Detection Of Parathyroid Adenomas Research Articles

Multimodality Evaluation of Persistent Hyperparathyroidism in a Rare Case of Ectopic Submandibular Parathyroid Adenoma.

A 53-year-old woman of primary hyperparathyroidism with both ultrasound neck examination and planar 99mTc-MIBI scan being negative revealed a tracer-avid focus in the left submandibular region in early (15 minutes postinjection) 99mTc-MIBI SPECT/CT views, raising a suspicion of rare ectopic parathyroid adenoma. This finding was correlated on 4D-CT and confirmed on histopathology following surgical excision. Submandibular region is an unusual location for ectopic parathyroid adenoma. Nevertheless, high degree of suspicion with utilization of multimodality imaging including 99mTc MIBI-SPECT/CT and 4D-CT improves preoperative detection of parathyroid adenoma at rare ectopic sites as seen in this case of persistent hyperparathyroidism.

Utilizing radiomic features of arterial phase computed tomography for delineating parathyroid adenomas from surrounding anatomical structures

Aim: The study aimed to correlate radiomic data of four-dimensional computed tomography (4D-CT) with pathology-proven parathyroid adenomas to identify and quantitate select dimensional and textural features that predict parathyroid adenomas with a high degree of confidence, with the ultimate goal of improving the reliability of parathyroid adenoma detection so as to facilitate the subsequent unilateral minimally invasive parathyroidectomy (MIP). Methods: A total of 144 subjects with a history of neck 4D-CT, parathyroidectomy, and intraoperative pathology-proven parathyroid adenoma(s) were retrospectively reviewed. Following the exclusion of patients with a thyroidectomy, unsuccessful surgery, or indeterminate localization of the parathyroid adenoma on 4D-CT, a preliminary sample of 20 patients was obtained. Four anatomical structures (carotid artery, internal jugular vein, thyroid, and parathyroid adenoma) were segmented twice on 25-second arterial phase axial sections of a 4D-CT, and radiomic data of the shape, first-order, and second-order classes (106 variables) were extracted from the four structures for each patient. Results: Select radiomic variables among the carotid artery, jugular vein, and thyroid groups exhibited overall significant differences when compared to the parathyroid adenoma data (P < 0.05). Further Tukey’s post hoc analysis revealed that, when the parathyroid adenoma group was treated as the reference, 11/16 shape class, 16/18 first-order class, and 46/69 second-order class variables significantly differ from the carotid artery, jugular vein, and/or thyroid group(s). In addition, we found that the thyroid has distinct textural features compared to the parathyroid group, with 1/18 first-order and 19/69 second-order variables differing significantly between the two (P < 0.05). Notably, the texture variables such as dependence non-uniformity, long run emphasis, run percentage, run variance, and busyness exhibited the highest level of differences between the two groups (P < 0.0001). Conclusion: The parathyroid adenoma group is associated with a unique set of radiomic variables in comparison to surrounding anatomy such as the carotid artery, internal jugular vein, and thyroid. Relevance for Patients: The distinct, quantifiable differences in dimensional and textural features serve as a set of signature markers distinguishing parathyroid adenomas from their surrounding structures in 4D-CT. These attributes obviate the need for invasively locating parathyroid adenomas preoperatively, thereby enhancing the utilization rate of MIP, which has a favorable implication in the overall clinical outcomes.

The significance of early detection of parathyroid adenoma

Introduction. Parathyroid adenoma is the leading cause of primary hyperparathyroidism in 85% of cases, followed by multiglandular hyperplasia (15%) and parathyroid carcinoma (1%). Clinical complications can manifest in the bones, gastrointestinal tract, kidneys, heart, and can also lead to mental disorders and altered consciousness, including coma. Surgical intervention is the primary treatment for primary hyperparathyroidism. However, for patients who do not meet the criteria for surgery or choose to avoid it, medical management is provided. Case Report. A 52-year-old female patient presented in late 2019 with a visible, firm, irregular mass above the right clavicle. Initial bone marker tests raised suspicion of a parathyroid adenoma. The COVID-19 pandemic caused delays in further specialized examinations and postponed surgical treatment. The referring physician scheduled a parathyroid scintigraphy while awaiting an endocrinologist?s evaluation. Surgery was eventually performed in March 2023. Despite consistently elevated parathyroid hormone and ionized calcium levels, the patient avoided potential complications due to continuous monitoring by her referring physician. Conclusion. Early diagnosis of parathyroid adenoma reduces the risk of complications and improves the quality of life for patients.

Comparing accuracy of machine learning approaches to identifying parathyroid adenomas: Lessons and new directions

PurposeThe purpose of this investigation is to understand the accuracy of machine learning techniques to detect biopsy-proven adenomas from similar appearing lymph nodes and factors that influence accuracy by comparing support vector machine (SVM) and bidirectional Long short-term memory (Bi-LSTM) analyses. This will provide greater insight into how these tools could integrate multidimensional data and aid the detection of parathyroid adenomas consistently and accurately. MethodsNinety-nine patients were identified; 93 4D-CTs of patients with pathology-proven parathyroid adenomas were reviewed; 94 parathyroid adenomas and 112 lymph nodes were analyzed. A 2D slice through the lesions in each phase was used to perform sequence classification with ResNet50 as the pre-trained network to construct the Bi-LSTM model, and the mean enhancement curves were used to form an SVM model. The model characteristics and accuracy were calculated for the training and validation data sets. ResultsOn the training data, the area under the curve (AUC) of the Bi-LSTM was 0.99, while the SVM was 0.95 and statistically significant on the DeLong test. The overall accuracy of the Bi-LSTM on the validation data set was 92 %, while the SVM was 88 %. The accuracy for parathyroid adenomas specifically was 93 % for the Bi-LSTM and 83 % for the SVM model. ConclusionEnhancement characteristics are a distinguishing feature that accurately identifies parathyroid adenomas alone. The Bi-LSTM performs statistically better in identifying parathyroid adenomas than the SVM analysis when using both morphologic and enhancement information to distinguish between parathyroid adenomas and lymph nodes. Summary statementThe Bi-LSTM more accurately identifies parathyroid adenomas than the SVM analysis, which uses both morphologic and enhancement information to distinguish between parathyroid adenomas and lymph nodes, performs statistically better.

Head-to-head comparison of [11C]methionine PET, [11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism.

Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [11C]methionine PET/CT, [11C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan. We conducted a powered, prospective, blinded cohort study in patients with biochemically proven pHPT and prior negative or discordant first-line imaging consisting of ultrasonography and 99mTc-sestamibi. All patients underwent [11C]methionine PET/CT, [11C]choline PET/CT, and 4D-CT. At first, all scans were interpreted by a nuclear medicine physician, and a radiologist who were blinded from patient data and all imaging results. Next, a non-blinded scan reading was performed. The scan results were correlated with surgical and histopathological findings. Serum calcium values at least 6months after surgery were used as gold standard for curation of HPT. A total of 32 patients were included in the study. With blinded evaluation, [11C]choline PET/CT was positive in 28 patients (88%), [11C]methionine PET/CT in 23 (72%), and 4D-CT in 15 patients (47%), respectively. In total, 30 patients have undergone surgery and 32 parathyroid lesions were histologically confirmed as parathyroid adenomas. Based on the blinded evaluation, lesion-based sensitivity of [11C]choline PET/CT, [11C]methionine PET/CT, and 4D-CT was respectively 85%, 67%, and 39%. The sensitivity of [11C]choline PET/CT differed significantly from that of [11C]methionine PET/CT and 4D-CT (p = 0.031 and p < 0.0005, respectively). In the setting of pHPT with negative first-line imaging, [11C]choline PET/CT is superior to [11C]methionine PET/CT and 4D-CT in localizing parathyroid adenomas, allowing correct localization in 85% of adenomas. Further studies are needed to determine cost-benefit and efficacy of these scans, including the timing of these scans as first- or second-line imaging techniques.

Diagnostic utility of 11 C-methionine PET/CT in primary hyperparathyroidism in a UK cohort: A single-centre experience and literature review.

Primary hyperparathyroidism is a common endocrine disorder, with 80% of all cases usually caused by one single hyperfunctioning parathyroid adenoma. Conventional imaging modalities for the diagnostic work-up of primary hyperparathyroidism (PHPT) include ultrasound of the neck, 99mTc-sestamibi scintigraphy, and four-dimensional computed tomography (4D-CT). However, the role of other imaging modalities, such as 11C-methionine PET/CT, in the care pathway for PHPT is currently unclear. Here, we report our experience of the diagnostic utility of 11C-methionine PET/CT in a single-center patient cohort (n = 45). Retrospective single-center cohort study. The data of eligible patients that underwent 11C-methionine PET/CT between 2014 and 2022 at Addenbrooke's Hospital (Cambridge, UK) were collected and analyzed. The clinical utility of imaging modalities was determined by comparing the imaging result with histopathological and biochemical outcomes following surgery. In patients with persistent primary hyperparathyroidism following previous surgery, 11C-methionine PET/CT identified a candidate lesion in 6 of 10 patients (60.0%), and histologically confirmed in 5 (50.0%). 11C-methionine PET/CT also correctly identified a parathyroid adenoma in 9 out of 12 patients (75.0%) that failed to be localized on other imaging modalities. 11C-methionine PET/CT had a sensitivity of 70.0% (95% CI 55.8 - 84.2%) for the detection of parathyroid adenomas. This study highlights a diagnostic role for 11C-methionine PET/CT in patients that have undergone unsuccessful prior surgery or have equivocal or negative prior imaging results, aiding localization and a targeted surgical approach.

Relative Perfusion Differences between Parathyroid Adenomas and the Thyroid on Multiphase 4DCT.

A multiphase 4DCT technique can be useful for the detection of parathyroid adenomas. Up to 16 different phases can be obtained without significant increase of exposure dose using wide beam axial scanning. This technique also allows for the calculation of perfusion parameters in suspected lesions. We present data on 19 patients with histologically proven parathyroid adenomas. We find a strong correlation between 2 perfusion parameters when comparing parathyroid adenomas and thyroid tissue: parathyroid adenomas show a 55% increase in blood flow (BF) (p < 0.001) and a 50% increase in blood volume (BV) (p < 0.001) as compared to normal thyroid tissue. The analysis of the ROC curve for the different perfusion parameters demonstrates a significantly high area under the curve for BF and BV, confirming these two perfusion parameters to be a possible discriminating tool to discern between parathyroid adenomas and thyroid tissue. These findings can help to discern parathyroid from thyroid tissue and may aid in the detection of parathyroid adenomas.

Thyroid 18F-fluorocholine uptake in patients with chronic autoimmune thyroiditis.

Objective18F-Fluorocholine (18FCH) PET/CT has high sensitivity for parathyroid adenoma detection and can reliably exclude malignancy in thyroid nodules with indeterminate cytology. Data regarding 18FCH uptake in chronic autoimmune thyroiditis (CAT) are scarce. We aimed to assess thyroid 18FCH uptake in CAT with biological and histological correlation.Methods This is an ancillary study from the Chocolate trial (NCT02784223) that prospectively enrolled 107 patients planned for thyroid surgery. 18FCH PET/CT acquisitions were performed 20 and 60 min after injection. 18FCH uptake in the thyroid gland was assessed by measuring maximum (SUVmax) and mean (SUVmean) standardized uptake values. Thyrotropin, free thyroxine (FT4), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies were collected. The intensity of thyroiditis and the degree of fibrosis were assessed on pathology.Results CAT was evidenced in 19/107 (18%) patients. Of these, 13 (68%) displayed an increased and diffuse 18FCH thyroid uptake. This uptake pattern was not observed in patients without CAT. SUVmax and SUVmean were higher in patients with CAT than in those without (P < 0.001). At both acquisition times, SUVmax showed a monotonic relationship with the intensity of thyroiditis (Spearman ρ = 0.44 and 0.51, respectively, P < 0.001) and with the degree of fibrosis (Spearman ρ = 0.55 and 0.62, respectively, P < 0.001). SUVmax showed a linear relationship with TPOAb titers at 20 min (Pearson r = 0.54, P < 0.05; Spearman ρ = 0.59, P = 0.03).Conclusions More than two-thirds of the patients with CAT present high and diffuse thyroid 18FCH uptake. This uptake pattern is highly specific to CAT and is correlated with pathology and TPOAb titers.

Diagnostic Performance of 18F-Choline Positron Emission Tomography/Contrast-Enhanced Computed Tomography in Adenoma Detection in Primary Hyperparathyroidism after Inconclusive Imaging: A Retrospective Study of 215 Patients.

Simple SummaryPrimary hyperparathyroidism is a common pathology. Its curative treatment is based on surgery with precise localisation of the affected parathyroid glands. Our retrospective study aimed to assess the diagnostic performance of a novel imaging method called 18F-choline positron emission tomography/contrast-enhanced computed tomography (PET/ceCT) in adenoma detection after inconclusive imaging. 18F-choline PET/ceCT presented excellent diagnostic performance as a second-line imaging method. These results confirm its utility, and it could replace Tc99m-sestamibi single photon emission CT/CT as the first-line imaging method in patients with primary hyperparathyroidism.This large, retrospective, single-centre study evaluated the diagnostic performance of 18F-choline positron emission tomography/contrast-enhanced computed tomography (PET/ceCT) in preoperative parathyroid adenoma detection in primary hyperparathyroidism cases after negative/inconclusive ultrasound or other imaging findings. We included patients who underwent surgery and 18F-choline PET/ceCT for inconclusive imaging results between 2015 and 2020. We compared the 18F-choline PET/ceCT results with surgical and histopathological findings and identified the variables influencing the correlation between 18F-choline PET/ceCT and surgical findings. Of 215 enrolled patients, 269 glands (mean lesion size, 10.9 ± 8.0 mm) were analysed. There were 165 unilocular and 50 multilocular lesions; the mean preoperative calcium level was 2.18 ± 0.19 mmol/L. Among 860 estimated lesions, 219 were classified as true positive, 21 as false positive, and 28 as false negative. The per-lesion sensitivity was 88.66%; specificity, 96.57%; positive predictive value, 91.40%; and negative predictive value, 95.39%. The detection and cure rates were 82.0% and 95.0%, respectively. On univariate and multivariate analyses, the maximum standardised uptake value (SUVmax), lesion size, and unilocularity correlated with the pathologic findings of hyperfunctioning glands. 18F-choline PET/ceCT presents favourable diagnostic performance as a second-line imaging method, with SUVmax, lesion size, and unilocularity predicting a high correlation between the 18F-choline PET/ceCT and surgical findings.

Deep learning-based detection of parathyroid adenoma by 99mTc-MIBI scintigraphy in patients with primary hyperparathyroidism.

It is important to detect parathyroid adenomas by parathyroid scintigraphy with 99m-technetium sestamibi (99mTc-MIBI) before surgery. This study aimed to develop and validate deep learning (DL)-based models to detect parathyroid adenoma in patients with primary hyperparathyroidism, from parathyroid scintigrams with 99mTc-MIBI. DL-based models for detecting parathyroid adenoma in early- and late-phase parathyroid scintigrams were, respectively, developed and evaluated. The training dataset used to train the models was collected from 192 patients (165 adenoma cases, mean age: 64years ± 13, 145 women) and the validation dataset used to tune the models was collected from 45 patients (30 adenoma cases, mean age: 67years ± 12, 37 women). The images were collected from patients who were pathologically diagnosed with parathyroid adenomas or in whom no lesions could be detected by either parathyroid scintigraphy or ultrasonography at our institution from June 2010 to March 2019. The models were tested on a dataset collected from 44 patients (30 adenoma cases, mean age: 67years ± 12, 38 women) who took scintigraphy from April 2019 to March 2020. The models' lesion-based sensitivity and mean false positive indications per image (mFPI) were assessed with the test dataset. The sensitivity was 82% [95% confidence interval 72-92%] with mFPI of 0.44 for the scintigrams of the early-phase model and 83% [73-92%] with mFPI of 0.31 for the scintigrams of the delayed-phase model in the test dataset, respectively. The DL-based models were able to detect parathyroid adenomas with a high sensitivity using parathyroid scintigraphy with 99m-technetium sestamibi.

Utility of Contrast-Enhanced Ultrasound and 4-Dimensional Computed Tomography for Preoperative Detection and Localization of Parathyroid Adenomas Compared With Surgical Results.

To investigate the accuracy, sensitivity, and specificity of contrast-enhanced ultrasound (CEUS) for detection of parathyroid adenomas and compare it to those of 4-dimensional computed tomography (4DCT), which has been established as a reliable, effective tool for preoperative localization of parathyroid adenomas. About 27 patients with suspected parathyroid pathology underwent imaging evaluations with 4DCT and CEUS and 22 patients subsequently underwent surgical resection of parathyroid lesions. 4DCT and CEUS were performed and interpreted by consensus of two expert radiologists with extensive experience in each modality. Assessment for the side, z-axis (craniocaudal axis), and quadrant of the pathologically proven lesion was performed based on the surgical report. For single-gland disease, the accuracy for CEUS localization to the correct quadrant and side were 81.0 and 90.1% respectively. For single-gland disease, the accuracy for 4DCT localization to the correct quadrant and side were 81.0 and 90.5% respectively. 4DCT localization sensitivity and specificity were comparable to those for CEUS. 4DCT allowed for accurate diagnosis in multigland disease in contradistinction to CEUS. CEUS is a noninvasive, real-time imaging technique that has relatively high diagnostic confidence and accuracy of localization which are comparable to the accuracy of 4DCT for preoperative parathyroid adenoma detection, characterization, and localization. This technique should be considered for primary preoperative diagnosis, especially in younger patients.

High-frequency Multiphase 4DCT for the Detection of Parathyroid Adenomas: A Pictorial Essay.

4-Dimensional computed tomography (4DCT) for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. In our center, we introduced a high-frequency multiphase 4DCT protocol obtaining 16 phases, including 11 different arterial phases. Exposure to this multiphase 4DCT technique is similar to that for classic helical 4DCT. In this pictorial essay we reconstructed our multiphase 4DCT series in the manner of a classic helical 4DCT and compare both techniques. We illustrate how multiphase 4DCT may aid in the detection of parathyroid adenomas. We found 17 out of 19 lesions demonstrating a type A pattern of enhancement, therefore suggesting this pattern could be more prevalent than previously thought. Some parathyroid adenomas may be mistaken for enlarged lymph nodes using classic 4DCT whereas high-frequency multiphase 4DCT can detect a temporary rise in enhancement, thus suggesting the lesions in question to be of parathyroid origin. Smaller lesions may prove more obvious as the difference in enhancement between parathyroid and thyroid can become more prominent.Key PointUsing high-frequency multiphase 4DCT an arterial phase with maximum enhancement of parathyroid tissue can be defined. This phase may aid in the detection of parathyroid adenomas.

4DCT Scanning Technique for Primary Hyperparathyroidism: A Scoping Review.

Objective 4DCT for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. Protocols are often institution-specific; this review aims to summarize the different protocols and explore the reported sensitivity and specificity of different 4DCT protocols as well as the associated dose. Materials and Methods A literature study was independently conducted by two radiologists from April 2020 until May 2020 using the Medical Literature Analysis and Retrieval System Online (MEDLINE) database. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize different parameters of the scanning protocol and observed diagnostic attributes. Results A total of 51 articles were included and 56 scanning protocols were identified. Most protocols use three (n = 25) or four different phases (n = 23). Almost all authors include noncontrast enhanced imaging and an arterial phase. Arterial images are usually obtained 25–30 s after administration of contrast, and less agreement exists concerning the timing of the venous phase(s). A mean contrast bolus of 100 mL is administered at 3-4 mL/s. Bolus tracking is not often used (n = 3). A wide range of effective doses are reported, up to 28 mSv. A mean sensitivity of 81.5% and a mean specificity of 86% are reported. Conclusion Many different 4DCT scanning protocols for the detection of parathyroid adenomas exist in the literature. The number of phases does not appear to affect sensitivity or specificity. A triphasic approach, however, seems preferable, as three patterns of enhancement of parathyroid adenomas are described. Bolus tracking could help to reduce the variability of enhancement. Sensitivity and specificity also do not appear to be affected by other scan parameters like tube voltage or tube current. To keep the effective dose within limits, scanning at a lower fixed tube current seems preferable. Lowering tube voltage from 120 kV to 100 kV may yield similar image contrast but would also help lower the dose.

Detection of parathyroid adenomas with multiphase 4DCT: towards a true four-dimensional technique

BackgroundFour-dimensional computed tomography (4DCT) is a commonly performed examination in the management of primary hyperparathyroidism, combining three-dimensional imaging with enhancement over time as the fourth dimension. We propose a novel technique consisting of 16 different contrast phases instead of three or four different phases. The main aim of this study was to ascertain whether this protocol allows the detection of parathyroid adenomas within dose limits. Our secondary aim was to examine the enhancement of parathyroid lesions over time.MethodsFor this prospective study, we included 15 patients with primary hyperparathyroidism and a positive ultrasound prior to surgery. We performed 4DCT with 16 different phases: an unenhanced phase followed by 11 consecutive arterial phases and 4 venous phases. Continuous axial scanning centered on the thyroid was performed over a fixed 8 cm or 16 cm coverage volume after the start of contrast administration.ResultsIn all patients, an enlarged parathyroid lesion was demonstrated, and the mean lesion size was 13.6 mm. The mean peak arterial enhancement for parathyroid lesions was 384 Hounsfield units (HU) compared to 333 HU for the normal thyroid. No significant difference could be found. The time to peak (TTP) was significantly earlier for parathyroid adenomas than for normal thyroid tissue: 30.8 s versus 32.3 s (p value 0.008). The mean slope of increase (MSI) of the enhancement curve was significantly steeper than that of normal thyroid tissue: 29.8% versus 22.2% (p value 0.012). The mean dose length product was 890.7 mGy cm with a calculated effective dose of 6.7 mSv.ConclusionOur 4DCT protocol may allow better visualization of the pattern of enhancement of parathyroid lesions, as enhancement over time curves can be drawn. In this way, wash-in and wash-out of contrast in suspected lesions can be readily demonstrated. Motion artifacts are less problematic as multiple phases are available. Exposure to our proposed 4DCT technique is comparable to that for classic helical 4DCT. Careful selection of parameters (lowering kV and SNR) can help to further reduce the dose.

Accuracy of 18F-Fluorocholine PET for the Detection of Parathyroid Adenomas: Prospective Single-Center Study.

The purpose of this prospective study was to determine the correct localization rate (CLR) of 18F-fluorocholine PET for the detection of parathyroid adenomas in comparison to 99mTc-sestamibi imaging. Methods: This was a single-arm prospective trial. Ninety-eight patients with biochemical evidence of primary hyperparathyroidism were imaged before parathyroidectomy using 18F-fluorocholine PET/MRI. 99mTc-sestamibi imaging performed separately from the study was evaluated for comparison. The primary endpoint of the study was the CLR on a patient level. Each imaging study was interpreted by 3 masked readers on a per-region basis. Lesions were validated by histopathologic analysis of surgical specimens. Results: Of the 98 patients who underwent 18F-fluorocholine PET, 77 subsequently underwent parathyroidectomy and 60 of those had 99mTc-sestamibi imaging. For 18F-fluorocholine PET in patients who underwent parathyroidectomy, the CLR based on the masked reader consensus was 75% (95% CI, 0.63-0.82). In patients who underwent surgery and had an available 99mTc-sestamibi study, the CLR increased from 17% (95% CI, 0.10-0.27) for 99mTc-sestamibi imaging to 70% (95% CI, 0.59-0.79) for 18F-fluorocholine PET. Conclusion: In this prospective study using masked readers, the CLR for 18F-fluorocholine PET was 75%. In patients with a paired 99mTc-sestamibi study, the use of 18F-fluorocholine PET increased the CLR from 17% to 70%. 18F-fluorocholine PET is a superior imaging modality for the localization of parathyroid adenomas.

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas.

Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands’ localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the ‘ideal’ approach for the diagnosis of parathyroid adenomas.

Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas.

To compare detectability of hyperfunctioning parathyroid tissue (HPT) by digital and analog 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT. Thirty-three patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT were prospectively included. All patients accepted to be scanned by digital and analog PET/CT in the same imaging session after a single injection of 18F-fluorocholine. Three nuclear medicine physicians evaluated the digital and analog PET/CT datasets to assess the detection rate of HPT. Maximum standard uptake values (SUVmax) of HPT and locoregional lymph nodes were measured in both systems. HPT was detected in 30/33 patients by the digital system, whereas it was detected in 22/33 patients by the analog system (p < 0.01). Moreover, in 21 of these 33 patients, both systems detected one focal 18F-fluorocholine uptake, and in one patient the digital system detected two foci. Histopathology demonstrated HPT in 32 patients and it was inconclusive in one patient. The digital PET/CT detected HPT in 29 of the 32 patients, and the analog system in 22 of the 32 (p < 0.01). All HPT suspected lesions resected and detected only by the digital system (n = 8) were < 10mm (7.5 ± 1.3mm), while those detected by both systems (n = 22) were > 10mm (13 ± 3.8mm). SUVmax of HPT lesions was significantly higher than SUVmax of locoregional lymph node independently of the PET/CT system used (4.5 ± 1.9 vs. 2.9 ± 1.3, p < 0.0001). Digital PET/CT offers superior performance over analog system in patients with suspected HPT and previous negative/inconclusive imaging examinations, particularly in sub-centimeter lesions. SUVmax can help in the differentiation between HTP and locoregional lymph nodes.

Diagnostic ability of SPECT-CT of Parathyroid Gland in correlation with different Biochemical Markers, BMD and USG of neck -Single Institute based Experience.

Objective: Detection of parathyroid adenoma or hyperplasia/ carcinoma by imaging is very challenging.The objective of this study was to assess the imaging findings of Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in neck and thorax of patients and correlation with parathyroid hormone (PTH), Serum calcium, Inorganic phosphate(IP), Bone mineral density ( BMD) and also with neck ultrasonography (USG of neck).&#x0D; Material &amp; Methods: A total 75 study subjects were included in this retrospective study conducted from January 2011 to November 2018 in the Institute of Nuclear Medicine and Allied Sciences (INMAS), SSMCH, Mitford, Dhaka. All the patients came in this institute forparathyroid SPECT-CT were included for this study. SPECT-CT findings were compared with USG of neck, serum calcium, inorganic phosphate (IP) level and BMD findings.&#x0D; Results: In this study 29 (38%) were male and 46(62%) were female. Mean PTH was 469±667 pg/ml, range 20-3110pg/ml, mean serum calcium 9.8±1.5 mg/dl with range 6.20 -14.30 mg/dl, mean IP3.00.8 mg/dl with range of 1.7 -4 mg/dl. SPECT-CT positive patients were 32 (42.7%) and negative patients were 43 (53.3%). USG of neck positive patients were 21 (28%) and negative patients were 54 (72%).The PTH (r=0.53, p=0.0) serum Calcium (r=0.66,p= 0.0) positively correlate with SPECT-CT positive patients and negatively with IP level (r=-0.177, p&gt; 0.05). Among 75 the patients, 44 patients had BMD report. 28 (63.6%) patients had SPECT –CT negative findings and 16 (36.4%) patients with positive SPECT-CT findings with P value &lt;0.05.&#x0D; Conclusion: This study showed the positivity of SPECT-CT parathyroid imaging positively correlate with PTH, s.ca and inversely correlate with IP. This study also showed that SPECT-CT is better than USG of neck not only localization of parathyroid gland in normal anatomical position but also in ectopic position.&#x0D; Bangladesh J. Nuclear Med. 21(2): 69-72, July 2018

Abstract #185 Efficacy of 18F-Fluorocholine PET/ CT, 99MTC-MIBI Spect/CT and Highresolution Neck US in the Detection of Parathyroid Adenomas

Abstract #185 Efficacy of 18F-Fluorocholine PET/ CT, 99MTC-MIBI Spect/CT and Highresolution Neck US in the Detection of Parathyroid Adenomas

Integrated Cervical Ultrasound by the Same Specialist Who Performed Parathyroid Scintigraphy Improves Parathyroid Adenoma Detection

Clinical ThyroidologyVol. 30, No. 10 SummariesIntegrated Cervical Ultrasound by the Same Specialist Who Performed Parathyroid Scintigraphy Improves Parathyroid Adenoma DetectionMartin BiermannMartin BiermannSearch for more papers by this authorPublished Online:11 Oct 2018https://doi.org/10.1089/ct.2018;30.471-475AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byMultimodal imaging of thyroid cancer6 August 2020 | Current Opinion in Endocrinology, Diabetes & Obesity, Vol. 27, No. 5 Volume 30Issue 10Oct 2018 InformationCopyright 2018 American Thyroid Association, Inc.To cite this article:Martin Biermann.Integrated Cervical Ultrasound by the Same Specialist Who Performed Parathyroid Scintigraphy Improves Parathyroid Adenoma Detection.Clinical Thyroidology.Oct 2018.471-475.http://doi.org/10.1089/ct.2018;30.471-475Published in Volume: 30 Issue 10: October 11, 2018PDF download