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Journal of Nuclear Medicine : Official... Sep 2003Clinical or subclinical hyperparathyroidism is one of the most common endocrine disorders. Excessive secretion of parathyroid hormone is most frequently caused by an... (Review)
Review
Clinical or subclinical hyperparathyroidism is one of the most common endocrine disorders. Excessive secretion of parathyroid hormone is most frequently caused by an adenoma of >or=1 parathyroid gland. Unsuccessful surgery with persistent hyperparathyroidism, due to inadequate preoperative or intraoperative localization, may be observed in about 10% of patients. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy (MIP) has been made possible by the introduction of (99m)Tc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. In MIP, the incision is small, dissection is minimal, postoperative pain is less, and hospital stay is shorter. Localization imaging techniques include ultrasonography, CT, MRI, and scintigraphy. Parathyroid scintigraphy with (99m)Tc-sestamibi is based on longer retention of the tracer in parathyroid than in thyroid tissue. Because of the frequent association of parathyroid adenomas with nodular goiter, the optimal imaging combination is (99m)Tc-sestamibi scintigraphy and ultrasonography. Different protocols are used for (99m)Tc-sestamibi parathyroid scintigraphy, depending on the institutional logistics and experience (classical dual-phase scintigraphy, various subtraction techniques in combination with radioiodine or (99m)Tc-pertechnetate). MIP is greatly aided by intraoperative guidance with a gamma-probe, based on in vivo radioactivity counting after injection of (99m)Tc-sestamibi. Different protocols used for gamma-probe-guided MIP are based on different timing and doses of tracer injected. Gamma-probe-guided MIP is a very attractive surgical approach to treat patients with primary hyperparathyroidism due to a solitary parathyroid adenoma. The procedure is technically easy, safe, with a low morbidity rate, and has better cosmetic results and lower overall cost than conventional bilateral neck exploration. Specific guidelines should be followed when selecting patients for gamma-probe-guided MIP.
Topics: Humans; Hyperparathyroidism; Intraoperative Care; Minimally Invasive Surgical Procedures; Parathyroid Glands; Parathyroidectomy; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Surgery, Computer-Assisted; Technetium Tc 99m Sestamibi
PubMed: 12960191
DOI: No ID Found -
European Annals of Otorhinolaryngology,... Nov 2020Minimally invasive surgery has become the standard surgical attitude in primary hyperparathyroidism. It requires precise preoperative lesion localization. The aim of the...
INTRODUCTION
Minimally invasive surgery has become the standard surgical attitude in primary hyperparathyroidism. It requires precise preoperative lesion localization. The aim of the present study was to evaluate the performance of ultrasonography and 99mTc-sestamibi scintigraphy in minimally invasive surgery for primary hyperparathyroidism.
MATERIALS AND METHODS
A retrospective study included all patients managed surgically for primary hyperparathyroidism between January 2008 and November 2017 in the University Hospital of Brest (France). Two hundred and seventy-three patients underwent ultrasonography and 99mTc-sestamibi scintigraphy. Results determined intrinsic (sensitivity and specificity) and extrinsic (positive and negative predictive values) performance on per-patient and per-gland analysis. Demographic, preoperative, interventional and cure data were compared according to ultrasonography and scintigraphy results, distinguishing 3 patient groups: concordant n=156, discordant n=99, negative n=18.
RESULTS
On per-gland analysis, sensitivity was 70% for ultrasound, 74% for 99mTc-sestamibi scintigraphy and 81% for associated ultrasound-scintigraphy; positive predictive values were 89%, 91% and 96%, respectively. Gland volume and concomitant thyroid pathology rates differed significantly (both p=0.003) between the 3 imaging results groups.
CONCLUSION
The performance of associated ultrasound-99mTc-sestamibi-scintigraphy provided a positive predictive value of 96%. Combining the two techniques reduced surgical morbidity.
Topics: Humans; Hyperparathyroidism, Primary; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Ultrasonography
PubMed: 32446647
DOI: 10.1016/j.anorl.2020.03.009 -
The Western Journal of Medicine Aug 1994The generally accepted indications for stress testing in patients with coronary artery disease include confirming the diagnosis of angina, determining the limitation of... (Review)
Review
The generally accepted indications for stress testing in patients with coronary artery disease include confirming the diagnosis of angina, determining the limitation of activity caused by angina, assessing prognosis in patients with known coronary artery disease, assessing perioperative risk, and evaluating responses to therapy. In patients with a clinical scenario strongly suggestive of angina, testing is not necessary to diagnose coronary artery disease. The exercise treadmill-electrocardiogram test is the oldest and most extensively used stress test and can be reliably performed in patients who are clinically stable and who have an interpretable resting electrocardiogram. The addition of myocardial imaging agents such as thallium 201, technetium Tc 99m sestamibi, and technetium Tc 99m teboroxime increases the sensitivity and specificity for detecting coronary disease. Pharmacologic agents such as dipyridamole, adenosine, and dobutamine may be used in patients who cannot exercise adequately. Myocardial ischemia can also be evaluated by echocardiography, computed tomography, or magnetic resonance imaging, especially when additional information such as left ventricular and valvular function is desired. We review the indications for the noninvasive evaluation of coronary artery disease and the rationale for selecting a diagnostic test.
Topics: Adenosine; Coronary Disease; Dipyridamole; Dobutamine; Echocardiography; Electrocardiography; Exercise Test; Humans; Organotechnetium Compounds; Oximes; Radionuclide Ventriculography; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed
PubMed: 7941543
DOI: No ID Found -
Journal of Nuclear Medicine : Official... Jun 1997
Topics: Adenoma; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon
PubMed: 9189126
DOI: No ID Found -
Clinical Medicine (London, England) 2006
Review
Topics: Coronary Artery Disease; Gated Blood-Pool Imaging; Heart; Heart Diseases; Humans; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Perfusion; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Thallium Radioisotopes
PubMed: 16826859
DOI: 10.7861/clinmedicine.6-3-263 -
Tomography (Ann Arbor, Mich.) Jan 2023This study aims to establish a local diagnostic reference level (LDRL) for single-photon emission tomography/computed tomography (SPECT/CT) and positron emission...
OBJECTIVE
This study aims to establish a local diagnostic reference level (LDRL) for single-photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/CT (PET/CT) with respect to myocardial perfusion imaging (MPI).
MATERIALS AND METHODS
The acquisition protocol and dosimetry data on the MPI procedures of five SPECT/CT scans and one PET/CT scan were collected. Data on technitum-99m sestamibi (Tc-sestamibi), Tc-tetrofosmin, thallium-201 (Tl), and rubidium-82 (RB) were all collected from one centre via questionnaire booklets. Descriptive data analysis was used to analyse all variables, and the 50th percentile was used to analyse each radiation dose quantity.
RESULTS
The reported 50th percentile dose for a one-day stress/rest protocol using Tc-sestamibi (445/1147 MBq) and Tc-tetrofosmin (445/1147 MBq) and for a two-day stress/rest protocol using Tc-sestamibi (1165/1184 MBq) and Tc-tetrofosmin (1221/1184 MBq) are in good agreement with reported national diagnostic reference levels (NDRLs). However, the dose from the study data on a one-day stress/rest protocol using Tc-sestamibi was more than the 50th percentile dose from the Brazilian data (370/1110 MBq) on a similar protocol, and the dose from the study data on a two-day stress/rest protocol using Tc-tetrofosmin was more than the 50th percentile dose (1084/1110 MBq) from the United States data on MPI scans. Regarding the computed tomography (CT) portion of the SPECT/CT framework, the 50th percentile doses were lower than all the identified doses in the data considered in the literature reviewed. However, regarding the CT component of the PET/CT MPI scans, the RB dose was more than the recorded doses in the CT data in the published literature.
CONCLUSION
This study determined the LDRL of five SPECT/CT protocols and one PET/CT MPI protocol. The results suggest that there may be opportunities to optimise the patient radiation burden from administered activities in patients undergoing SPECT examinations and the CT components associated with RB PET/CT scans without compromising diagnostic image quality.
Topics: Humans; United States; Positron Emission Tomography Computed Tomography; Organotechnetium Compounds; Technetium Tc 99m Sestamibi; Radiation Dosage; Perfusion
PubMed: 36828373
DOI: 10.3390/tomography9010021 -
Annals of the Royal College of Surgeons... Feb 2019Minimally invasive parathyroidectomy has advantages over the traditional bilateral neck exploration for the surgical treatment of primary hyperparathyroidism. It... (Observational Study)
Observational Study
INTRODUCTION
Minimally invasive parathyroidectomy has advantages over the traditional bilateral neck exploration for the surgical treatment of primary hyperparathyroidism. It requires accurate localisation of the parathyroid pathology prior to surgery. The best method of preoperative localisation in a district general hospital setting is not well understood.
METHODS
All patients who underwent parathyroidectomy for primary hyperparathyroidism from 2008 to 2016 were identified from a prospectively maintained database. Operative findings were correlated with radiological and histological results. Sensitivity and specificity of ultrasound, sestamibi scintigraphy and the two together were calculated for diagnostic precision and compared.
RESULTS
One hundred and eighty-four patients met the inclusion criteria, of whom 81.5% had a histological diagnosis of a parathyroid adenoma. Ultrasound had higher sensitivity than sestamibi scintigraphy. Used together, ultrasound and sestamibi scintigraphy performed better than either ultrasound or sestamibi scintigraphy alone (P< 0.001). Twenty-two of 184 cases had no lesion located by either ultrasound or sestamibi scintigraphy preoperatively. Where neither ultrasound nor sestamibi scintigraphy located the lesion, additional computed tomography led to the excision of parathyroid pathology in one in ten patients.
CONCLUSION
The combination of ultrasound and sestamibi scintigraphy provides the highest sensitivity of preoperative localisation. This approach led to a high success rate of minimally invasive parathyroidectomy. Where preoperative localisation is not achieved with ultrasound or sestamibi scintigraphy, computed tomography adds little additional benefit. In this setting other modalities of localisation such a selective venous sampling, intraoperative methylene blue or intraoperative parathyroid hormone levels could be considered.
Topics: Aged; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroidectomy; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Ultrasonography
PubMed: 30286659
DOI: 10.1308/rcsann.2018.0158 -
Journal of Nuclear Medicine : Official... Jul 2022Preoperative localization of pathologic parathyroids is crucial for minimally invasive treatment of primary hyperparathyroidism (PHPT). This study compared...
Preoperative localization of pathologic parathyroids is crucial for minimally invasive treatment of primary hyperparathyroidism (PHPT). This study compared contrast-enhanced F-fluorocholine PET/CT, cervical ultrasonography (CU), and conventional scintigraphic imaging modalities (MIBI scintigraphy, consisting of Tc-sestamibi/I-sodium iodide SPECT/CT, Tc-sestamibi/I-sodium iodide planar subtraction imaging, and Tc-sestamibi planar dual-phase imaging), combined and individually, for preoperative localization of hyperfunctional parathyroids in PHPT. The gold standard was histologic examination. Data from consecutive patients with clinically suspected PHPT were retrospectively collected. All 3 imaging modalities were systematically performed. The ability of F-fluorocholine PET/CT, CU, and MIBI scintigraphy to identify a hyperfunctional parathyroid and specify the side or identify an ectopic location was noted. Patients underwent surgical exploration if at least 1 examination was positive. The findings of CU + MIBI scintigraphy combined were considered positive if CU and MIBI scintigraphy separately showed a hyperfunctional parathyroid gland on the same side or in the same ectopic location; any findings other than these were considered negative. The composite judgment criterion for pathologic parathyroid was a combination of histologic analysis and normalization of parathyroid hormone and calcium levels. In total, 149 pathologic parathyroids were found in 143 of the 144 included patients. F-fluorocholine PET/CT diagnosed 148 of 149 pathologic parathyroids. Only 4 false-positives and 1 false-negative were found. The F-fluorocholine PET/CT sensitivity of 99.3% was superior to that of CU, at 75.2% ( < 0.0001); MIBI scintigraphy, at 65.1% ( < 0.0001); and CU + MIBI scintigraphy, at 89.9%, ( = 0.0009). Five of the 5 ectopic locations were diagnosed by F-fluorocholine PET/CT, 2 of the 5 by MIBI scintigraphy, and none by CU. Accuracy was better for F-fluorocholine PET/CT, at 98%, than for CU, at 84% ( < 0.0001); MIBI scintigraphy, at 81% ( < 0.0001); or CU + MIBI scintigraphy, at 91% ( < 0.0001). Among the 72 (50%) patients who had a negative CU + MIBI scintigraphy result, F-fluorocholine PET/CT correctly identified hyperfunctional thyroids in 70 (97.2%). Average uptake in the F-fluorocholine PET/CT hyperfunctional parathyroid was higher than that in the adjacent thyroid (SUV adjusted for lean body mass, 6.45 vs. 2.15) ( < 0.0001). The accuracy of F-fluorocholine PET/CT is higher than that of CU and MIBI scintigraphy for localization of hyperfunctional parathyroids, justifying the systematic use of F-fluorocholine PET/CT as the first-line method for PHPT diagnosis.
Topics: Humans; Choline; Hyperparathyroidism, Primary; Parathyroid Glands; Positron Emission Tomography Computed Tomography; Radionuclide Imaging; Retrospective Studies; Sodium Iodide; Technetium Tc 99m Sestamibi; Ultrasonography
PubMed: 34857659
DOI: 10.2967/jnumed.121.261900 -
Journal of Nuclear Cardiology :... Aug 2021Based on superior image quality, more accurate gated images, and lower radiation exposure to patients, Technetium-99m (Tc-99m) based tracers are preferred over...
Based on superior image quality, more accurate gated images, and lower radiation exposure to patients, Technetium-99m (Tc-99m) based tracers are preferred over Thallium-201 for SPECT myocardial perfusion imaging. The two Tc-99m tracers, sestamibi and tetrofosmin, have many similar characteristics but there are differences in blood and liver clearance rates, as well as the recommended time after injection for imaging to achieve optimal image quality. Because published peer-reviewed studies examining optimal times between injection and imaging are limited, it can be difficult to identify evidence-based opportunities to optimize imaging protocols. Using systematic literature review methods, this study was designed to identify and consolidate the available evidence on the use of sestamibi compared to tetrofosmin for variable injection to imaging times in regard to test efficiency, including test length and re-scan rates, and image quality, including overall quality and cardiac to extra-cardiac ratios. The composite of this data shows that earlier imaging with tetrofosmin is equivalent to later imaging with sestamibi when assessing subjective image quality or when quantifying heart-to-extra-cardiac ratios. Image quality and heart-to-extra-cardiac ratios comparing early versus later imaging with tetrofosmin were comparable if not equivalent to each other. The equivalency of the imaging quality occurs with 15 minutes (on average) earlier imaging compared to sestamibi and 30 minutes compared to standard time tetrofosmin. The subjective findings of equivalent image quality are also shown with objective measurements of heart-to-extra-cardiac ratios. In this review, the significantly shorter injection-to-acquisition times with tetrofosmin compared to sestamibi resulted in better efficiency and less waiting times for patients; in addition, significantly higher re-scan rates with sestamibi compared to tetrofosmin due to hepatic activity contributed to better throughput with tetrofosmin.
Topics: Heart Diseases; Humans; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Technetium Tc 99m Sestamibi; Time Factors; Tomography, Emission-Computed, Single-Photon
PubMed: 32236839
DOI: 10.1007/s12350-020-02093-5 -
Clinical Cardiology Apr 1998The noninvasive assessment of myocardial viability in patients with coronary artery disease and depressed left ventricular function has proven clinically useful for... (Comparative Study)
Comparative Study Review
The noninvasive assessment of myocardial viability in patients with coronary artery disease and depressed left ventricular function has proven clinically useful for identifying those patients with ischemic cardiomyopathy who benefit most from coronary revascularization. Thallium-201 (201Tl) imaging at rest has been the radionuclide imaging technique most often utilized for distinguishing viable myocardium from scar. However, new technetium-99m (99mTc) perfusion agents such as 99mTc-sestamibi and 99mTc-tetrofosmin have emerged as alternatives to 201Tl for imaging of regional myocardial perfusion. Whether these new agents, which have better physical properties for imaging with a gamma camera than 201Tl, are valid for use in assessing myocardial viability is still uncertain. Recent clinical studies have demonstrated that these agents, when imaged using quantitative SPECT, can identify patients with myocardial hibernation who exhibit improved regional systolic function following revascularization. Experimental laboratory studies have shown that the uptake of 99mTc-sestamibi and 99mTc-tetrofosmin in ischemic myocardium is only slightly lower than the uptake of 201Tl. These 99mTc-labeled agents remain bound intracellularly in mitochondria of viable myocytes under conditions of myocardial stunning and short-term hibernation, producing severe myocardial asynergy. With respect to determination of viability, the inferior wall region is at times problematic since attenuation of 99mTc-sestamibi and 99mTc-tetrofosmin is greatest in this area. Demonstration of preserved systolic thickening on ECG-gated SPECT images is indicative of viability in the instance of decreased regional 99mTc counts due to attenuation and not scar. Administration of nitrates prior to tracer injection improves the sensitivity for identifying viable myocardial segments using rest imaging with 99mTc-sestamibi or 99mTc-tetrofosmin. Thus, it appears that the new 99mTc perfusion imaging agents can be successfully employed for the determination of myocardial viability in the setting of severe regional dysfunction and chronic coronary artery disease. The greater the myocardial uptake of these agents in the resting state, the greater the probability of improved systolic function after coronary revascularization.
Topics: Animals; Coronary Disease; Electrocardiography; Humans; Myocardial Reperfusion; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left
PubMed: 9562932
DOI: 10.1002/clc.4960210402