green angiography for assessment of parathyroid perfusion. Sci Rep 2023; 13:17270. [PMID: 37828222 PMCID: PMC10570279 DOI: 10.1038/s41598-023-42649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
Accurate intraoperative assessment of parathyroid blood flow is crucial to preserve function postoperatively. Indocyanine green (ICG) angiography has been successfully employed, however its conventional application has limitations. A label-free method overcomes these limitations, and laser speckle contrast imaging (LSCI) is one such method that can accurately detect and quantify differences in parathyroid perfusion. In this study, twenty-one patients undergoing thyroidectomy or parathyroidectomy were recruited to compare LSCI and ICG fluorescence intraoperatively. An experimental imaging device was used to image a total of 37 parathyroid glands. Scores of 0, 1 or 2 were assigned for ICG fluorescence by three observers based on perceived intensity: 0 for little to no fluorescence, 1 for moderate or patchy fluorescence, and 2 for strong fluorescence. Speckle contrast values were grouped according to these scores. Analyses of variance were performed to detect significant differences between groups. Lastly, ICG fluorescence intensity was calculated for each parathyroid gland and compared with speckle contrast in a linear regression. Results showed significant differences in speckle contrast between groups such that parathyroids with ICG score 0 had higher speckle contrast than those assigned ICG score 1, which in turn had higher speckle contrast than those assigned ICG score 2. This was further supported by a correlation coefficient of -0.81 between mean-normalized ICG fluorescence intensity and speckle contrast. This suggests that ICG angiography and LSCI detect similar differences in blood flow to parathyroid glands. Laser speckle contrast imaging shows promise as a label-free alternative that overcomes current limitations of ICG angiography for parathyroid assessment.
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Affiliation(s)
- Emmanuel A Mannoh
- Vanderbilt Biophotonics Center, Vanderbilt University, PMB 351631, Nashville, TN, 37235, USA.
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.
| | - Naira Baregamian
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University, PMB 351631, Nashville, TN, 37235, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
| | - Carmen C Solόrzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Vanderbilt University, PMB 351631, Nashville, TN, 37235, USA.
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
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19
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DeHoog RJ, King ME, Keating MF, Zhang J, Sans M, Feider CL, Garza KY, Bensussan A, Krieger A, Lin JQ, Badal S, Alore E, Pirko C, Brahmbhatt K, Yu W, Grogan R, Eberlin LS, Suliburk J. Intraoperative Identification of Thyroid and Parathyroid Tissues During Human Endocrine Surgery Using the MasSpec Pen. JAMA Surg 2023; 158:1050-1059. [PMID: 37531134 PMCID: PMC10398548 DOI: 10.1001/jamasurg.2023.3229] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 08/03/2023]
Abstract
Importance Intraoperative identification of tissues through gross inspection during thyroid and parathyroid surgery is challenging yet essential for preserving healthy tissue and improving outcomes for patients. Objective To evaluate the performance and clinical applicability of the MasSpec Pen (MSPen) technology for discriminating thyroid, parathyroid, and lymph node tissues intraoperatively. Design, Setting, and Participants In this diagnostic/prognostic study, the MSPen was used to analyze 184 fresh-frozen thyroid, parathyroid, and lymph node tissues in the laboratory and translated to the operating room to enable in vivo and ex vivo tissue analysis by endocrine surgeons in 102 patients undergoing thyroidectomy and parathyroidectomy procedures. This diagnostic study was conducted between August 2017 and March 2020. Fresh-frozen tissues were analyzed in a laboratory. Clinical analyses occurred in an operating room at an academic medical center. Of the analyses performed on 184 fresh-frozen tissues, 131 were included based on sufficient signal and postanalysis pathologic diagnosis. From clinical tests, 102 patients undergoing surgery were included. A total of 1015 intraoperative analyses were performed, with 269 analyses subject to statistical classification. Statistical classifiers for discriminating thyroid, parathyroid, and lymph node tissues were generated using training sets comprising both laboratory and intraoperative data and evaluated on an independent test set of intraoperative data. Data were analyzed from July to December 2022. Main Outcomes and Measures Accuracy for each tissue type was measured for classification models discriminating thyroid, parathyroid, and lymph node tissues using MSPen data compared to gross analysis and final pathology results. Results Of the 102 patients in the intraoperative study, 80 were female (78%) and the median (IQR) age was 52 (42-66) years. For discriminating thyroid and parathyroid tissues, an overall accuracy, defined as agreement with pathology, of 92.4% (95% CI, 87.7-95.4) was achieved using MSPen data, with 82.6% (95% CI, 76.5-87.4) accuracy achieved for the independent test set. For distinguishing thyroid from lymph node and parathyroid from lymph node, overall training set accuracies of 97.5% (95% CI, 92.8-99.1) and 96.1% (95% CI, 91.2-98.3), respectively, were achieved. Conclusions and Relevance In this study, the MSPen showed high performance for discriminating thyroid, parathyroid, and lymph node tissues intraoperatively, suggesting this technology may be useful for providing near real-time feedback on tissue type to aid in surgical decision-making.
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Affiliation(s)
- Rachel J. DeHoog
- Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Mary E. King
- Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Chemistry, The University of Texas at Austin, Austin
| | | | - Jialing Zhang
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Marta Sans
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Clara L. Feider
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Kyana Y. Garza
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Alena Bensussan
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Anna Krieger
- Department of Chemistry, The University of Texas at Austin, Austin
| | - John Q. Lin
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Sunil Badal
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Elizabeth Alore
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | | | - Wendong Yu
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Raymon Grogan
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Livia S. Eberlin
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - James Suliburk
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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20
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Rawat A, Grover M, Kataria T, Samdhani S, Mathur S, Sharma B. Minimally Invasive Parathyroidectomy as the Surgical Management of Single Parathyroid Adenomas: A Tertiary Care Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:271-277. [PMID: 37275056 PMCID: PMC10234993 DOI: 10.1007/s12070-022-03236-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/11/2022] [Indexed: 06/07/2023] Open
Abstract
The aim of our study is to assess the feasibility, safety and adequacy of focused parathyroidectomy for single parathyroid adenoma accurately localized preoperatively by ultrasound neck and Tc99m sestamibi scan. The study was conducted in the department of Otorhinolaryngology of SMS Medical College and Hospital, Jaipur on 116 patients of primary hyperparathyroidism who underwent minimally invasive parathyroidectomy (MIP) for single gland adenoma localized by USG neck and tc99m sestamibi scans. S. Calcium and S. PTH followed up on day 1, 6th week and 6th month. Outcomes were determined on the basis of cure rate, duration of hospitalization, complication rates and disease persistence/recurrence rate. 82 (70.68%) females and 34 (29.31%) males belonging to the age group of 21-67 years (43.02 ± 14) formed the basis of our study. Skeletal (73.27%) and renal (62.93%) were the most common presentations. Accuracy of USG and sestamibi accurately was 93.10% and 96.55% respectively with combined accuracy of 100%. Preoperative serum calcium levels of 10.7-16.03 mg/dl (13.09 ± 2.11) and serum PTH 127-2196 pg/ml (846.57 ± 776.55) were observed. Cure rate of MIP was 99.13%. No permanent complications seen. MIP can be used as the surgical procedure of choice for PHPT caused by single gland adenoma aided by USG and sestamibi scan. The cure rates are equivalent to the bilateral neck exploration (> 95%) with minimal morbidity and complications. Hence, it is a more feasible, safe and effective treatment option.
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Affiliation(s)
- Anshu Rawat
- Department of Otorhinolaryngology and Head and Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Mohnish Grover
- Department of Otorhinolaryngology and Head and Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan 302004 India
- Jaipur, India
| | - Tanmaya Kataria
- Department of Otorhinolaryngology and Head and Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sunil Samdhani
- Department of Otorhinolaryngology and Head and Neck Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sandeep Mathur
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Balram Sharma
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan 302004 India
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21
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Paik W, Lee JC, Noh BJ, Na DG. US Features of the Parathyroid Glands: An Intraoperative Surgical Specimen Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:596-605. [PMID: 37324996 PMCID: PMC10265225 DOI: 10.3348/jksr.2022.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/11/2022] [Accepted: 10/08/2022] [Indexed: 06/17/2023]
Abstract
Purpose This study aimed to evaluate the US features of the parathyroid glands (PTGs) using surgical specimens of normal PTGs obtained during thyroid surgery. Materials and Methods This study included 34 normal PTGs from 17 consecutive patients who underwent thyroid surgery between December 2020 and March 2021. All normal PTGs were histologically confirmed by intraoperative frozen-section biopsy for autotransplantation. Surgically resected parathyroid specimens were scanned in sterile normal saline using high-resolution US prior to autotransplantation. The US features of echogenicity (hyperechogenicity or hypoechogenicity), echotexture (homogeneous or heterogeneous), size, and shape (ovoid or round) were retrospectively evaluated. The echogenicity of the three PTGs was compared with that of the thyroid parenchyma of the resected thyroid specimens in two patients. Results All PTGs showed hyperechogenicity similar to that of gauze soaked in normal saline. Homogeneous hyperechogenicity was observed in 32/34 (94.1%) patients, and the echogenicity of the three PTGs was hyperechoic compared with that of the thyroid parenchyma. The long diameter of the PTGs ranged from 5.1 mm to 9.8 mm (mean, 7.1 mm) and the shape of the PTGs was ovoid in 33/34 (97.1%) patients. Conclusion The echogenicity of normal PTG specimens was consistently hyperechoic, and the small ovoid homogeneously hyperechoic structure was a characteristic US feature of the PTGs.
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22
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Gulati S, Chumber S, Puri G, Spalkit S, Damle NA, Das CJ. Multi-modality parathyroid imaging: A shifting paradigm. World J Radiol 2023; 15:69-82. [PMID: 37035829 PMCID: PMC10080580 DOI: 10.4329/wjr.v15.i3.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/27/2023] Open
Abstract
The goal of parathyroid imaging in hyperparathyroidism is not diagnosis, rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach. Hence, the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration. The common causes include solitary parathyroid adenoma, multiple parathyroid adenomas, parathyroid hyperplasia and parathyroid carcinoma. It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging. The various imaging modalities available include high resolution ultrasound of the neck, nuclear imaging studies, four-dimensional computed tomography (4D CT) and magnetic resonance imaging. Contrast enhanced ultrasound is a novel technique which has been recently added to the armamentarium to differentiate between parathyroid adenomas and its mimics. Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.
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Affiliation(s)
- Shrea Gulati
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Gopal Puri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Stanzin Spalkit
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - N A Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - CJ Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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Localization Strategy Prior to Radiofrequency Ablation for Primary and Secondary Hyperparathyroidism. Biomedicines 2023; 11:biomedicines11030672. [PMID: 36979651 PMCID: PMC10045656 DOI: 10.3390/biomedicines11030672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Objective: Preoperative localization in patients with primary or secondary hyperparathyroidism before radiofrequency ablation (RFA) is crucial. There is currently a lack of consensus regarding imaging protocol. Evaluating the diagnostic performance of ultrasound, four-dimensional computed tomography (4D-CT), and technetium 99m-sestamibi single-photon-emission-computed tomography/computed tomography (SPECT/CT) is necessary for RFA of hyperparathyroidism. Methods: This retrospective study recruited patients with primary or secondary hyperparathyroidism who underwent ultrasound, 4D-CT, and SPECT/CT before RFA at a single institution. The sensitivity, accuracy, and receiver operating characteristic curve analysis were used to evaluate the diagnostic performance of the imaging modalities. Results: A total of 33 patients underwent RFA for hyperparathyroidism (8 patients with primary hyperparathyroidism, 25 patients with secondary hyperparathyroidism). Ultrasound had the highest sensitivity (0.953) and accuracy (0.943), while 4D-CT had higher sensitivity and accuracy than SPECT/CT (sensitivity/accuracy, 4D-CT vs. SPECT/CT: 0.929/0.920 vs. 0.741/0.716). Combined ultrasound with 4D-CT and the three combined modalities achieved equivalent, and the highest, diagnostic performance (sensitivity 1.000, accuracy 0.989). The lesion length and volume were important predictors of the diagnostic performance of 4D-CT and SPECT/CT (area under curve of length in 4D-CT/volume in 4D-CT/length in SPECT/volume in SPECT: 0.895/0.834/0.767/0.761). Conclusion: Combined ultrasound with 4D-CT provides optimal preoperative localization prior to RFA in patients with primary or secondary hyperparathyroidism. The length and volume of parathyroid lesions are determinative of the diagnostic performance of 4D-CT and SPECT/CT.
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Seyedinia SS, Mirshahvalad SA, Schweighofer-Zwink G, Hehenwarter L, Rendl G, Pirich C, Beheshti M. Evolving Role of [ 18F]Flurocholine PET/CT in Assessing Primary Hyperparathyroidism: Can It Be Considered the First-Line Functional Imaging Approach? J Clin Med 2023; 12:jcm12030812. [PMID: 36769460 PMCID: PMC9917644 DOI: 10.3390/jcm12030812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The accurate detection of hyperfunctioning parathyroid tissue (HFPT) is pivotal in the preoperative assessment of primary hyperparathyroidism (PHPT). PET/CT using [18F]fluorocholine ([18F]FCH) showed superior diagnostic performance compared to conventional functional imaging modalities. We aimed to evaluate the diagnostic performance of [18F]FCH PET/CT as a first-line functional imaging approach in patients with clinically diagnosed PHPT. The imaging and clinical data of 321 PHPT patients, including 271 overt PHPT and 50 mild PHPT, who underwent [18F]FCH PET/CT as first-line imaging were analysed in this retrospective study. Histopathology was the reference standard. In case of no available histopathology evaluation (conservative management), imaging and clinical follow-ups were considered reference standards. In the overt group (n = 271), [18F]FCH PET/CT showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 0.99, 0.91, 1.00, 0.80, and 0.99, respectively. Regarding the correlation of the index lesions and initial laboratory data, all [18F]FCH PET/CT parameters (SUVs, SULs, and mSAD) were significantly correlated with the serum iPTH level. Additionally, SUVmax, SULpeak, and mSAD were significantly associated with the serum calcium level. In the mild group (n = 50), [18F]FCH PET/CT showed a sensitivity, specificity, PPV, NPV, and accuracy of 0.93, 0.75, 0.95, 0.67, and 0.90. In conclusion, [18F]FCH PET/CT revealed high diagnostic performance in the detection of HFPTs and the potential to be considered as a first-line imaging modality in the assessment of PHPT, including both overt and mild types. However, its cost-benefit concerning the clinical impact of early PHPT detection should be investigated in future studies.
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Affiliation(s)
- Seyedeh Sara Seyedinia
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON M5G 2M2, Canada
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-(0)5-7255-26602
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Piccin O, D'Alessio P, Serra C, Felicani C, Vicennati V, Repaci A, Pagotto U, Cavicchi O. The Diagnostic Value of Contrast Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism: Comparison With Color Doppler Ultrasound: Comparison With Color Doppler Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:91-98. [PMID: 35357028 DOI: 10.1002/jum.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Preoperative localization of pathological parathyroid glands with imaging is essential for focused unilateral neck exploration and minimally invasive techniques. Recently published studies suggested that contrast-enhanced ultrasonography (CEUS) had high accuracy in the localization of hyperfunctioning parathyroid glands, with a general increase in the sensitivity as compared to conventional sonography. The purpose of this study was to determine the usefulness of CEUS in the localization of parathyroid lesions relating to surgical and histopathological data, in comparison to color Doppler ultrasound (CDUS), in the same series of patients. METHODS Records of 142 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings. RESULTS The overall sensitivity of CEUS was 77.6% compared with 74.6% for CDUS, although no significative differences were found (P = .516). Conversely, CDUS has shown higher sensitivity than CEUS in the group of patients with associated thyroid pathology but there was no statistical difference (P = .529). The sensitivity for detection of multiple adenomas was the same for both procedures. CONCLUSIONS We found no significative superior sensitivity of CEUS also in case of concomitant thyroid pathology and multiple glands disease.
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Affiliation(s)
- Ottavio Piccin
- Department of Otolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pasquale D'Alessio
- Department of Otolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carla Serra
- Department of Organ Insufficiency and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Felicani
- Department of Organ Insufficiency and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Vicennati
- Department of Endocrinology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Repaci
- Department of Endocrinology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Department of Endocrinology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ottavio Cavicchi
- Department of Otolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Ayadi C, Lanjery S, Andour H, Kamel F, Qandili HE, Papys M, Jroundi L, Laamrani FZ. Multiple brown tumors in primary hyperparathyroidism. Radiol Case Rep 2022; 17:4239-4243. [PMID: 36120515 PMCID: PMC9471336 DOI: 10.1016/j.radcr.2022.07.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
Brown tumors are benign bone tumors that rarely complicate hyperparathyroidism, manifesting as fibrous and erosive lesions secondary to rapid and localized osteoclast turnover. These lesions are typical of primary hyperparathyroidism, but they are not often observed. We present the case of a 72-year-old woman presenting with asthenia, bone pain, and hemiplegia. Biological analysis showed primary hyperparathyroidism, cervical ultrasound a right parathyroid adenoma that fixed on scintigraphy. When cross-sectional imaging was performed, it revealed multiple bone tumors of the axial and peripheral trunk with spinal cord compression which were diagnosed as brown tumors related to parathyroid adenoma. We illustrate through this case the importance of multidisciplinary imaging techniques before raising the diagnosis, especially in unusual pathologies such as brown tumors.
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Affiliation(s)
- Chirihan Ayadi
- Department of Radiology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
- Corresponding author.
| | - Safae Lanjery
- Department of Radiology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Hajar Andour
- Department of Radiology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Farah Kamel
- Department of Endocrinology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Hamza El Qandili
- Department of Endocrinology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Mendes Papys
- Department of Anatomopathology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Laila Jroundi
- Department of Radiology, CHU Ibn Sina, Mohamed V University, Rabat, Morocco
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Kawai Y, Iima M, Yamamoto H, Kawai M, Kishimoto AO, Koyasu S, Yamamoto A, Omori K, Kishimoto Y. The added value of non-contrast 3-Tesla MRI for the pre-operative localization of hyperparathyroidism. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S58-S64. [PMID: 34716111 DOI: 10.1016/j.bjorl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We investigated the efficacy of non-contrast 3-Tesla MR imaging added to the combination of sestamibi with99mTc (MIBI) scintigraphy and Ultrasonography (US) for the pre-operative localization of Primary Hyperparathyroidism (PHPT) lesions. METHODS A total of 34 parathyroid glands, including nine normal glands, were examined with MIBI, US, and non-contrast 3-Tesla MRI. MRI was performed with the acquisition of T1- and T2-weighted images and fat-suppressed T2-weighted images. We calculated the sensitivities of MIBI, US, and the 'additional' MRI, with knowledge of the former two modalities' results. RESULTS For the diagnosis of PHPT lesions, the sensitivity values of MIBI, US, and additional MRI were 88.0% (22/25), 84.0% (21/25), and 92.0% (23/25), respectively. Normal glands were not visualized with any modality (0/9). One lesion was detected neither with US nor MRI, but only with MIBI, with the limitation that MIBI represented no more than laterality. The two glands not identified in MRI were 4 mm and 6 mm in their size, which are within the range of normal gland's size. Two lesions were not detected with US or MIBI but were visualized with the additional MRI, which indicated that the MRI contributed an 8.0% (2/25) improvement of sensitivity, compared from that of US. Fat-suppressed T2-weighted images were useful in the identification of parathyroid lesions, as these images helped to differentiate between the lesion and the adjacent tissue. CONCLUSION Additional non-contrast 3-Tesla MRI was a useful adjunctive tool for localization of PHPT, which improved the sensitivity of the pre-operative localization of PHPT lesions. Fat-suppressed T2-weighted images contributed to their identification. LEVEL VI Evidence from a single descriptive or qualitative study.
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Affiliation(s)
- Yoshitaka Kawai
- Kyoto University, Graduate School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan
| | - Mami Iima
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan; Kyoto University Hospital, Institute for Advancement of Clinical and Translational Science (iACT), Department of Clinical Innovative Medicine, Kyoto, Japan
| | | | - Makiko Kawai
- Department of Radiology, Kyoto City Hospital, Kyoto, Japan
| | - Ayami Ohno Kishimoto
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan
| | - Sho Koyasu
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan
| | - Akira Yamamoto
- Kyoto University, Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan
| | - Koichi Omori
- Kyoto University, Graduate School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan
| | - Yo Kishimoto
- Kyoto University, Graduate School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan.
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Lerner A, Grant EG, Acharya J, Chambers TN, Maceri DR, Cen SY, Tchelepi H. Utility of Contrast-Enhanced Ultrasound and 4-Dimensional Computed Tomography for Preoperative Detection and Localization of Parathyroid Adenomas Compared With Surgical Results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2295-2306. [PMID: 34918364 DOI: 10.1002/jum.15916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the accuracy, sensitivity, and specificity of contrast-enhanced ultrasound (CEUS) for detection of parathyroid adenomas and compare it to those of 4-dimensional computed tomography (4DCT), which has been established as a reliable, effective tool for preoperative localization of parathyroid adenomas. METHODS About 27 patients with suspected parathyroid pathology underwent imaging evaluations with 4DCT and CEUS and 22 patients subsequently underwent surgical resection of parathyroid lesions. 4DCT and CEUS were performed and interpreted by consensus of two expert radiologists with extensive experience in each modality. Assessment for the side, z-axis (craniocaudal axis), and quadrant of the pathologically proven lesion was performed based on the surgical report. RESULTS For single-gland disease, the accuracy for CEUS localization to the correct quadrant and side were 81.0 and 90.1% respectively. For single-gland disease, the accuracy for 4DCT localization to the correct quadrant and side were 81.0 and 90.5% respectively. 4DCT localization sensitivity and specificity were comparable to those for CEUS. 4DCT allowed for accurate diagnosis in multigland disease in contradistinction to CEUS. CONCLUSIONS CEUS is a noninvasive, real-time imaging technique that has relatively high diagnostic confidence and accuracy of localization which are comparable to the accuracy of 4DCT for preoperative parathyroid adenoma detection, characterization, and localization. This technique should be considered for primary preoperative diagnosis, especially in younger patients.
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Affiliation(s)
- Alexander Lerner
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edward G Grant
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jay Acharya
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamara N Chambers
- Department of Otolaryngology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis R Maceri
- Department of Otolaryngology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven Yong Cen
- Department of Neurology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hisham Tchelepi
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Machado N, Wilhelm SM. Evolution of intra-operative parathyroid hormone and its application in parathyroid surgery. VITAMINS AND HORMONES 2022; 120:271-288. [PMID: 35953113 DOI: 10.1016/bs.vh.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The history and evolution of parathyroid hormone is a true testament to inter-disciplinary collaboration among anatomists, biochemists and surgeons. The parathyroid glands were the last endocrine glands to be discovered in the mid-1800s. Over the next century, progress in the evaluation of primary hyperparathyroidism, the identification of parathyroid hormone (PTH) and its application for use in the field of parathyroid surgery have led to a significant improvement in surgical cure rates, accompanied by a shift toward minimally invasive surgical options. This chapter provides a historical lens through which we can view these relatively recent advancements, as well as the current role of parathyroid hormone, both with regards to pre-operative localization and intra-operative detection of abnormal glands. Furthermore, we discuss the importance of parathyroid hormone in the management of complex multiglandular disease and reoperative cases, as well as the significance of persistently elevated PTH levels post-parathyroidectomy.
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Affiliation(s)
- Nikita Machado
- Department of General Surgery, University Hospitals Conneaut, OH, Clinical Assistant Professor of Surgery, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Scott M Wilhelm
- Department of General and Endocrine Surgery, University Hospitals Cleveland, OH, Professor of Surgery, Case Western Reserve School of Medicine, Cleveland, OH, United States.
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Staouni IB, Haloua M, Nizar B, Alami BE, Lamrani YA, Maâroufi M, Boubbou M. Primary hyperparathyroidism presenting as a brown tumor in the mandible: A case report. Radiol Case Rep 2022; 17:2283-2286. [PMID: 35574569 PMCID: PMC9092295 DOI: 10.1016/j.radcr.2022.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
A brown tumor is a non-neoplastic lesion resulting from an abnormality of bone metabolism in the context of hyperparathyroidism. We report the case of a 51-year-old woman who initially consulted for edentulism and a growing mandibular mass. She benefited from a radiological and biological assessment which made the diagnosis of primary hyperparathyroidism combined with a parathyroid adenoma. We remind through this observation the difficulty to establish a correct diagnosis in patients with an osteolytic process of the maxilla and the necessity to look for hyperparathyroidism in front of a giant cell lesion given the insidious character of this endocrinopathy.
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Affiliation(s)
- Imane Benabdallah Staouni
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Haloua
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Bouardi Nizar
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badr-Eddine Alami
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Youssef Alaoui Lamrani
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Maâroufi
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Boubbou
- Department of Radiology mother & child, CHU Hassan II FEZ Sidi Mohammed Ben Abdellah University, Fez, Morocco
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Minimally Invasive Parathyroidectomy: Can Intraoperative Parathyroid Hormone Monitoring be Omitted? World J Surg 2022; 46:1908-1914. [DOI: 10.1007/s00268-022-06537-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
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32
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Uremic leontiasis ossea: distinctive imaging features allow differentiation from other clinical causes of leontiasis ossea. Radiol Case Rep 2022; 17:553-557. [PMID: 34987683 PMCID: PMC8693403 DOI: 10.1016/j.radcr.2021.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022] Open
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Riley K, Anzai Y. Imaging of Treated Thyroid and Parathyroid Disease. Neuroimaging Clin N Am 2021; 32:145-157. [PMID: 34809835 DOI: 10.1016/j.nic.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The thyroid and parathyroid glands are endocrine structures located in the visceral space of the infrahyoid neck. Imaging plays a critical role in the evaluation of patients with thyroid cancer, both in the pre and posttreatment setting. Disorders of thyroid function, that is, hyperthyroidism and hypothyroidism, are also fairly common, although imaging utilization is less frequent with these conditions. Parathyroid dysfunction results in disordered calcium metabolism. Imaging is frequently applied in the preoperative assessment of these patients undergoing parathyroidectomy; however, routine imaging in the postoperative setting is uncommon. Parathyroid carcinoma is rare; however, imaging may be used in the pre and posttreatment setting.
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Affiliation(s)
- Kalen Riley
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202, USA.
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132, USA. https://twitter.com/@yoshimianzai
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Sankaran SJ, Davidson J. Diagnosis and localization of parathyroid adenomas using 16-slice SPECT/CT: A clinicopathological correlation. J Med Imaging Radiat Oncol 2021; 66:618-622. [PMID: 34545687 DOI: 10.1111/1754-9485.13330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed to evaluate a new 16-slice SPECT/CT scanner at Auckland City Hospital for its use in the detection and localization of parathyroid adenomas in patients with primary, secondary and tertiary hyperparathyroidism. The secondary outcome was to compare findings from SPECT/CT with ultrasound and operative findings. METHODS One hundred patients who underwent a SPECT/CT scan for primary/secondary/tertiary hyperparathyroidism were included in this study. Of these patients, 45 received surgery. SPECT/CT and ultrasound findings were collated for each patient, and of those who received surgery, operative and pathological findings were compared with those on SPECT/CT. RESULTS The sensitivity of diagnosis and localization was 86.5% (95% CI: 71.2-95.5%). Specificity was 25.0% (95% CI: 3.2-65.1%). Comparison between SPECT/CT and ultrasound findings demonstrated a kappa coefficient of 0.203 (95% CI: -0.036 to 0.442), correlating with fair agreement. These figures are in line with other published series. CONCLUSION The SPECT/CT scanner (and associated reporters) at Auckland City Hospital demonstrates high sensitivity in the detection and localization of parathyroid adenomas and is an effective first-line investigation in patients with primary/secondary/tertiary hyperparathyroidism.
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Affiliation(s)
- Sharanya J Sankaran
- Department of Nuclear Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Jennifer Davidson
- Department of Nuclear Medicine, Auckland District Health Board, Auckland, New Zealand.,Department of Oncology, University of Auckland, Auckland, New Zealand
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Mohamed W, El Ansari W, Al Hassan MS, Sibira RM, Abusabeib A. Water clear cell ectopic non-iatrogenic giant parathyroid adenoma in sternohyoid muscle with thyroid nodule and asymptomatic hypercalcemia due to primary hyperparathyroidism: Case report and literature review. Int J Surg Case Rep 2021; 86:106295. [PMID: 34450530 PMCID: PMC8397889 DOI: 10.1016/j.ijscr.2021.106295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/07/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Ectopic parathyroid gland is not uncommon, and is associated with primary hyperparathyroidism. Giant parathyroid adenoma (PA) and concurrent presence of enlarged thyroid nodule increases the probability of ectopic location. The combination of a giant PA that is ectopic (within the strap muscle) in the neck is very rare, especially in cases with no previous surgery. The rare histopathological findings of the current case, water clear cell parathyroid adenoma (WCCPA), could explain the patient's presentation, since it has low endocrine function. Case presentation A 56-year-old Qatari female on routine visit to primary health care physician for hypertension, was incidentally discovered to be hypercalcemic and was referred to the emergency department of our institution. Neck ultrasound showed a thyroid nodule on the left side, but 99mTc-sestamibi scintigraphy identified a left PA. FNAC of the thyroid nodule showed that it was a colloid nodule. She underwent left hemithyroidectomy and excision of left PA. Intraoperatively, the PA was giant and in the sternohyoid muscle. Intraoperative monitoring of intact PTH (IOiPTH) confirmed successful excision. Discussion Ectopic giant parathyroid adenoma is rare especially with the intramuscular location in sternohyoid muscle in the neck without previous neck surgeries. The presence of thyroid nodule could be a precipitating factor for migration of the PA. Preoperative assessment with the radiological image is crucial for diagnosis but sometimes fail to localized the PA. Conclusion Giant asymptomatic PA with long standing low function before hyperfunctioning should raise the suspicion of WCCPA. If diagnosis is confirmed, metastasis from a clear cell renal cell carcinoma should be ruled out.
We report a unique rare case of non-iatrogenic ectopic giant water clear cell parathyroid adenoma (WCCPA) A parathyroid adenoma >3.5 gm, asymptomatic and with low function before hyperfunctioning, should raise suspicion of WCCPA. History, examination, ultrasound, sesta-MIBI scintigraphy and immunohistochemical studies are important for diagnosis. High preoperative parathyroid hormone and calcium need monitoring in post-operative period to avoid hypocalcemia.
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Affiliation(s)
- Walla Mohamed
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| | - Mohamed S Al Hassan
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rayan M Sibira
- Department of Laboratory Medicine & Pathology, Hamad General Hospital, Doha, Qatar
| | - Abdelrahman Abusabeib
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Enlarged Parathyroid Glands on Trauma Computed Tomography: Frequency and Assessment for Possible Primary Hyperparathyroidism. J Comput Assist Tomogr 2021; 45:926-931. [PMID: 34407058 DOI: 10.1097/rct.0000000000001214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to determine the frequency of enlarged parathyroid glands among patients undergoing trauma computed tomography (CT) who fall within the typical primary hyperparathyroidism (PHPT) age range and to assess for evidence of PHPT. METHODS For this retrospective study of 336 emergency department patients, concurrent cervical spine CT and neck CT angiography (CTA) examinations were reviewed for visible parathyroid glands. When visible, estimated weight was calculated, and a PHPT likelihood category was assigned after medical record review. RESULTS At least 1 parathyroid gland was visible in 17 patients (5%) and enlarged (estimated weight > 60 mg) in 11 (3%). Patients classified as "highly likely" or "likely" of having PHPT exhibited larger glands (median, 355 mg) than those classified as "unlikely" or "highly unlikely" (median, 47 mg; P = 0.01). CONCLUSIONS Parathyroid glands were enlarged in 3% of our cohort. Although PHPT likelihood seems to increase with gland size, definitive determination requires both serum calcium and serum parathyroid hormone.
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Wei Y, Peng CZ, Wang SR, He JF, Peng LL, Zhao ZL, Cao XJ, Li Y, Yu MA. Effectiveness and Safety of Thermal Ablation in the Treatment of Primary Hyperparathyroidism: A Multicenter Study. J Clin Endocrinol Metab 2021; 106:2707-2717. [PMID: 33846740 PMCID: PMC8372654 DOI: 10.1210/clinem/dgab240] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Ultrasound (US)-guided thermal ablation has generated recent interest as minimally invasive treatments of primary hyperparathyroidism (pHPT). But definitive evidence for the efficacy of thermal ablation in treating pHPT is not well characterized. OBJECTIVE This work aims to evaluate the effectiveness and safety of thermal ablation for pHPT. METHODS From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1 months (interquartile range, 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed. RESULTS A total of 119 patients (mean age, 57.2 ± 16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ± 0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except for cases with pHPT nodules less than 0.6 cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA groups (MWA vs RFA, 90.6% vs 87.0%; χ 2 = 0.275, P = .699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). With the exception of one patient with persistent voice impairment, other symptoms spontaneously resolved within 6 months. CONCLUSION Thermal ablation is effective and safe for pHPT.
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Affiliation(s)
- Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Cheng-Zhong Peng
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Baotou 014000, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Yantai 264100, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
- Correspondence: Ming-an Yu, MD, Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan E St, Chao-yang district, Beijing 100029, China.
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Spierling A, Kikano EG, Chagarlamudi K, Vos D, Rao S, Smith DA, Ramaiya NH. Imaging features of hypercalcemia: A primer for emergency radiologists. Clin Imaging 2021; 80:215-224. [PMID: 34352494 DOI: 10.1016/j.clinimag.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Hypercalcemia is a marker for a wide variety of underlying etiologies, and its presentation in the emergency setting may be asymptomatic, incidental, or a primary complaint with associated symptoms and physical exam findings. While the workup is initially driven through serum laboratory testing, imaging plays an important role in diagnosis and post-treatment follow up. This review covers multiple common and uncommon etiologies of hypercalcemia, details their underlying mechanisms, and identifies the most important associated imaging findings. It is important for radiologists to be familiar with these etiologies and imaging findings, particularly in the emergency setting since hypercalcemia may represent the only significant laboratory abnormality associated with the presenting condition. Furthermore, the radiologist's interpretation of a study may be directly influenced by knowing about a patient's hypercalcemia.
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Affiliation(s)
- Angela Spierling
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Elias G Kikano
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kaushik Chagarlamudi
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Derek Vos
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Sanjay Rao
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Daniel A Smith
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Nikhil H Ramaiya
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
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Baser OO, Koseoglu D, Cetin Z, Catak M, Berker D. The Detection of Preoperative Parathyroid Lesions: The Success of Ultrasonography, Technetium-99m Methoxyisobutylisonitrile Parathyroid Scintigraphy and Spect-CT. Endocr Pract 2021; 27:1193-1198. [PMID: 34298158 DOI: 10.1016/j.eprac.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023]
Abstract
AIMS We aimed to find out and compare the efficacy of ultrasonography (US), technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy (MIBI-S) and single-photon emission computed tomography-computed tomography (SPECT-CT) in detecting the localization of parathyroid adenomas in patients with primary hyperparathyroidism. METHODS Preoperative parathyroid imaging with US, MIBI-S, and SPECT-CT were evaluated and compared with operative findings. 348 patients were included in the study. The results of the imaging methods were compared with the pathology and operation reports. RESULTS It was seen that in 318 (91.3%) of 348 patients, one of the imaging methods was able to localize the lesion correctly. US detected the localization of the parathyroid lesions correctly in 268 patients (77%), whereas SPECT and MIBI-S were correct in 254 (73%) and 209 (60%) patients, respectively. There was a statistically significant relationship between the PTH level and three imaging methods' success rates (p<0.05). The PTH cut-off value, which best determined the correct localization, was 152.5 pg/ml in the US, 143 pg/ml in the MIBI-S, and 143 pg/ml in the SPECT-CT. It was observed that the correct localization rate for parathyroid lesions increased with higher PTH levels. CONCLUSION In our study population, US was more successful than other imaging methods in localizing parathyroid lesions in most cases, but SPECT-CT was more successful in localizing mediastinal lesions accurately. It was also detecte that preoperative PTH levels affect the accuracy of imaging methods.
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Affiliation(s)
- Ozden Ozdemir Baser
- Yozgat City Hospital, Department of Endocrinology and Metabolism, Yozgat, Turkey.
| | - Derya Koseoglu
- Erol Olcok Education and Research Hospital, Department of Endocrinology and Metabolism, Corum, Turkey
| | - Zeynep Cetin
- Amasya University Sabuncuoglu Serefeddin Education and Research Hospital, Department of Endocrinology and Metabolism, Amasya, Turkey
| | - Merve Catak
- Tokat Public Hospital, Department of Endocrinology and Metabolism, Tokat, Turkey
| | - Dilek Berker
- University of Medical Sciences Ankara City Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
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Pediatric hyperparathyroidism: review and imaging update. Pediatr Radiol 2021; 51:1106-1120. [PMID: 33904951 DOI: 10.1007/s00247-021-05050-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Hyperparathyroidism, due to increased secretion of parathyroid hormones, may be primary, secondary or tertiary. Most pediatric patients with sporadic primary hyperparathyroidism will be symptomatic, presenting with either end-organ damage or nonspecific symptoms. In younger patients with primary hyperparathyroidism, there is a higher prevalence of familial hyperparathyroidism including germline inactivating mutations of the calcium-sensing receptor genes that result in either neonatal severe hyperparathyroidism or familial hypocalciuric hypercalcemia. Parathyroid scintigraphy and ultrasound are complementary, first-line imaging modalities for localizing hyperfunctioning parathyroid glands. Second-line imaging modalities are multiphase computed tomography (CT) and magnetic resonance imaging. In pediatrics, multiphase CT protocols should be adjusted to optimize radiation dose. Although, the role of these imaging modalities is better established in preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism, the same principles apply in secondary and tertiary hyperparathyroidism. In this manuscript, we will review the embryology, anatomy, pathophysiology and preoperative localization of parathyroid glands as well as several subtypes of primary familial hyperparathyroidism. While most of the recent imaging literature centers on adults, we will focus on the issues that are pertinent and applicable to pediatrics.
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Abstract
OBJECTIVE. The purpose of this article is to review the clinical manifestations, endocrine tumors types, and multimodality diagnostic tools available to physicians involved in the management of patients with multiple endocrine neoplasia (MEN) syndrome, in addition to discussing relevant imaging findings and appropriate imaging follow-up. CONCLUSION. Thorough knowledge of the spectrum of tumors associated with MEN gene mutations aids in the screening, diagnostic workup, and posttreatment monitoring of patients with MEN-related gene mutations.
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Guneylı S, Aygun MS, Taskın OC, Sagtas E, Colakoglu B. Intrathyroidal Ectopic Thymus and Sonoelastographic Findings. Curr Med Imaging 2021; 17:1209-1215. [PMID: 33781193 DOI: 10.2174/1573405617666210329095227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intrathyroidal ectopic thymus (IET) can be misdiagnosed as thyroid nodules. PURPOSE To evaluate the sonoelastographic findings of IET in pediatric population. METHODS Twelve children who had been examined with ultrasound (US) and strain elastography between December 2012 and December 2019 were included in this retrospective study. The patients' demographics and ultrasonographic findings including the location, margin, shape, diameters, volume, structure, vascularity, and elastography values of the lesions were evaluated. RESULTS Twelve lesions were detected in 12 asymptomatic patients (3 females and 9 males) with a mean age of 4.67 ± 2.27 years. The most common location of the IET was in posterior part and middle third of thyroid, and the most common appearance on US was a well-defined, ovoid-shaped, and predominantly hypoechoic solid lesion with punctate/linear branching hyperechogenities. The lesions were mostly hypovascular on Doppler US. The mean strain ratio on elastography was found to be 1.10 ± 0.04. In the follow-up of 7 patients with available information, there was not any significant change in size or appearance of IET on US. CONCLUSION IET should be considered in the differential diagnosis of the lesions within the thyroid. The first step to accurately diagnose an IET is to consider it in the differential diagnosis. In addition to US, strain elastography findings can be used to distinguish IETs from papillary thyroid cancers which can have similar US appearance, and help avoid unnecessary biopsies.
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Affiliation(s)
- Serkan Guneylı
- Department of Radiology, Koc University School of Medicine, Istanbul. Turkey
| | - Murat Serhat Aygun
- Department of Radiology, Koc University School of Medicine, Istanbul. Turkey
| | - Orhun Cig Taskın
- Department of Pathology, Koc University School of Medicine, Istanbul. Turkey
| | - Ergin Sagtas
- Department of Radiology, Pamukkale University School of Medicine, Denizli. Turkey
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Murugan N, Kandasamy D, Sharma R, Goyal A, Gupta AK, Tandon N, Gupta N, Goswami R, Vurthaluru S, Damle N, Agrawal S. Comparison of 4DMRI and 4DCT for the preoperative evaluation of patients with primary hyperparathyroidism. Eur J Radiol 2021; 138:109625. [PMID: 33714845 DOI: 10.1016/j.ejrad.2021.109625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/23/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Minimally invasive parathyroid surgery is the standard of care in patients with Primary Hyperparathyroidism (PHPT) which requires accurate preoperative localization. Of all the available imaging modalities, 4DCT is considered the best modality for localization, however it entails the risk of ionizing radiation. To circumvent this 4DMRI was evaluated for parathyroid lesion localization. PURPOSE To evaluate and compare the accuracy of 4DCT and 4DMRI in the localization of parathyroid Lesions. MATERIALS AND METHODS In this ethically approved observational diagnostic study, 135 patients (age range: 10-75 years, male: female ratio - 1:2.1) with clinically and biochemically suspected PHPT were recruited. Of these, 56 patients underwent both 4DCT and 4DMRI. Six patients with positive imaging who didn't undergo surgery were excluded. A total of 50 patients with 61 proven parathyroid lesions were included for analysis. 48 patients had surgical and histopathological findings for the confirmation of imaging findings. RESULTS Both 4DCT and 4DMRI correctly detected 59/61 lesions in 48 patients. There was one false positive and two true negatives. In addition, 2 (3.22 %) lesions which were not detected by 4DCT and 4DMRI were found on surgery. The sensitivity of both 4DCT and 4DMRI was 96.7 %; specificity was 66.6 % and accuracy was 95.2 %. CONCLUSION 4DMRI and 4DCT had similar accuracy for the detection of parathyroid lesions. However, 4DMRI has the advantage of lack of exposure to ionizing radiation, which can be beneficial in younger patients.
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Affiliation(s)
- Narasimman Murugan
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Devasenathipathy Kandasamy
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Raju Sharma
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ankur Goyal
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Arun Kumar Gupta
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nandita Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ravinder Goswami
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Seenu Vurthaluru
- Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Shipra Agrawal
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Ying W, Zhen-Long Z, Xiao-Jing C, Li-Li P, Yan L, Ming-An Y. A study on the causes of operative failures after microwave ablation for primary hyperparathyroidism. Eur Radiol 2021; 31:6522-6530. [PMID: 33651201 PMCID: PMC8379100 DOI: 10.1007/s00330-021-07761-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
Objective To summarize the occurrence of operative failures after microwave ablation (MWA) in patients with primary hyperparathyroidism (pHPT), analyze the possible reasons, and explore strategies for preventing and managing these situations. Methods This retrospective study reviewed 91 pHPT patients who underwent MWA from April 2015 to November 2019. A cure was defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months. An operative failure was defined as a failure to normalize serum intact parathyroid hormone (iPTH) and/or calcium levels at 6 months or longer. Patients who encountered operative failures were compared with patients who were successfully cured. Results Eighty-eight pHPT patients, consisting of 29 men and 59 women, were finally enrolled. The median follow-up duration was 15.9 months (IQR, 6.1–31.5 months). Seventy-eight patients (78/88, 88.6%) were cured. Ten (10/88, 11.4%) patients experienced operative failure, including 9 persistent pHPT (10.2%) and 1 (1.1%) recurrent pHPT. Small parathyroid nodules (maximum diameter < 0.6 cm) and incomplete ablation were the two key factors leading to operative failure. Of the 9 patients with a maximum nodule diameter less than 0.6 cm, 77.8% (7/9) of them encountered operative failure. Conclusion Operative failure occurred in 11.4% of the pHPT patients who underwent MWA. The possibility of operative failure was increased when the maximum diameter of parathyroid nodule was less than 0.6 cm. Complete ablation could help avoid operative failure. Key Points • Failed to ablate the target lesion and incomplete ablation were the key factors attributed to operative failures. • When the maximum diameter of the parathyroid nodules is less than 0.6 cm, the possibility of operative failure was higher.
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Affiliation(s)
- Wei Ying
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Zhao Zhen-Long
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Cao Xiao-Jing
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Peng Li-Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Li Yan
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Yu Ming-An
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China.
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Piccin O, D'Alessio P, Cioccoloni E, Burgio L, Poggi C, Altieri P, Vicennati V, Repaci A, Pagotto U, Cavicchi O. Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience. Am J Otolaryngol 2021; 42:102819. [PMID: 33157312 DOI: 10.1016/j.amjoto.2020.102819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Preoperative imaging in patients with primary hyperparathyroidism provides important localization information, allowing the surgeon to perform a focused surgery. However there are no evidence-based guidelines suggesting which preoperative imaging should be used, resulting in a risk of excessive prescription of exams and waste of economic resources. The main purpose of this study was to describe our experience on the performance of various imaging techniques for the preoperative localization of abnormal parathyroid gland/s, with a focus on the sensitivity and specificity of each technique. Secondly, we carried out an analysis of the cost utility of each technique in order to determine the most clinical and cost-effective combination of localization studies. MATERIALS AND METHODS Records of 336 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings to evaluate the accuracy in parathyroid detection of each imaging technique. Costs were determined by regional health system reimbursement. RESULTS We found that the sensitivity of color Doppler US was significantly higher than SPECT (p 0,023), while the sensitivity of 4D-CT was significantly better than US (p 0,029) and SPECT (p 0,0002). CONCLUSIONS In experienced hands color Doppler US is a highly sensitive technique especially in patients with no thyroid diseases. In patients with concomitant thyroid pathology, the combination of US and 4D-CT represents a reliable localization technique.
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Affiliation(s)
- Ottavio Piccin
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy.
| | - Pasquale D'Alessio
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Eleonora Cioccoloni
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Luca Burgio
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Cristina Poggi
- Department of Radiology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Paola Altieri
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Valentina Vicennati
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Ottavio Cavicchi
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
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Ectopic parathyroid adenoma adherent to vagus nerve at internal carotid artery. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Evangelista L, Ravelli I, Magnani F, Iacobone M, Giraudo C, Camozzi V, Spimpolo A, Cecchin D. 18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature. Ann Nucl Med 2020; 34:601-619. [PMID: 32767248 PMCID: PMC7438295 DOI: 10.1007/s12149-020-01507-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022]
Abstract
The aims of the present systematic review were to: (1) assess the role of 18F-fluorocholine (FCH) positron emission tomography (PET) with computed tomography (CT) and PET with magnetic resonance imaging (MRI) in patients with biochemically known hyperparathyroidism; (2) compare the diagnostic performance of FCH PET/CT or PET/MRI with conventional morphological and functional imaging. A literature search until December 2019 was performed in the PubMed, Scopus and Web of Science databases, using the terms “choline” AND “PET” AND “hyperparathyroidism”. The search was conducted with and without the addition of filters (e.g., language: English only; type of article: original article; subjects: humans only) and selecting only articles published in the last 5 years. Twenty-three articles and 1112 patients were considered. Different FCH PET/CT acquisition protocols were adopted across the studies, using dynamic, early or delayed scans. FCH PET/CT proved more accurate than ultrasonography (US) or 99mTc-sestamibi single-photon emission tomography (SPET). PET/MRI also seemed to be more accurate than MRI alone in detecting benign parathyroid lesions. FCH PET/CT is more accurate than conventional morphological and functional imaging modalities (US or SPET) for the detection of benign parathyroid lesions. It could, therefore, be a reliable tool in both primary and recurrent hyperparathyroidism.
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Affiliation(s)
- Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Ilaria Ravelli
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Fabio Magnani
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Maurizio Iacobone
- Surgery Unit, Department of Surgery, University of Padova, Padua, Italy
| | - Chiara Giraudo
- Radiology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Valentina Camozzi
- Endocrine Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Alessandro Spimpolo
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,Surgery Unit, Department of Surgery, University of Padova, Padua, Italy.,Radiology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy.,Endocrine Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy.,International PhD Program in Arterial Hypertension and Vascular Biology (ARHYVAB), Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Bononi M, Viviana F, De Feo MS, Sollaku S, Pani A, Falconi R, Pani R, Cavallaro G, Brozzetti S, De Vincentis G. Gonioprobe, an Innovative Gamma-probe to Guide Parathyroid Radioguided Surgery: First Clinical Experiences with Navigator and Lock-ontarget Functions. Curr Radiopharm 2020; 14:161-169. [PMID: 32693772 DOI: 10.2174/1874471013666200721013903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radioguided surgery represents a validated technique for the detection and the excision of abnormal parathyroid glands responsible for primary hyperparathyroidism (PHPT). To date little attention has been paid as to how the characteristics of gamma-probes can influence surgical procedure and time, thus having an impact on postoperative morbidity, hospitalization and costs. METHODS We designed a new prototype of gamma-probe, the Gonioprobe, and tested its clinical utility in the operating room. Gonioprobe, thanks to its 5 scintillating independent crystals, performs the dual function of Navigator and Lock-on-target. These characteristics allow the immediate guidance of the surgeon's hand towards the source with very high precision, and with a much higher spatial resolution than commercial probes. Gonioprobe was used during intervention to detect abnormal parathyroid tissue, and to ensure no radioactivity in surgery bed after adenoma removal. RESULTS We tested our gamma-probe on parathyroid adenomas particularly difficult to identify at a visual inspection due to anatomy modifications from previous neck surgery and/or characterized by uncommon localization. Moreover, parathyroid adenomas were hardly removable due to the proximity to the esophagus, neck vessels and/or recurrent laryngeal nerve (RLN). An intraoperative nerve monitoring system was used to protect the recurrent laryngeal nerve from injuries. Parathyroid hormone (PTH) assay and frozen biopsy confirmed the successful excision of the adenomas. CONCLUSION The intraoperative use of the innovative Gonioprobe along with the nerve monitoring system allowed an accurate and safe removal of parathyroid adenomas and offered a significant advantage by reducing surgical time and postoperative complications, as well as hospitalization and costs.
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Affiliation(s)
- Marco Bononi
- Department of General and Plastic Surgery "Pietro Valdoni", "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Frantellizzi Viviana
- Department of Molecular Medicine, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
| | - Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
| | - Saadi Sollaku
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
| | - Arianna Pani
- Department of oncology and hemato- oncology, University of Milan "Statale", Italy
| | - Rita Falconi
- Specialty School in Medical Physics, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Roberto Pani
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cavallaro
- Department of General and Plastic Surgery "Pietro Valdoni", "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Stefania Brozzetti
- Department of General and Plastic Surgery "Pietro Valdoni", "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
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Suh HY, Na HY, Park SY, Choi JY, So Y, Lee WW. The Usefulness of Maximum Standardized Uptake Value at the Delayed Phase of Tc-99m sestamibi single-photon emission computed tomography/computed tomography for Identification of Parathyroid Adenoma and Hyperplasia. Medicine (Baltimore) 2020; 99:e21176. [PMID: 32664158 PMCID: PMC7360288 DOI: 10.1097/md.0000000000021176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tc-99m sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has been used to help surgeons explore the location of parathyroid diseases, but quantitative parameters have not been systemically investigated for this purpose. We aimed to establish objective criteria for adenoma and hyperplasia using the standardized uptake value (SUV) in patients with hyperparathyroidism.Thirty-nine hyperparathyroid patients (male/female: 17/22, age: 58.33 ± 11.69 years) with at least 1 uptake-positive lesion of any degree by visual assessment in preoperative Tc-99m sestamibi quantitative SPECT/CT were included from Oct 2015 to Oct 2017. Pathologically, 44 lesions (32 adenomas and 12 hyperplasia) were identified. All patients experienced normalized levels of intact parathyroid hormone immediately after surgery. Quantitative SPECT/CT was performed at 10 minute and 2 hour post injection of Tc-99m sestabmibi (dose = 740 MBq), and maximum SUV (SUVmax) was measured for the parathyroid lesions. Experienced pathologists evaluated the percentage cellular proportions of chief cells, oxyphil cells, and clear cells.SUVmax (g/mL) of adenomas, hyperplasia, and reference thyroid tissue were 12.92 ± 6.68, 7.90 ± 5.49, and 7.01 ± 2.62 at 10min (early phase), decreasing to 7.46 ± 5.66, 4.65 ± 3.14, and 2.21 ± 1.07 at 2 hour (delayed phase), respectively. The adenomas showed significantly higher SUVmax than both the hyperplasia (P = .0131) and reference thyroid tissue (P < .0001) along the early and delayed phases, but the SUVmax of the hyperplasia did not differ from that of the reference thyroid tissue (P = .4196). The adenomas and hyperplasia were discriminated from the reference thyroid tissue using a cutoff SUVmax of 3.26 at the delayed phase. The adenomas had lower %proportions of oxyphil cells than the hyperplasia (P = .0054), but its SUVmax at the delayed phase was positively correlated with the %proportions of mitochondria-abundant oxyphil cells (rho = 0.418, P = .0173). The hyperplasia showed no correlation between SUVmax and cellular proportions.SUVmax at the delayed phase in the Tc-99m sestamibi quantitative SPECT/CT was useful for the identification and differentiation of parathyroid lesions causing hyperparathyroidism.
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Affiliation(s)
- Hoon Young Suh
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University
| | | | | | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Young So
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Macfarland S, Mostoufi-Moab S. Genetic syndromes associated with endocrine tumors in children. Semin Pediatr Surg 2020; 29:150919. [PMID: 32571504 DOI: 10.1016/j.sempedsurg.2020.150919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Suzanne Macfarland
- Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Sogol Mostoufi-Moab
- Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States; Division of Endocrinology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States.
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