Improving the yield of preoperative parathyroid localization: technetium Tc 99m-sestamibi imaging after thyroid suppression. Surgery 2002 Dec;132(6):968-74; discussion 974-5
Date
12/20/2002Pubmed ID
12490843DOI
10.1067/msy.2002.128609Scopus ID
2-s2.0-0036915699 (requires institutional sign-in at Scopus site) 33 CitationsAbstract
BACKGROUND: Preoperative localization is essential for successful directed, minimally invasive or reoperative parathyroidectomy. Standard technetium Tc 99m-sestamibi imaging is the most sensitive modality for localization. We reviewed our experience with (99m)Tc-sestamibi imaging and specifically investigated the effect of thyroid suppression on repeat imaging of patients who had initially nonlocalizing scans.
METHODS: . The records of patients who underwent (99m)Tc-sestamibi imaging during evaluation for primary hyperparathyroidism were reviewed. A subset of patients with initially nonlocalizing scans underwent thyroid suppression with either thyroxin or liothyronine and then had their scans repeated.
RESULTS: Ninety-nine patients with primary hyperparathyroidism underwent (99m)Tc-sestamibi imaging followed by parathyroidectomy (initial operation, 78; reoperation, 21). Successful parathyroid localization was obtained on standard imaging in 67 patients. Fourteen of 32 patients who had nonlocalizing (99m)Tc-sestamibi imaging studies underwent an additional scan after thyroid suppression. In 10 of 14 patients (71%), repeat (99m)Tc-sestamibi imaging after thyroid suppression successfully localized abnormal parathyroid tissue.
CONCLUSIONS: Thyroid suppression may improve the yield of (99m)Tc-sestamibi imaging in patients with hyperparathyroidism who have an initially nonlocalizing study. This diagnostic strategy may be helpful in patients motivated to undergo a directed, minimally invasive operation, as well as in the evaluation of patients for reoperative parathyroidectomy.
Author List
Royal RE, Delpassand ES, Shapiro SE, Fritsche HA Jr, Vassilopoulou-Sellin R, Sherman SI, Gagel RF, Evans DB, Lee JEAuthor
Douglas B. Evans MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
HumansHyperparathyroidism
Nickel
Parathyroid Glands
Preoperative Care
Radiopharmaceuticals
Retrospective Studies
Technetium Tc 99m Sestamibi
Thyroxine
Titanium
Tomography, Emission-Computed, Single-Photon
Triiodothyronine
