title: Intraoperative scintigraphy using a large field-of-view portable gamma camera for primary hyperparathyroidism: initial experience.
abstract: BACKGROUND
  We investigated a novel technique, intraoperative (99 m)Tc-Sestamibi (MIBI) imaging (neck and excised specimen (ES)), using a large field-of-view portable gamma camera (LFOVGC), for expediting confirmation of MIBI-avid parathyroid adenoma removal.
  
  
  METHODS
  Twenty patients with MIBI-avid parathyroid adenomas were preoperatively administered MIBI and intraoperatively imaged prior to incision (neck) and immediately following resection (neck and/or ES). Preoperative and intraoperative serum parathyroid hormone monitoring (IOPTH) and pathology (path) were also performed.
  
  
  RESULTS
  MIBI neck activity was absent and specimen activity was present in 13/20 with imaging after initial ES removal. In the remaining 7/20 cases, residual neck activity and/or absent ES activity prompted excision of additional tissue, ultimately leading to complete hyperfunctioning tissue excision. Postexcision LFOVGC ES imaging confirmed parathyroid adenoma resection 100% when postresection imaging qualitatively had activity (ES) and/or no activity (neck). The mean ± SEM time saving using intraoperative LFOVGC data to confirm resection versus first IOPTH or path result would have been 22.0 ± 2 minutes (specimen imaging) and 26.0 ± 3 minutes (neck imaging).
  
  
  CONCLUSIONS
  Utilization of a novel real-time intraoperative LFOVGC imaging approach can provide confirmation of MIBI-avid parathyroid adenoma removal appreciably faster than IOPTH and/or path and may provide a valuable adjunct to parathyroid surgery.
authors: Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, 4th Floor, Columbus, OH 43210, USA.
authors: Nathan C
authors: NC
authors: Hall
authors: Department of Surgery, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH 43210, USA.
authors: Robert L
authors: RL
authors: Plews
authors: Department of Otolaryngology, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH 43210, USA.
authors: Amit
authors: A
authors: Agrawal
authors: Department of Surgery, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH 43210, USA.
authors: Stephen P
authors: SP
authors: Povoski
authors: Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, 4th Floor, Columbus, OH 43210, USA.
authors: Chadwick L
authors: CL
authors: Wright
authors: Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, 4th Floor, Columbus, OH 43210, USA.
authors: Jun
authors: J
authors: Zhang
authors: Department of Surgery, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH 43210, USA.
authors: Edward W
authors: EW
authors: Martin
authors: Department of Surgery, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH 43210, USA.
authors: John
authors: J
authors: Phay
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D007430:Intraoperative Care / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D011300:Preoperative Care; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi
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