[en] Purpose: This prospective study was conducted to determine the interest of 99mTc-MIBI pinhole SPECT (pSPECT) compared with conventional SPECT (cSPECT), planar scintigraphy and ultrasonography, for the preoperative localization of parathyroid lesions in primary hyperparathyroidism.
Methods: Fifty one patients cured after surgery were studied. pSPECT was reconstructed with a dedicated OSEM algorithm. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extra-thyroidal location of suspected lesions and was defined as follows: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive.
Results: Surgery revealed 55 lesions. Sensitivity of ultrasonography, planar imaging, cSPECT and pSPECT were respectively 51%, 76%, 82% and 87%. Five glands were only detected by pSPECT. Combination of ultrasonography, planar and pSPECT showed the highest sensitivity (94.5%). The mean CS of the 55 pathologic glands was significantly higher with pSPECT compared with planar imaging and cSPECT (p<0.0001). Compared with planar imaging and cSPECT, pSPECT increased CS for 42% and 53% of parathyroid lesions respectively, and contributed to markedly reduce the number of uncertain results. Nevertheless, planar imaging and ultrasonography were useful to analyze thyroid morphology and to detect some ectopic glands.
Conclusion: The use of pSPECT increases sensitivity and CS of scintigraphy. Combination of ultrasonography, planar and pSPECT appears to be complementary and the optimal preoperative imaging procedure in primary hyperparathyroidism. [fr] But : Evaluer prospectivement la tomoscintigraphie sténopéïque (S-TEMP) comparativement aux procédures classiquement réalisées [scintigraphies planaires Tc99m / MIBI-Tc99m, tomoscintigraphie parallèle (P-TEMP) et échographie], pour la localisation préopératoire des lésions parathyroïdiennes dans l’hyperparathyroïdie primaire.
Patients et méthodes : Les données des 51 patients guéris après chirurgie ont été analysées. La S-TEMP était reconstruite en utilisant un algorithme dédié OSEM. Après analyse visuelle des scintigraphies, un indice de confiance diagnostique (ICD) prenant en compte l’intensité et la localisation des fixations suspectes était attribué pour chaque procédure: 0=négatif ; 1=douteux ; 2=modérément positif ; 3= franchement positif.
Résultats : Cinquante cinq lésions parathyroïdiennes ont été réséquées. Les sensibilités de l’échographie, des planaires, de la P-TEMP et de la S-TEMP étaient respectivement de 51%, 76%, 82% et 87%. Cinq glandes étaient uniquement détectées en S-TEMP. La combinaison de l’échographie, des planaires et de la S-TEMP donnait la meilleure sensibilité (94.5%). L’ICD moyen des 55 lésions était significativement plus élevé en S-TEMP qu’en P-TEMP et planaire (p<0,0001). Comparativement aux planaires et à la P-TEMP, la S-TEMP améliorait l’ICD pour 42% et 53% des glandes respectivement. La S-TEMP permettait de réduire nettement les résultats douteux. Les planaires double isotope et l’échographie restaient utiles pour l’étude de la morphologie thyroïdienne et la détection de certaines ectopies.
Conclusion : La S-TEMP augmente la sensibilité et l’ICD de la scintigraphie. La combinaison échographie / planaires / S-TEMP apparaît la méthode optimale pour la détection et la localisation des lésions parathyroïdiennes.
Disciplines :
Radiology, nuclear medicine & imaging
Author, co-author :
Oudoux, Aurore; Hôtel Dieu - CHU de Nantes - France > Service de Médecine Nucléaire
Carlier, Thomas; Hôtel Dieu - CHU de Nantes - France > Service de Médecine Nucléaire
Miraillé, Eric; Hôtel Dieu - CHU de Nantes - France > Service de chirurgie
Bodet-Milin, Caroline; Hôtel Dieu - CHU de Nantes - France > Service de Médecine Nucléaire
Seret, Alain ; Université de Liège - ULiège > Département de physique > Imagerie médicale expérimentale
Defrise, Michel; Vrije Universiteit Brussel (VUB) > Nuclear Medicine Department
Aubron, F.; Centre d’Echographie - Nantes - France
Daumy, Isabelle; Centre d’Echographie - Nantes - France
Leux, Christophe; Hôpital Saint Jacques - CHU de Nantes - France > PIMESP
Kraeber-Bodéré, Françoise; Hôtel Dieu - CHU de Nantes - France > Service de Médecine Nucléaire
Ansquer, Catherine; Hôtel Dieu - CHU de Nantes - France > Service de Médecine Nucléaire
Language :
French
Title :
Tomographie sténopéïque au 99mTc-MIBI dans l’hyperparathyroïdie primaire
Alternative titles :
[en] 99mTc-MIBI pinhole SPECT in primary hyperparathyroidism
Publication date :
2007
Journal title :
Médecine Nucléaire: Imagerie Fonctionnelle et Métabolique
Mariani G., Gulec S.A., Rubello D., Boni G., Puccini M., Pelizzo M.R., et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 44 (2003) 1443-1458
Henry J.F., Iacobone M., Mirallie E., Deveze A., and Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery 130 (2001) 999-1004
Arbab A.S., Koizumi K., Toyama K., Arai T., and Arak T. Ion transport systems in the uptake of 99Tcm-tetrofosmin, 99Tcm-MIBI and 201Tl in a tumour cell line. Nucl Med Commun 18 (1997) 235-240
Carpentier A., Jeannotte S., Verreault J., Lefebvre B., Bisson G., Mongeau C.J., et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med 39 (1998) 1441-1444
Caillard C., Sebag F., Mathonnet M., Gibelin H., Brunaud L., Loudot C., et al. Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up). Surgery 141 (2007) 153-160
Moka D., Voth E., Dietlein M., Larena-Avellaneda A., and Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 128 (2000) 29-35
Biertho L.D., Kim C., Wu H.S., Unger P., and Inabnet W.B. Relationship between sestamibi uptake, parathyroid hormone essay, and nuclear morphology in primary hyperparthyroidism. J Am Coll Surg 199 (2004) 229-233
Parikshak M., Castillo E.D., Conrad M.F., and Talpos G.B. Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Am Surg 69 (2003) 393-398
Sharma J., Mazzaglia P., Milas M., Berber E., Schuster D.M., Halkar R., et al. Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality?. Surgery 140 (2006) 856-863
Arveschoug A.K., Bertelsen H., and Vammen B. Presurgical localization of abnormal parathyroid glands using a single injection of Tc-99m sestamibi: comparison of high-resolution parallel-hole and pinhole collimators, and interobserver and intraobserver variation. Clin Nucl Med 27 (2002) 249-254
Vanhove C., Defrise M., Franken P.R., Everaert H., Decninck F., and Bossuyt A. Interest of the ordered expectation maximization (OS-EM) algorithm in pinhole single-photon emission tomography reconstruction: a phantom study. Eur J Nucl Med 27 (2000) 140-146
Wanet P.M., Sand A., and Abramovici J. Physical and clinical evaluation of high-resolution thyroid pinhole tomography. J Nucl Med 37 (1996) 2017-2020
Beque D., Nuyts J., Suetens P., and Bormans G. Optimization of geometrical calibration in pinhole SPECT. IEEE Trans Med Imaging 24 (2005) 180-190
Beque D., Nuyts J., Bormans G., Suetens P., and Dupont P. Characterization of pinhole SPECT acquisition geometry. IEEE Trans Med Imaging 22 (2003) 599-612
Carlier T., Bodet-Milin C., Oudoux A., Defrise M., Seret A., Couturier O., et al. Technical feasibility of pinhole SPECT acquisition in primary hyperparathyroidism: phantoms and patients studies [abstract]. J Nucl Med 47 (2006) 378P
Smith M.F., and Jaszczak R.J. Penetration and angle-dependent sensitivity for pinhole collimation. Med Phys 24 (1997) 1701-1709
http://lib.stat.cmu.ed/R:CRAN.
Rubello D., Pelizzo M.R., and Casara D. Nuclear medicine and minimally invasive surgery of parathyroid adenomas: a fair marriage [editorial]. Eur J Nucl Med 30 (2003) 189-192
Grant C.S., Thompson G., Farley D., and van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140 (2005) 472-478
Berczi C., Mezosi E., Galuska L., Varga J., Bajnok L., Lukacs G., et al. Technetium-99m-sestamibi/pertechnetate substraction scintigraphy vs ultrasonography for preoperative localization of hyperparathyroidism. Eur Radiol 12 (2002) 605-609
Coakley A.J., Kettle A.G., Wells C.P., O'Doherty M.J., and Collins R.E. 99Tcm sestamibi - a new agent for parathyroid imaging. Nucl Med Commun 10 (1989) 791-794
Benard F., Lefebvre B., Beuvon F., Langlois M.F., and Bisson G. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med 36 (1995) 241-243
Hetrakul N., Civelek A.C., Stagg C.A., and Udelsman R. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery 130 (2001) 1011-1018
Bhatnagar A., Vezza P.R., Bryan J.A., Atkins F.B., and Ziessman H.A. Technetium-99m-sestamibi parathyroid scintigraphy: effect of P-glycoprotein, histology and tumor size on detectability. J Nucl Med 39 (1998) 1617-1620
Yamaguchi S., Yachiku S., Hashimoto H., Kaneko S., Nishihara M., Niibori D., et al. Relation between technetium 99m-methoxyisobutylisonitrile accumulation and multidrug resistance protein in the parathyroid glands. World J Surg 26 (2002) 29-34
Kao A., Shiau Y.C., Tsai S.C., Wang J.J., and Ho S.T. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging 29 (2002) 1012-1015
Taillefer R., Boucher Y., Potvin C., and Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med 33 (1992) 1801-1807
Chen C.C., Holder L.E., Scovill W.A., Tehan A.M., and Gann D.S. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT. J Nucl Med 38 (1997) 834-839
Geatti O., Shapiro B., Orsolon P.G., Proto G., Guerra U.P., Antonucci F., et al. Localization of parathyroid enlargement: experience with technetium 99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasound and computed tomography. Eur J Nucl Med 21 (1994) 17-23
Hindié E., Mellière D., Jeanguillaume C., Perlemuter L., Chéhadé F., and Galle P. Parathyroid imaging using simultaneous double window recording of technetium-99m-sestamibi and iodine-123. J Nucl Med 39 (1998) 1100-1105
Billotey C., Sarfati E., Aurengo A., Duet M., Mundler O., Toubert M.E., et al. Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 11 (1996) 1773-1778
Ansquer C., Mirallie E., Sadot S., Couturier O., Valette F., and Kraeber-Bodéré F. Comparison of 99mTc-MIBI/99mTc dual planar scintigraphy, 99mTc-MIBI SPECT and ultrasound in preoperative localization of parathyroid lesions for primary hyperparathyroididsm [abstract]. Eur J Nucl Med Mol Imaging 31 (2005) S263
Seret A., Defrise M., and Blocklet D. 180° pinhole SPET with a tilted detector and OS-EM reconstruction: phantom studies and potential clinical applications. Eur J Nucl Med 28 (2001) 1836-1841
Palmer J., and Wollmer P. Pihnole emission computed tomography: method and experimental evaluation. Phys Med Biol 35 (1990) 339-350
Profanter C., Gabriel M., Wetscher G.J., Gadenstatter M., Mittermair R., Moncayo R., et al. Accuracy of preoperative pinhole subtraction single photon emission computed tomography for patients with primary and recurrent hyperparathyroidism in an endemic goiter area. Surg Today 34 (2004) 493-497
Spanu A., Falchi A., Manca A., Marongiu P., Cossu A., Pisu N., et al. The usefulness of neck pinhole SPECT as a complementary tool to planar scintigraphy in primary and secondary hyperparathyroidism. J Nucl Med 45 (2004) 40-48
Vanhove C., Andreyev A., Defrise M., Nuyts J., and Bossuyt A. Resolution recovery in pinhole SPECT based on multi-ray projections: a phantom study. Eur J Nucl Med Mol Imaging 34 (2007) 170-180
Feldkamp L.A., Davis L.C., and Kress J.W. Practical cone-beam algorithm. J Opt Soc Am A1 (1984) 612-619
Jaszczak R.J., Li J., Wang H., Zalutsky M.R., and Coleman R.E. Pinhole collimation for ultrahigh resolution, small field of view SPECT. Phys Med Biol 39 (1994) 425-437
Manglos S.H., Jaszczak R.J., and Floyd C.E. Maximum likelihood reconstruction for cone beam SPECT: development and initial tests. Phys Med Biol 34 (1989) 1947-1957
Krausz Y., Bettman L., Guralnik L., Yosilevsky G., Keidar Z., Bar-Shalom R., et al. Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism. World J Surg 30 (2006) 76-83
Gayed I.W., Edmund Kim E., Broussard W.F., Evans D., Lee J., Broemeling L.D., et al. The value of 99mTc-Sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med 46 (2005) 248-252
Sohlberg A., Watabe H., Zeniya T., and Iida H. Comparison of multi-ray and point spread function based resolution recovery methods in pinhole SPECT reconstruction. Nucl Med Commun 27 (2006) 823-827