Computed axial tomography-MIBI image fusion for preoperative localization in primary hyperparathyroidism.
BACKGROUND
An imaging-guided unilateral surgical approach in patients with primary hyperparathyroidism (HPTH) requires reliable preoperative localization procedures. Using present imaging techniques, 60% to 80% of patients with primary HPTH can be treated successfully with limited surgery. Thus, further improvement of diagnostic accuracy is required. Computed axial tomography (CAT)-MIBI image fusion was introduced as a new technique for localizing enlarged parathyroid glands. We describe the new method and present its first results.


METHODS
Six consecutive patients with primary HPTH underwent CAT-MIBI image fusion for preoperative parathyroid localization. CAT and technetium-99m-sestamibi scan were performed separately. The patient's head and neck were fixed with the noninvasive Vogele-Bale-Hohner Head Holder (VBH HeadFIX; Medical Intelligence, Schwabmünchen, Germany) and the BodyFIX (Medical Intelligence) vacuum cushion. Radiographic and scintigraphic markers were mounted at the head holder and the patient. CAT and MIBI images were fused by overlaying radiographic markers using a commercial software and workstation.


RESULTS
In 5 patients, localization and dimension of the solitary adenomas were exactly predicted. In 1 patient with multiglandular disease (3 enlarged glands), CAT-MIBI image fusion was not able to predict multiple gland involvement. However, in a retrospective analysis of the localization study, the other two enlarged parathyroid glands could be correctly identified regarding their site and size.


CONCLUSIONS
First results of CAT-MIBI image fusion are promising. The new technique provides a higher image resolution and better delimitation of enlarged parathyroid glands and adjacent anatomic structures than conventional scintigraphic methods.
Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. christoph.profanter@uibk.ac.at
Christoph
C
Profanter
Rupert
R
Prommegger
Michael
M
Gabriel
Roy
R
Moncayo
Gerold J
GJ
Wetscher
Thomas
T
Lang
Reto
R
Bale
D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi