Optimization of SPECT/CT scan schemes in localizing preoperative parathyroid lesions / 中华核医学与分子影像杂志

Objective To compare the diagnostic efficiencies of different scanning schemes of dualphase 99Tcm-methoxyisobutylisonitrile (MIBI) planar imaging with or without SPECT/CT in the preoperative localization of parathyroid lesions.Methods Forty-two patients (20 males,22 females;average age (53.1 ± 14.8) years) with primary or secondary hyperparathyroidism who underwent parathyroidectomy from June 2011 to June 2016 were analyzed retrospectively.All patients underwent dual-phase 99Tcm-MIBI planar scan and dual-phase SPECT/CT scan.The images were collected according to the following 4 procedures:dualphase planar imaging (S1),dual-phase planar imaging+early-phase SPECT/CT (S2),dual-phase planar imaging+delayed-phase SPECT/CT (S3),dual-phase planar imaging+dual-phase SPECT/CT (S4).Pathological results were considered as the gold standard.A total of 168 parathyroid glands in 42 patients were evaluated by the 4 imaging procedures respectively.The diagnostic efficiencies were calculated and compared by x2 test.Results Seventy-eight abnormal parathyroid lesions were found.The diagnostic sensitivities of S1,S2,S3,S4 were 66.7％ (52/78),89.7％(70/78),69.2％(54/78),89.7％(70/78),and the accuracies were 78.6％ (132/168),94.0％ (158/168),85.1％ (143/168),94.0％ (158/168),respectively.The diagnostic accuracies of S2 and S4 were significantly higher than those of S1 and S3 (x2 values:17.027 and 7.176,both P＜0.01).Condusions The dual-phase planar imaging together with early-phase and dualphase SPECT/CT imaging have high diagnostic efficiencies in the preoperative localization of parathyroid lesions.Considering reducing radiation dose and examine time,the dual-phase planar imaging together with early-phase SPECT/CT is a better choice.

Multiple endocrine neoplasia type 1 with anterior mediastinal parathyroid adenoma: successful localization using Tc-99m sestamibi SPECT/CT

The most common manifestation of multiple endocrine neoplasia type 1 (MEN1) is hyperparathyroidism. Treatment of hyperparathyroidism in MEN patients is surgical removal of the parathyroid glands, however ectopic parathyroid gland is challenging for treatment. A 51-year-old female, the eldest of 3 MEN1 sisters, had hyperparathyroidism with ectopic parathyroid adenoma in the mediastinal para-aortic region, which was detected by technetium-99m (Tc-99m) sestamibi scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT). She underwent total parathyroidectomy with video-assisted thoracoscopic surgery on an anterior mediastinal mass. Anterior mediastinal parathyroid adenoma in MEN1 patients is rare. Precise localization of an ectopic parathyroid gland with Tc-99m sestamibi SPECT/CT can lead to successful treatment of hyperparathyroidism. This is the first reported case in the literature of mediastinal parathyroid adenoma in MEN1 patient visualized by Tc-99m sestamibi SPECT/CT.

The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality / 한국유방암학회지

PURPOSE: We wanted to assess the clinical efficacy of breast-specific gamma imaging (BSGI) as compared with that of conventional imaging modalities (mammography, ultrasonography and magnetic resonance imaging) as a preoperative examination for patients with breast cancer. METHODS: From April to May 2009, a retrospective review was performed for the prospectively collected 143 patients who were diagnosed with breast cancer. All the patients received a conventional imaging examination and BSGI before definitive surgery. The patients underwent BSGI with intravenous injection of 30 mCi of (99m)Tc-sestamibi through the contralateral antecubital vein. After 10 minutes, the craniocaudal and mediolateral oblique images were obtained. All the imaging findings were correlated with the final pathologic examination. RESULTS: The mean age of the patients was 49.7+/-9.4 years (range, 27-77). In 143 patients, 166 malignant lesions were identified by pathologic examination (invasive cancer: 96 (67.1%), ductal carcinoma in situ 14 (9.8%) and invasive cancer with carcinoma in situ 33 (23.1%). The conventional imaging modalities found 166 malignant lesions and BSGI found 156 malignant lesions. The rate of correspondence was 94.0% between the conventional imaging modalities and BSGI for malignant lesions. For BSGI, there were 4 false positive findings and 10 false negative findings. BSGI found no occult cancers that were missed by conventional imaging modality. For making the diagnosis of axillary lymph node metastasis, the sensitivity, specificity and accuracy were 33.3%, 92.1%, and 69.9% for BSGI, and 55.6%, 77.5%, and 69.2%, for ultrasonography, respectively. CONCLUSION: BSGI may have the potentiality to make a correct diagnosis in breast cancer patients. However, in this study, it seems that BSGI is not superior to conventional imaging modalities. BSGI is not a standard method to evaluate breast cancer lesions before surgery.

A case of mediastinal parathyroid adenoma presenting as fracture of brown tumor / 대한내과학회지

Primary hyperparathyroidism is characterized by hypercalcemia and increased intact parathyroid hormone, and associated with reduced bone density and bony change. We experienced the case of a 18-year-old man presenting as fracture of brown tumor. And then ectopic superior mediastinal parathyroid adenoma was detected by preoperative localization studies (Tc-99m sestamibi scan, neck CT). The patient presented with fracture of the right 5th proximal phalanx which was brown tumor, and was diagnosed as having primary hyperparathyroidism due to elevated serum calcium level (12.1 mg/dl) and intact parathyroid hormone levels (1631.8 pg/ml). Ultrasonography, Tl-201/Tc-99m subtraction scan, Tc-99m sestamibi scan, computed tomography was performed, and then revealed an enlarged parathyroid gland in the superior mediastinum. Tumor was removed via a transcervical approach. Pathologically, the tumor was confirmed to be a parathyroid adenoma. After his operation, his calcium level rapidly returned to within normal ranges, and increased bone density and some remineralization of brown tumor has occurred after eight months.

Technetium-99m sestamibi whole Body Scintigraphy in Postoperative Follow-up of Differentiated Thyroid Carcinoma / 대한내분비학회지

BACKGROUND: Recently technetium-99m sestamibi (99mTc MIBI), which dose not require withdrawal of thyroid hormone, has been used for imaging of thyroid carcinoma. The aim of this study was to determine the clinical usefulness of Tc MIBI scintigraphy after total thyroidectomy for thyroid carcinoma. The results were compared with those of standard 131I scintigraphy. METHODS: One hundred twelve patients with a median age of 44 years (range, 14-76 years) were included in the study. After optimal endogenous thyroid stimulating hormone stimulation (>50 mIU/mL), whole body scintigraphy using 4 mCi of 'I and 20 mCi of Tc sestamibi were done simultaneously. Concomitantly serum thyroglobulin and anti-thyroglobulin antibody levels were checked. If abnormal findings on any of the scintigraphic methods or high levels of thyroglobulin (> 10ng/mL) were detected, diagnostic imaging studies were done to confirm the existence of the disease. And high dose (150-200 mCi) 'I was administered as therapy and then whole body scans were performed again after the therapy. The presence or absence of thyroid cancer was established by pathologic, radiologic, and/or high dose I scan findings. RESULTS: In 11 patients, Tc MIBI scan revealed positive accumulations which were not found on 131I scan, of whom 6 had elevated thyroglobulin levels. In these cases, 5 cases were interpreted to have normal thyroid remnant and 6 cases showed pathologic findings (2 lung, 1 lymph node, 1 lung and lymph node, 1 local recurrent cancer, and 1 false positive accumulation of 99mTc MIBI). Metastasis or residual cancer were confirmed histologically in 1 and radiologically in 4 cases. Negative 99mTc MIBI scans, despite of positive I scans, occurred in 9 patients, of whom 2 had abnormal thyroglobulin levels. Seven cases were interpreted to have thyroid remnant, 2 cases were confirmed to have lung metastasis, and another one was misinterpreted due to breast shadow. CONCLUSION: In conclusion, these results suggest that 99mTc MIBI scan may have similar sensitivity and specificity for the detection of residual or metastatic differentiated thyroid carcinoma. The 99mTc MIBI scan, especially in cases of negative 131I scan despite of abnormal thyroglobulin levels, can be used as a very useful complementary diagnostic tool.