SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery.
OBJECTIVE
Single photon emission computed tomography/computed tomography (SPECT/CT) now makes it possible to use combined morphologic CT and functional scintigraphy information. It has proved useful for localization of abnormal parathyroid glands, especially in the case of an ectopic gland. We experienced that it was also beneficial for patients with a history of previous neck surgery, and we report 4 cases in this entity.


METHODS
Four patients with prior neck surgery and hyperparathyroidism underwent parathyroid Tc-99m MIBI scintigraphy with SPECT/CT. Two patients had undergone surgery for hyperparathyroidism and 2 had undergone thyroidectomy, 1 for thyroid cancer and 1 for multinodular goiter. Parathyroid hormone levels were assessed during surgery, and patients were followed several months after treatment.


RESULTS
SPECT/CT successfully localized the abnormal gland, including an uncommon anterior situation for which previous surgery guided by planar imagery failed to cure the hyperparathyroidism. It allowed efficient surgical treatment, as confirmed by parathyroid hormone level normalization, without complications and with a relatively short operation time in those challenging cases.


CONCLUSIONS
SPECT/CT seems to be a useful tool for presurgical assessment in hyperparathyroidism, not only for ectopic glands but also for patients with previous neck surgery.
Papathanassiou
Dimitri
D
Service de Médecine Nucléaire, Institut Jean Godinot, Centre Hospitalier et Universitaire de Reims, France. d.papathanassiou@reims.fnclcc.fr
Flament
Jean-Bernard
JB
Pochart
Jean-Marie
JM
Patey
Martine
M
Marty
Hélène
H
Liehn
Jean-Claude
JC
Schvartz
Claire
C
D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D013965:Thyroidectomy; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*