CT-MIBI-SPECT Fusion Imaging Combined with Gamma Probe for Minimally Invasive Radioguided Parathyroidectomy (MIRP)

Ashley      L. Pistorio; David      Goldenberg

Abstract

Primary hyperparathyroidism (HPT) occurs in approximately 42 out of every 100,000 individuals, with women affected nearly three times more than men. It is predominantly caused by a single parathyroid adenoma, but can also be caused by glandular hyperplasia, and carcinoma. Definitive treatment for primary hyperparathyroidism remains surgical removal of affected glands, often a challenge due to the considerable anatomical variability. Minimally invasive radioguided parathyroidectomy (MIRP) is a directed surgical approach, made possible by the introduction of novel imaging techniques. Detection and precise localization of adenoma has been achieved by the use of sestamibi scans for a decade prior to the advent of computed tomography-(99m)Tc-sestamibi-single photon emission computed tomography image fusion (CT-MIBI-SPECT). In this paper, we present the use of CT-MIBI-SPECT fusion imaging in combination with a gamma probe intra-operatively as an accurate method for guided parathyroidectomy and discuss effects of the development of nuclear imaging techniques on radioguided parathyroid surgery.

Keywords: MIRP, minimally invasive radioguided parathyroidectomy, sestamibi scan, primary hyperparathyroidism, parathyroid adenoma, parathyroid hormone, rapid parathyroid hormone, serum calcium, ionized calcium, technetium 99, Fusion Imaging, Gamma Probe, glandular hyperplasia, carcinoma, hyperparathyroidism, computed tomography, parathyroidectomy, radionucleotide scan, hyperparathyroidism surgery, hypercalcemia, Adenomas, bilateral neck exploration, methoxy-isobutyl-isonitrile, CT-MIBI-SPECT, technetium-99m sestamib, multiglandular disease, osteoporosis, Parathyroid hyperplasia, Immunoscintigraphy