Download PDF
Nuklearmedizin 2004; 43(03): 85-90
DOI: 10.1055/s-0038-1625596
Original Article
Schattauer GmbH

Preoperative localization of parathyroid glands

Use of MRI, scintigraphy, and image fusionPräoperative Lokalisationsdiagnostik von NebenschilddrüsenNutzen der MRT, Szintigraphie und Bildfusion
J. Ruf
1   Department of Radiology and Nuclear Medicine
,
E. Lopez Hänninen
1   Department of Radiology and Nuclear Medicine
,
Th. Steinmüller
2   Visceral and Transplant Surgery, Charité, Universitätsmedizin Berlin, Campus Virchow Clinic, Germany
,
T. Rohlfing
3   Image Guidance Laboratories, Department of Neurosurgery, Stanford University, USA
,
H. Bertram
1   Department of Radiology and Nuclear Medicine
,
M. Gutberlet
1   Department of Radiology and Nuclear Medicine
,
A.-J. Lemke
1   Department of Radiology and Nuclear Medicine
,
R. Felix
1   Department of Radiology and Nuclear Medicine
,
H. Amthauer
1   Department of Radiology and Nuclear Medicine
› Author Affiliations
Further Information

Publication History

Eingegangen: 10 October 2003

in revidierter Form: 03 December 2003

Publication Date:
10 January 2018 (online)

Also available at
    Permissions and Reprints

Summary

Aim: Minimally invasive resection of hyperfunctional parathyroid glands is an alternative to open surgery. However, it requires a precise preoperative localization. This study evaluated the diagnostic use of magnetic resonance (MR) imaging, parathyroid scintigraphy, and consecutive image fusion. Patients, methods: 17 patients (9 women, 8 men; age: 29-72 years; mean: 51.2 years) with primary hyperparathyroidism were included. Examination by MRI used unenhanced T1- and T2-weighted sequences as well as contrast-enhanced T1-weighted sequences. 99mTc-MIBI scintigraphy consisted of planar and SPECT (single photon emission tomography) imaging techniques. In order to improve the anatomical localization of a scintigraphic focus, SPECT-data were fused with the corresponding MR-data using a modified version of the Express 5.0 software (Advanced Visual Systems, Waltham, MA). Results of image fusion were then compared to histopathology. Results: In 14/17 patients, a single parathyroid adenoma was found. There were 3 cases with hyperplastic glands. MRI detected 10 (71%), scintigraphy 12 (86%) adenomas. Both modalities detected 1/3 patients with hyperplasia. Image fusion improved the anatomical assignment of the 13 scintigraphic foci in five patients and was helpful in the interpretation of inconclusive MR-findings in two patients. Conclusions: Both MRI and 99mTc-MIBI scintigraphy sensitively detect parathyroid adenomas but are less reliable in case of hyperplastic glands. In case of a scintigraphic focus, image fusion considerably improves its topographic assignment. Furthermore, it facilitates the evaluation of inconclusive MRI findings.

Zusammenfassung

Ziel: Die minimal-invasive Resektion hypersezernierender Nebenschilddrüsen ist eine Alternative zur offenen Chirurgie, bedarf jedoch einer präzisen präoperativen Lokalisationsdiagnostik. Diese Studie evaluierte den Nutzen von Magnetresonanztomographie (MRT), Nebenschilddrüsenszintigraphie und konsekutiver Bild-fusion. Patienten, Methoden: 17 Patienten (9 Frauen, 8 Männer, Alter: 29-72 Jahre; Mittel: 51,2 Jahre) mit primärem Hyperparathyreoidismus wurden in diese Studie eingeschlossen. Die MRT-Untersuchung umfasste T2- und T1-gewichtete Sequenzen. Die 99mTc-MIBISzintigraphie wurde in planarer und SPECT(single photon emission tomography)-Technik durchgeführt. Zur Verbesserung der anatomischen Zuordnung eines szintigraphischen Fokus, wurden die SPECT-Daten mit dem korrespondierenden MRT-Datensatz fusioniert. Hierfür wurde eine modifizierte Version der Software Express 5.0 (Advanced Visual Systems, Waltham, MA) verwendet. Die Ergebnisse der Bildfusion wurden mit den histopathologischen Befunden verglichen. Ergebnisse: Bei 14 Patienten wurde ein singuläres Nebenschilddrüsenadenom nachgewiesen. Bei 3 Patienten wurden hyper-plastische Drüsen entdeckt. Die MRT entdeckte 10 (71%) und die Szintigraphie 12 (86%) der Adenome. Beide Verfahren detektierten hyperplastische Drüsen in einem von drei Fällen. Die Bildfusion verbesserte die anatomische Zuordnung der 13 szintigraphischen Foki bei 5 Patienten und war bei 2 Patienten für die Interpretation uneindeutiger MRT-Befunde von Nutzen. Schlussfolgerung: Während Adenome der Nebenschilddrüse sowohl mit der MRT als auch mit der 99mTc-MIBISzintigraphie zuverlässig nachgewiesen werden, ist die Detektion hyperplastischer Drüsen mit beiden Verfahren weniger sensitiv. Im Falle eines szintigraphischen Fokus verbessert die Bildfusion in hohem Maße seine topographische Zuordnung. Darüber hinaus erleichtert sie die Interpretation nicht eindeutiger MRT-Befunde.

Keywords

Parathyroid gland - adenoma - scintigraphy - magnetic resonance imaging - image fusion

Schlüsselwörter

Nebenschilddrüsenadenom - Bildfusion
 

  • References

  • 1 Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery 1984; 95: 14-21.
    PubMedGoogle Scholar
  • 2 Auffermann W, Guis M, Tavares NJ. et al. MR signal intensity of parathyroid adenomas: correlation with histopathology. Am J Roentgenol 1989; 153: 873-6.
    CrossrefPubMedGoogle Scholar
  • 3 Caixas A, Berna L, Hernandez A. et al. Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism. Surgery 1997; 121: 535-41.
    CrossrefPubMedGoogle Scholar
  • 4 Casara D, Rubello D, Pelizzo MR. et al. Clinical role of 99mTcO4/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism. Eur J Nucl Med 2001; 28: 1351-9.
    CrossrefPubMedGoogle Scholar
  • 5 Coakley AJ. Parathyroid imaging. Nucl Med Commun 2003; 24: 111-3.
    CrossrefPubMedGoogle Scholar
  • 6 Even-Sapir E, Keidar Z, Sachs J. et al. The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasms. J Nucl Med 2001; 42: 998-1004.
    PubMedGoogle Scholar
  • 7 Giordano A, Rubello D, Casara D. New trends in parathyroid scintigraphy. Eur J Nucl Med 2001; 28: 1409-20.
    CrossrefPubMedGoogle Scholar
  • 8 Gotway MB, Reddy GP, Webb WR. et al. Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism. Radiology 2001; 218: 783-90.
    CrossrefPubMedGoogle Scholar
  • 9 Hetrakul N, Civelek AC, Stagg CA. et al. In vitro accumulation of technetium-99msestamibi in human parathyroid mitochondria. Surgery 2001; 130: 1011-8.
    CrossrefPubMedGoogle Scholar
  • 10 Hosten N, Lemke AJ, Wiedenmann B. et al. Combined imaging techniques for pancreatic cancer. Lancet 2000; 356 9233 909-10.
    CrossrefPubMedGoogle Scholar
  • 11 Hosten N, Kreissig R, Puls R. et al. Fusion von CT- und PET-Daten: Methoden und klinische Bedeutung am Beispiel der Planung der laser-induzierten Thermotherapie von Lebermetastasen. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 2000; 172: 630-5.
    PubMedGoogle Scholar
  • 12 Ishibashi M, Nishida H, Hiromatsu Y. et al. Localization of ectopic parathyroid glands using technetium-99m sestamibi imaging: comparison with magnetic resonance and computed tomographic imaging. Eur J Nucl Med 1997; 24: 197-201.
    CrossrefPubMedGoogle Scholar
  • 13 Israel O, Keidar Z, Iosilevsky G. et al. The fusion of anatomic and physiologic imaging in the management of patients with cancer. Semin Nucl Med 2001; 31: 191-205.
    CrossrefPubMedGoogle Scholar
  • 14 Kaczirek K, Prager G, Kienast O. et al. Combined transmission and 99mTc-sestamibi emission tomography for localization of mediastinal parathyroid glands. Nuklearmedizin 2003; 42: 220-3.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Krausz Y, Lebensart PD, Klein M. et al. Preoperative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease. World J Surg 2000; 24: 1573-8.
    CrossrefPubMedGoogle Scholar
  • 16 Kumar A, Cozens NJ, Nash JR. Sestamibi scan-directed unilateral neck exploration for primary hyperparathyroidism due to a solitary adenoma. Eur J Surg Oncol 2000; 26: 785-8.
    CrossrefPubMedGoogle Scholar
  • 17 Lee VS, Spritzer CE, Coleman RE. et al. The complementary roles of fast spin-echo MR imaging and double-phase 99mTc-sestamibi scintigraphy for localization of hyperfunctioning parathyroid glands. AJR Am J Roentgenol 1996; 167: 1555-62.
    CrossrefPubMedGoogle Scholar
  • 18 Lopez Hänninen E, Vogl TJ, Steinmüller T. et al. Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism. Invest Radiol 2000; 35: 426-30.
    CrossrefPubMedGoogle Scholar
  • 19 Maes F, Collignon A, Vandermeulen D. et al. Multimodality image registration by maximization of mutual information. IEEE Trans Med Imaging 1997; 16: 187-98.
    CrossrefPubMedGoogle Scholar
  • 20 Maintz JB, Viergever MA. A survey of medical image registration. Med Image Anal 1998; 2: 1-36.
    CrossrefPubMedGoogle Scholar
  • 21 Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000; 343: 1863-75.
    CrossrefPubMedGoogle Scholar
  • 22 Mazzeo S, Caramella D, Lencioni R. et al. Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions. Am J Roentgenol 1996; 166: 1465-70.
    CrossrefPubMedGoogle Scholar
  • 23 Moka D, Voth E, Larena-Avellaneda A. et al. 99mTc-MIBI-SPECT-Nebenschilddrüsenszintigraphie zur präoperativen Lokalisation kleiner Nebenschilddrüsenadenome. Nuklearmedizin 1997; 36: 240-4.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Moka D, Voth E, Dietlein M. et al. Technetium-99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000; 128: 29-35.
    CrossrefPubMedGoogle Scholar
  • 25 Moka D, Voth E, Dietlein M. et al. Preoperative localization of parathyroid adenomas using 99mTc-MIBI scintigraphy. Am J Med 2000; 108: 733-6.
    CrossrefPubMedGoogle Scholar
  • 26 Perrier ND, Ituarte PH, Morita E. et al. Parathyroid surgery: separating promise from reality. J Clin Endocrinol Metab 2002; 87: 1024-9.
    CrossrefPubMedGoogle Scholar
  • 27 Pluim JP, Maintz JB, Viergever MA. Image registration by maximization of combined mutual information and gradient information. IEEE Trans Med Imaging 2000; 19: 809-14.
    CrossrefPubMedGoogle Scholar
  • 28 Pons F, Torregrosa V, Fuster D. Biological factors influencing parathyroid localization. Nucl Med Commun 2003; 24: 121-4.
    CrossrefPubMedGoogle Scholar
  • 29 Prager G, Czerny C, Kurtaran A. et al. Der Stellenwert präoperativer Lokalisationsmethoden beim primären Hyperparathyreoidismus. Chirurg 1999; 70: 1082-8.
    CrossrefPubMedGoogle Scholar
  • 30 Rohlfing T, Beier J. Improving reliability and performance of voxel-based registration by coincidence thresholding and volume clipping. In: Hawkes DJ, Hill DLG, Gaston R. (eds). Proceedings of medical image understanding and analysis. London: Kings College; 1999: 165-8.
    Google Scholar
  • 31 Rubello D, Casara D, Fiore D. et al. An ectopic mediastinal parathyroid adenoma accurately located by a single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction scintigraphy and MIBI-SPECT-computed tomo-graphic image fusion. Clin Nucl Med 2002; 27: 186-90.
    CrossrefPubMedGoogle Scholar
  • 32 Russell CF, Edis AJ. Surgery for primary hyper-parathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br J Surg 1982; 69: 244-7.
    CrossrefPubMedGoogle Scholar
  • 33 Scheiner JD, Dupuy DE, Monchik JM. et al. Preoperative localization of parathyroid adenomas: a comparison of power and colour Doppler ultrasonography with nuclear medicine scintigraphy. Clin Radiol 2001; 56: 984-8.
    CrossrefPubMedGoogle Scholar
  • 34 Staudenherz A, Abela C, Niederle B. et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases. Eur J Nucl Med 1997; 24: 143-9.
    CrossrefPubMedGoogle Scholar
  • 35 Takebayashi S, Hidai H, Chiba T. et al. Hyper-functional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings. J Nucl Med 1999; 40: 1792-7.
    PubMedGoogle Scholar
  • 36 Torregrosa JV, Fernandez-Cruz L, Canalejo A. et al. 99mTc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg 2000; 24: 1386-90.
    CrossrefPubMedGoogle Scholar
  • 37 Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002; 235: 665-70.
    CrossrefPubMedGoogle Scholar
  • 38 Wakamatsu H, Noguchi S, Yamashita H. et al. Technetium-99m tetrofosmin for parathyroid scintigraphy: a direct comparison with 99mTcMIBI, 201Tl, MRI and US. Eur J Nucl Med 2001; 28: 1817-27.
    CrossrefPubMedGoogle Scholar
  • 39 Weber AL, Randolph G, Aksoy FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am 2000; 38: 1105-29.
    CrossrefPubMedGoogle Scholar
  • 40 Weber DA, Ivanovic M. Correlative image registration. Semin Nucl Med 1994; 24: 311-23.
    CrossrefPubMedGoogle Scholar
  • 41 Weiss M, Benecke F, Schmid R. et al. Kann durch den Einsatz der SPECT-Technik die diagnostische Aussage der präoperativen Tc-99m-MIBI-Szintigraphie beim primären Hyperparathyreoidismus verbessert werden?. Med Klin 2002; 97: 389-95.
    CrossrefPubMedGoogle Scholar
  • 42 West J, Fitzpatrick JM, Wang MY. et al. Comparison and evaluation of retrospective inter-modality brain image registration techniques. J Comput Assist Tomogr 1997; 21: 554-66.
    CrossrefPubMedGoogle Scholar