CT-MIBI image fusion: A new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism

• Published in: Surgery Vol. 135; no. 2; pp. 157 - 162
• Main Authors: Profanter, Christoph, Wetscher, Gerold J, Gabriel, Michael, Sauper, Tonja, Rieger, Michael, Kovacs, Peter, Bale, Reto, Prommegger, Rupert
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2004; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Endocrinopathies; Female; General aspects; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Preoperative Care; Prospective Studies; Recurrence; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Endocrinopathy; Relapse; Radiodiagnosis; Recurrent; Image; Medicine; Primitive; Treatment; Parathyroid diseases; Surgery; Primary; Medical imagery; Computerized axial tomography; Preoperative; Technique; Localization; Hyperparathyroidism
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(03)00396-9

Successful minimally invasive or imaging-guided operations in patients with primary, recurrent, and persistent hyperparathyroidism are based on the reliability of preoperative parathyroid localization studies. The CT-MIBI image fusion promises a higher diagnostic accuracy than current imaging procedures. The aim of our study was to assess its reliability in correctly detecting enlarged parathyroid glands. In a prospective study 24 consecutive patients underwent CT-MIBI image fusion as preoperative parathyroid localization procedure. The results of technetium 99m sestamibi single photon emission computed tomography (MIBI-SPECT) alone, today the standard method in parathyroid imaging, and CT-MIBI image fusion were analyzed by a blinded reviewer, and the imaging results were compared with the intraoperative findings. For CT-MIBI image fusion a sensitivity of 93% and a specificity of 100% in correctly detecting the position of enlarged parathyroid glands was calculated and compared with a sensitivity of MIBI-SPECT of 31% and a specificity of 87% ( P<.001). This new imaging technique enabled us to successfully treat 22 of our patients (92%) with imaging-guided surgery. Twenty (83%) underwent unilateral or minimally invasive operations. CT-MIBI image fusion appears to be superior to MIBI-SPECT in preoperative parathyroid imaging. CT-MIBI image fusion can be performed on existing CT- and MIBI-SPECT units. We recommend this method for preoperative localization in patients with primary, recurrent and persistent hyperparathyroidism.