title: CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism.
abstract: BACKGROUND
  To perform focused or minimally invasive surgery for hyperparathyroidism (HPT) exact preoperative localization is mandatory. Computed tomography-(99m)Tc-sestamibi-single photon emission computed tomography image fusion (CT-MIBI-SPECT) serves this difficult task in single gland HPT to a large extent. The aim of this study was to evaluate whether CT-MIBI-SPECT image fusion is superior to MIBI-SPECT alone and CT alone in detecting abnormal parathyroid tissue in patients with multiglandular disease.
  
  
  METHODS
  CT-MIBI-SPECT image fusion for preoperative localization was performed in 30 patients with multiglandular disease. There were six patients with primary hyperparathyroidism (four MEN I syndromes and two double adenomas; one of these patients has HRPT2 gene mutation), 14 with secondary, and eight with tertiary HPT, further one patient each suffering from persistent primary and persistent secondary hyperparathyroidism. In both persistent patients only one remaining gland was left from primary surgery. The results of MIBI-SPECT, CT, and CT-MIBI-SPECT image fusion were compared in these patients. The outcome and the exact predicted positions were correlated with intraoperative findings.
  
  
  RESULTS
  In five out of six patients with multiglandular primary hyperparathyroidism more than one gland was detected, thus multiglandular disease could be suspected preoperatively. Overall CT-MIBI-SPECT image fusion was able to predict the exact position of all abnormal glands per patient in 14 of 30 (46.7%) cases, whereas CT alone was successful in 11 (36.7%), and MIBI-SPECT alone just in four (13.3%) of 30 patients.
  
  
  CONCLUSIONS
  Multiglandular disease in primary hyperparathyroidism can be suspected preoperatively in a high percentage of patients. Additionally, this study shows that CT-MIBI-SPECT image fusion is superior to CT or MIBI-SPECT alone in preoperative localization of all pathologic glands in patients suffering from multiglandular disease.
authors.affiliation: Department of Operative Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Gerd
authors.initials: G
authors.lastname: Wimmer
authors.forename: Christoph
authors.initials: C
authors.lastname: Profanter
authors.forename: Peter
authors.initials: P
authors.lastname: Kovacs
authors.forename: Michael
authors.initials: M
authors.lastname: Sieb
authors.forename: Michael
authors.initials: M
authors.lastname: Gabriel
authors.forename: Daniel
authors.initials: D
authors.lastname: Putzer
authors.forename: Reto
authors.initials: R
authors.lastname: Bale
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Rupert
authors.initials: R
authors.lastname: Prommegger
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
references.citation: Arch Surg. 2002 Aug;137(8):896-9; discussion 899-900
references.pmid: 12146987
references.citation: Langenbecks Arch Surg. 2007 Jul;392(4):445-51
references.pmid: 17103223
references.citation: Am J Surg. 2004 Mar;187(3):383-7
references.pmid: 15006567
references.citation: Langenbecks Arch Surg. 2008 Sep;393(5):687-92
references.pmid: 18575883
references.citation: World J Surg. 2004 Dec;28(12):1287-92
references.pmid: 15517474
references.citation: Arch Otolaryngol Head Neck Surg. 2008 Sep;134(9):953-7
references.pmid: 18794440
references.citation: World J Surg. 2007 Oct;31(10):1947-53
references.pmid: 17665243
references.citation: Radiol Med. 2006 Oct;111(7):999-1008
references.pmid: 17021682
references.citation: Surgery. 2004 Feb;135(2):157-62
references.pmid: 14739850
references.citation: J Surg Res. 2009 Jul;155(1):100-3
references.pmid: 19135685
references.citation: World J Surg. 2006 Jan;30(1):76-83
references.pmid: 16369710
references.citation: Clin Endocrinol (Oxf). 2006 Sep;65(3):340-5
references.pmid: 16918953
references.citation: World J Surg. 2004 Feb;28(2):187-92
references.pmid: 14708048
references.citation: Surgery. 2008 Dec;144(6):970-6; discussion 976-9
references.pmid: 19041005
references.citation: World J Surg. 2009 Nov;33(11):2234-43
references.pmid: 19184636
references.citation: Scand J Surg. 2006;95(3):199-204
references.pmid: 17066618
references.citation: Nuklearmedizin. 2003 Oct;42(5):220-3
references.pmid: 14571319
references.citation: Surgery. 2006 Feb;139(2):174-80
references.pmid: 16455325
references.citation: Surgery. 2007 Sep;142(3):398-404
references.pmid: 17723893