[Imaging in parathyroid gland diseases with relation to surgery].
BACKGROUND
Despite the progress in the imaging techniques, the satisfactory preoperative detection of the hyperactive parathyroid glands has not been guaranteed yet. Many complementary techniques have been introduced including ultrasound imaging, CT-scanning, MRI and scintigraphy, also supported by intraoperative methods (methylene blue injections, gamma-probing, intraoperative PTH level assessment) simplifying the detection of the glands and assuring the surgeon on the adequacy of his/her treatment.


METHODS
The authors describe the methods instituted nowadays, and compare their quality parameters, applicability, indications and limitations. The critical review is accompanied by a brief presentation of own experience including 172 cases of hyperparathyroidism treated in the Department of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdansk, Poland between 1996 and 2003.


CONCLUSIONS
The authors conclude that radionuclid-based methods (Tc (99m)-MIBI preoperative scintigraphy and Tc (99m)-MIBI intraoperative gamma-probing) seem to be the most effective in both preoperative and intraoperative detection of hyperfunctioning parathyroids. It is also suggested that the effectiveness of the imaging is higher in primary than in secondary hyperparathyroidism. It is underlined that the effectiveness of the operative treatment is strongly determined by the experience of the operating endocrine surgeon.
Oseka
T
T
Department of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdansk, Poland.
Makarewicz
W
W
Kaska
L
L
Stefaniak
T
T
Kobiela
J
J
Lass
P
P
Lachinski
A
A
Gruca
Z
Z
D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007091:Image Processing, Computer-Assisted; D010279:Parathyroid Diseases / Q000175:diagnosis* / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi