Assuntos
Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Hiperparatireoidismo/cirurgia , Hiperparatireoidismo/diagnóstico por imagem , Radioisótopos de Flúor/química , Colina/análogos & derivados , Colina/química , Tomografia por Emissão de Pósitrons , Revisões Sistemáticas como AssuntoRESUMO
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 4â¯mm and 6â¯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.
Assuntos
Hiperparatireoidismo , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/patologia , Tecnécio Tc 99m Sestamibi , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Cintilografia , Compostos Radiofarmacêuticos , Imageamento por Ressonância Magnética , Ultrassonografia , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To determine whether combined ultrasonography and parathyroid scintigraphy improves hyperplastic parathyroid gland detection in the pediatric population for parathyroidectomy planning in patients with secondary or tertiary hyperparathyroidism. MATERIAL AND METHODS: An observational and analytical retrospective cohort study was carried out. Patients diagnosed with secondary or tertiary hyperparathyroidism from 2011 to 2018 undergoing total or subtotal parathyroidectomy were included - provided there was information available on pathological examination and surgical protocol. RESULTS: N = 15 patients. A total of 53 parathyroid glands diagnosed with hyperplasia using either of the imaging methods were analyzed. For each method (ultrasonography and scintigraphy) and the combination of both, sensitivity and area under the curve were calculated, using pathological examination result as a reference. Ultrasonography and scintigraphy diagnostic match was 66%. DISCUSSION AND CONCLUSIONS: The intraoperative difficulty of parathyroid gland identification as well as the anatomical variation that these present is well-known. Ultrasonography detected more glands than scintigraphy when diagnosing parathyroid hyperplasia. The combination of both methods allows patients with a first negative study to be detected.
OBJETIVO: Determinar si la combinación de la ecografía y la gammagrafia paratiroidea mejora la capacidad de detección de glándulas paratiroideas hiperplásicas en población pediátrica para la planificación de paratiroidectomía en pacientes con hiperparatiroidismo secundario o terciario. MATERIAL Y METODOS: Estudio observacional y analítico de una cohorte retrospectiva. Se incluyeron pacientes con hiperparatiroidismo secundario o terciario, entre 2011 y 2018, que fueron operados de paratiroidectomía total o subtotal, en los que haya podido recabarse información de la anatomía patológica y protocolo quirúrgico. RESULTADOS: N = 15 pacientes. Se analizaron un total de 53 glándulas paratiroides con diagnóstico de hiperplasia en alguno de los métodos por imágenes evaluados. Para cada método (ecografía y gammagrafía) y para la combinación de ambos, se obtuvieron la sensibilidad y área bajo la curva, tomando como referencia el resultado obtenido por anatomía patológica. La concordancia en el diagnóstico de la ecografía y de la gammagrafía fue del 66%. DISCUSION Y CONCLUSIONES: Es bien conocida la dificultad intraquirúrgica que se plantea en cuanto a la localización de las glándulas paratiroides así como la variación anatómica que estas presentan. La ecografía detectó más glándulas que la gammagrafía en el diagnóstico de hiperplasia paratiroidea. La combinación de ambos métodos permite detectar a aquellos pacientes en los cuales un primer estudio resultó negativo.
Assuntos
Hiperparatireoidismo , Tecnécio Tc 99m Sestamibi , Criança , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Cintilografia , Estudos Retrospectivos , UltrassonografiaRESUMO
INTRODUCTION: Hyperparathyroidism is an expected metabolic consequence of chronic kidney disease (CKD). Ectopic and/or supernumerary parathyroid glands (PT) may be the cause of surgical failure in patients undergoing total parathyroidectomy (PTX). AIM: To define the locations of ectopic and supernumerary PT in patients with renal hyperparathyroidism and to correlate intraoperative findings with preoperative tests. MATERIALS AND METHODS: A retrospective study was conducted with 166 patients submitted to PTX. The location of PT during surgery was recorded and classified as eutopic or ectopic. The preoperative localizations of PT found by ultrasonography (USG) and Tc99m-Sestamibi scintigraphy (MIBI) were subsequently compared with intraoperative findings. RESULTS: In the 166 patients studied, 664 PT were found. Five-hundred-seventy-seven (86.4%) glands were classified as eutopic and 91(13.6%) as ectopic. Eight supernumerary PT were found. The most common sites of ectopic PT were in the retroesophageal and thymic regions. Taken together, USG and MIBI did not identify 56 (61.5%) ectopic glands. MIBI was positive for 69,7% of all ectopic glands located in the mediastinal and thymic regions. CONCLUSION: The presence of ectopic and supernumerary PT in patients with renal hyperparathyroidism is significant. Although preoperative imaging tests did not locate most of ectopic glands, MIBI may be important for identifying ectopic PT in the mediastinal and thymic regions.
Assuntos
Coristoma , Hiperparatireoidismo/cirurgia , Glândulas Paratireoides/anormalidades , Paratireoidectomia , Adulto , Idoso , Coristoma/diagnóstico por imagem , Coristoma/patologia , Estudos Transversais , Feminino , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Cintilografia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Tecnécio Tc 99m Sestamibi , Falha de Tratamento , Ultrassonografia , Adulto JovemRESUMO
Parathyromatosis is a rare clinical condition resulting in recurrent hyperparathyroidism that often poses challenges in its diagnosis and complete surgical cure. We report the (99m)Tc MIBI SPECT findings in a patient with recurrent hyperparathyroidism requiring multiple parathyroid explorations. MIBI SPECT helped localize the areas of these "recurrent parathyroid lesions" that were often found outside of the expected locations within the neck.
Assuntos
Hiperparatireoidismo/diagnóstico por imagem , Doenças das Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Feminino , Humanos , Doenças das Paratireoides/patologia , Glândulas Paratireoides/patologia , RecidivaRESUMO
PURPOSE: To describe the clinical and radiologic features of orbital involvement in craniofacial brown tumors and to compare the rate of brown tumors in primary and secondary hyperparathyroidism. METHODS: A retrospective hospital-based study of 115 patients with chronic kidney disease and secondary hyperparathyroidism and 34 with primary hyperparathyroidism was conducted. Laboratory results such as serum levels of alkaline phosphatase, calcium, phosphorus, and parathyroid hormone were recorded. Demographic data (age, sex, duration of disease) and image findings (bone scan scintigraphy, skull and long bone x-rays, CT) were also obtained. The main outcome measures were analysis of clinical, biochemical, and radiologic findings of all patients. RESULTS: Of the 115 patients with chronic kidney disease, 10 (8.7%) had brown tumors in different bones of the skeleton. Five patients had lesions in the craniofacial bones. The maxilla, mandible, maxillary sinus, and nasal cavity were the most affected sites. The orbit was involved in 2 patients with lesions arising in the maxillary and ethmoid sinuses. One patient had facial leontiasis. All patients with brown tumors had extremely high levels of parathyroid hormone (>1,000 pg/ml, normal values 10-69 pg/ml) and alkaline phosphatase (>400 U/l, normal values 65-300 U/l). The mean serum levels of phosphorus and calcium were not abnormal among the patients with brown tumors. Age and time of renal failure were similar for patients with and without brown tumors. Among the patients with primary hyperparathyroidism, only 2 (5.8%) had brown tumors, and in just 1, the lesion was localized in the craniofacial skeleton. A 2-tailed Z test applied to compare the proportion of occurrence of brown tumors in the 2 groups revealed that the difference at the 90% of confidence level was not significant. CONCLUSIONS: Brown tumors are equally found in secondary and primary hyperparathyroidism. Craniofacial brown tumors involve the orbit, usually because of the osteodystrophy process that involves the maxilla and paranasal sinuses. The lesions do not necessarily need to be excised and may regress spontaneously after the control of hyperparathyroidism.
Assuntos
Transtornos Craniomandibulares/etiologia , Granuloma de Células Gigantes/etiologia , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo/complicações , Doenças Maxilares/etiologia , Doenças Orbitárias/etiologia , Adolescente , Adulto , Idoso , Fosfatase Alcalina/sangue , Cálcio/sangue , Criança , Pré-Escolar , Transtornos Craniomandibulares/sangue , Transtornos Craniomandibulares/diagnóstico por imagem , Feminino , Granuloma de Células Gigantes/sangue , Granuloma de Células Gigantes/diagnóstico por imagem , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico por imagem , Lactente , Falência Renal Crônica/complicações , Masculino , Doenças Maxilares/sangue , Doenças Maxilares/diagnóstico por imagem , Pessoa de Meia-Idade , Doenças Orbitárias/sangue , Doenças Orbitárias/diagnóstico por imagem , Doenças das Paratireoides/complicações , Hormônio Paratireóideo/sangue , Fósforo/sangue , Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Parathyroid scintigraphies have been used to detect pathological parathyroid glands either before as well as after the parathyroid resection surgery in patients with hyperparathyroidism. Although this test presents high specificity for detection of increased parathyroid glands, there exist causes of false positive results. In the present article, we report a case of a renal transplanted patient, with multiple lytic lesions on pelvic bones reported as brown tumors, who presented a focal uptake in the anterior portion of the superior mediastinum on Tc-99m sestamibi scintigraphy. This focal uptake, initially thought to be an ectopic parathyroid gland, after a more detailed analysis and the performance of other imaging diagnostic tests was demonstrated to be a brown tumor of the sternum.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Compostos Radiofarmacêuticos , Esterno/diagnóstico por imagem , Tecnécio Tc 99m Sestamibi , Adulto , Diagnóstico Diferencial , Reações Falso-Positivas , Feminino , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Osteíte Fibrosa Cística/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Antecedentes: El hiperparatiroidismo primario es causado por un adenoma único en alrededor del 90 por ciento de los casos; debido a la más precisa localización preoperatoria, se ha cuestionado la exploración cervical bilateral en todos los enfermos. Objetivos: Presentar la técnica y los resultados de la paratiroidectomia radioguiada mínimamente invasiva (PRM) en el tratamiento del hiperparatiroidismo primario. Lugar y aplicación: Servicio de cirugía oncológica. Diseño: Observacional retrospectivo. Población: 54 pacientes consecutivos operados por hiperparatiroidismo primario: 49 para tratamiento primario y 5 por recidiva. Método: Ecografía y centellograma con Sesta MIBI preoperatorios y paratiroidectomía radioguiada con cámara manual para detección de radiaciones gamma. Resultados: La cámara manual localizó al adenoma en el 88,8 por ciento de los casos, mientras que la ecografía y el centellograma lo hicieron en el 76 y 87 por ciento respectivamente. La combinación de los tres métodos permitió ubicar el adenoma en toda la serie; en 15 oportunidades fue necesario prolongar la cervicotomía por patología tiroidea sincrónica y en 2 por carcinoma de paratiroides. Conclusiones: La PRMI es una técnica complementaria de los estudios preoperatorios (AU)
Assuntos
Adulto , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Hiperparatireoidismo/cirurgia , Paratireoidectomia/métodos , Hiperparatireoidismo/diagnóstico por imagem , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tecnécio Tc 99m Sestamibi/diagnóstico , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Estudos RetrospectivosRESUMO
INTRODUCTION: Several advances have been made in the management of hyperparathyroidism. The preoperative sestamibi scan appears to have revolutionized the entire approach to parathyroid surgery including minimally invasive parathyroidectomy. Gamma probe is a useful tool that complements a well performed localization of parathyroid adenomas. METHODS: We conducted a retrospective analysis of the patients submitted to radio-guided parathyroidectomy between January and December 2003 at a Oncology tertiary hospital in Mexico City, for evaluate the results and shows the feasibility of this approach. RESULTS: Six patients was included, all of them referred to the hospital with the diagnosis of bone tumors or with bone disease suggest malignancy. Median serum level of preoperative calcium was 13.18 mg/dl. In all cases the transoperative localization of the affected gland was possible using gamma probe and according with Tc 99m sestamibi scintigraphy imaging. None perioperative deaths reported and there were no recurrent laryngeal nerve injuries neither recurrent hypercalcemia. Median serum level of postoperative calcium was 9.39 mg/dl. There were at histopathological analysis five adenomas and one hyperplasia. CONCLUSIONS: Radio-guided parathyroidectomy is a useful approach for transopertaive localization of the affected gland, we obtained a 100% success rate, according with the histopathologic analysis and the normal postoperative serum calcium level.