Preoperative localization of parathyroid glands. Use of MRI, scintigraphy, and image fusion.
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.
Ruf
J
J
Klinik für Strahlenheilkunde, Bereich Nuklearmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin. juri.ruf@charite.de
Lopez Hänninen
E
E
Steinmüller
Th
T
Rohlfing
T
T
Bertram
H
H
Gutberlet
M
M
Lemke
A-J
AJ
Felix
R
R
Amthauer
H
H
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
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi