title: Preoperative localization of parathyroid glands. Use of MRI, scintigraphy, and image fusion.
abstract: OBJECTIVE
  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.
  
  
  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. (99m)Tc-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 (99m)Tc-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.
authors.affiliation: Klinik für Strahlenheilkunde, Bereich Nuklearmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin. juri.ruf@charite.de
authors.forename: J
authors.initials: J
authors.lastname: Ruf
authors.forename: E
authors.initials: E
authors.lastname: Lopez Hänninen
authors.forename: Th
authors.initials: T
authors.lastname: Steinmüller
authors.forename: T
authors.initials: T
authors.lastname: Rohlfing
authors.forename: H
authors.initials: H
authors.lastname: Bertram
authors.forename: M
authors.initials: M
authors.lastname: Gutberlet
authors.forename: A-J
authors.initials: AJ
authors.lastname: Lemke
authors.forename: R
authors.initials: R
authors.lastname: Felix
authors.forename: H
authors.initials: H
authors.lastname: Amthauer
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi