title: Intraoperative near-infrared fluorescence imaging of parathyroid adenomas with use of low-dose methylene blue.
abstract: BACKGROUND
  Intraoperative identification of parathyroid adenomas can be challenging. We hypothesized that low-doses methylene blue (MB) and near-infrared fluorescence (NIRF) imaging could be used to identify parathyroid adenomas intraoperatively.
  
  
  METHODS
  MB was injected intravenously after exploration at a dose of 0.5 mg/kg into 12 patients who underwent parathyroid surgery. NIRF imaging was performed using the Mini-FLARE imaging system.
  
  
  RESULTS
  In 10 of 12 patients, histology confirmed a parathyroid adenoma. In 9 of these patients, NIRF could clearly identify the parathyroid adenoma during surgery. Seven of these 9 patients had a positive preoperative (99m) Tc-sestamibi single photon emission CT (SPECT) scan. Importantly, in 2 patients, parathyroid adenomas could be identified only using NIRF.
  
  
  CONCLUSIONS
  This is the first study to show that low-dose MB can be used as NIRF tracer for identification of parathyroid adenomas, and suggests a correlation with preoperative (99m) Tc-sestamibi SPECT scanning.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Joost R
authors.initials: JR
authors.lastname: van der Vorst
authors.forename: Boudewijn E
authors.initials: BE
authors.lastname: Schaafsma
authors.forename: Floris P R
authors.initials: FP
authors.lastname: Verbeek
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Swijnenburg
authors.forename: Quirijn R J G
authors.initials: QR
authors.lastname: Tummers
authors.forename: Merlijn
authors.initials: M
authors.lastname: Hutteman
authors.forename: Jaap F
authors.initials: JF
authors.lastname: Hamming
authors.forename: Job
authors.initials: J
authors.lastname: Kievit
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Vahrmeijer
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005453:Fluorescence; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D008751:Methylene Blue
keywords: hyperparathyroidism; image-guided surgery; methylene blue; near-infrared fluorescence imaging; parathyroid adenoma