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World Journal of Surgery

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01-07-2015 | Original Scientific Report

Preoperative ¹¹C-Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI-SPECT Negative Parathyroid Adenoma

Authors: Christina Lenschow, Peter Gassmann, Christian Wenning, Norbert Senninger, Mario Colombo-Benkmann

Published in: World Journal of Surgery | Issue 7/2015

Abstract

Background

Precise preoperative localization is essential for focussed parathyroidectomy. The imaging standard consists of cervical ultrasonography (cUS) and ^99mTc-MIBI-SPECT (MIBI-SPECT). ¹¹C-methionine positron emission tomography/computed tomography (Met-PET/CT) is a promising method for localizing parathyroid adenomas. The objective of our study was to elucidate whether additional Met-PET/CT increases the rate of focussed parathyroidectomy.

Methods

Fourteen patients with primary hyperparathyroidism (HPT) and three patients with tertiary HPT underwent cUS and MIBI-SPECT. Met-PET/CT was carried out in patients with negative MIBI results. Subsequent surgical strategy was adapted according to imaging results.

Results

cUS localized a single parathyroid adenoma in 10/17 patients (59 %), while MIBI-SPECT/CT identified 11/17 single adenomas (65 %). In the remaining six patients, Met-PET/CT identified five single adenomas. This step-up approach correctly identified single adenomas in 16/17 patients (94 %).

Conclusion

Met-PET/CT raises the rate of correctly localized single parathyroid adenomas in patients with negative cUS and MIBI-SPECT/CT and increases the number of focussed surgical approaches.

Untch BR, Adam MA, Scheri RP et al (2011) Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years. J Am Coll Surg 212:522–529; discussion 529–531

Judson BL (2008) Shaha AR Nuclear imaging and minimally invasive surgery in the management of hyperparathyroidism. J Nucl Med 49:1813–1818PubMedCrossRef

Nichols KJ, Tomas MB, Tronco GG et al (2012) Sestamibi parathyroid scintigraphy in multigland disease. Nucl Med Commun 33:43–50PubMedCrossRef

Bergenfelz AO, Jansson SK, Wallin GK et al (2009) Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg 394:851–860PubMedCrossRef

Barczynski M, Cichon S, Konturek A et al (2006) Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30:721–731. doi:10.1007/s00268-005-0312-6 PubMedCrossRef

Lombardi CP, Raffaelli M, Traini E et al (2009) Video-assisted minimally invasive parathyroidectomy: benefits and long-term results. World J Surg 33(2266–228):1. doi:10.1007/s00268-009-9931-7

Tang BN, Moreno-Reyes R, Blocklet D et al (2008) Accurate pre-operative localization of pathological parathyroid glands using 11C-methionine PET/CT. Contrast Media Mol Imaging 3:157–163PubMedCrossRef

Weber T, Cammerer G, Schick C et al (2010) C-11 methionine positron emission tomography/computed tomography localizes parathyroid adenomas in primary hyperparathyroidism. Horm Metab Res 42(3):209–214

Gassmann P, Senninger N (2010) Colombo-Benkmann M Intraoperative calcium monitoring is insufficient to predict the surgical success of parathyroidectomy for primary hyperparathyroidism. Surg Today 40(1123–112):8

10.

Westerdahl J, Lindblom P, Bergenfelz A (2002) Measurement of intraoperative parathyroid hormone predicts long-term operative success. Arch Surg 137:186–190PubMedCrossRef

11.

Carneiro DM, Solorzano CC, Nader MC et al (2003) Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 134:973–979; discussion 979–981

12.

Korovin LN (2013) Guerrero MA Laterality of central venous sampling: lack of effect on the accuracy of intraoperative parathyroid hormone monitoring. Am J Surg 206(883–88):7

13.

Weber T, Maier-Funk C, Ohlhauser D et al (2013) Accurate preoperative localization of parathyroid adenomas with C-11 methionine PET/CT. Ann Surg 257:1124–1128PubMedCrossRef

14.

Witteveen JE, Kievit J, Stokkel MP et al (2011) Limitations of Tc99m-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism. World J Surg 35:128–139. doi:10.1007/s00268-010-0818-4 PubMedCentralPubMedCrossRef

15.

Grant CS, Thompson G, Farley D et al (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140:472–478; discussion 478–479

16.

Shafiei B, Hoseinzadeh S, Fotouhi F et al (2012) Preoperative (9)(9)mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: comparison of SPECT-CT, SPECT, and planar imaging. Nucl Med Commun 33:1070–1076PubMedCrossRef

17.

Boi F, Lombardo C, Cocco MC et al (2013) Thyroid diseases cause mismatch between MIBI scan and neck ultrasound in the diagnosis of hyperfunctioning parathyroids: usefulness of FNA-PTH assay. Eur J Endocrinol 168(49–5):8

18.

Reiners C, Wegscheider K, Schicha H et al (2004) Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14:926–932PubMedCrossRef

19.

Slepavicius A, Beisa V, Janusonis V et al (2008) Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial. Langenbecks Arch Surg 393:659–666PubMedCrossRef

20.

Dralle H, Sekulla C, Haerting J et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136(1310–132):2

21.

Bergenfelz A, Kanngiesser V, Zielke A et al (2005) Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 92(190–19):7

22.

Hellman P, Ahlstrom H, Bergstrom M et al (1994) Positron emission tomography with 11C-methionine in hyperparathyroidism. Surgery 116:974–981

23.

Kutler DI, Moquete R, Kazam E et al (2011) Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism. Laryngoscope 121:1219–1224PubMedCrossRef

24.

Schalin-Jantti C, Ryhanen E, Heiskanen I et al (2013) Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism? J Nucl Med 54:739–747PubMedCrossRef

25.

Oksuz MO, Dittmann H, Wicke C et al (2011) Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol 17:297–307PubMed

26.

Otto D, Boerner AR, Hofmann M et al (2004) Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET. Eur J Nucl Med Mol Imaging 31:1405–1412PubMedCrossRef

27.

Hessman O, Stalberg P, Sundin A et al (2008) High success rate of parathyroid reoperation may be achieved with improved localization diagnosis World J Surg 32; 774–781. doi:10.1007/s00268-008-9537-5; discussion 782–773

28.

Martinez-Rodriguez I, Martinez-Amador N, de Arcocha-Torres M et al (2014) Comparison of Tc-sestamibi and C-methionine PET/CT in the localization of parathyroid adenomas in primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 33(2):93–98

29.

Weber T, Luster M (2014) Localization of parathyroid adenomas with C11-methionine PET-CT. Chirurg 85:601–606PubMedCrossRef

30.

Traub-Weidinger T, Mayerhoefer ME, Koperek O et al (2014) C-methionine PET/CT imaging of Tc-MIBI-SPECT/CT negative patients with primary hyperparathyroidism and previous neck surgery. J Clin Endocrinol Metab 99(11):4199–4205

31.

Schmidt MC, Kahraman D, Neumaier B et al (2011) Tc-99m-MIBI-negative parathyroid adenoma in primary hyperparathyroidism detected by C-11-methionine PET/CT after previous thyroid surgery. Clin Nucl Med 36:1153–1155PubMedCrossRef

32.

Hermann K, Takei T, Kanegae K et al (2009) Clinical value and limitations of [11C]-methionine pet for detection and localization of suspected parathyroid adenomas. Mol Imaging Biol 11:356–363CrossRef

Title: Preoperative 11C-Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI-SPECT Negative Parathyroid Adenoma
Authors: Christina Lenschow
Peter Gassmann
Christian Wenning
Norbert Senninger
Mario Colombo-Benkmann
Publication date: 01-07-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-2992-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative ¹¹C-Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI-SPECT Negative Parathyroid Adenoma

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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