Recent advances in the techniques of preoperative parathyroid localization include ultrasonography, computed tomography, thallium-technetium subtraction scanning, magnetic resonance imaging, digital subtraction angiography with selective venous catheterization for PTH measurement, and ultrasound or CT-guided needle aspiration biopsy for cytological examination or PTH assay. These techniques are helpful for patients with hyperparathyroidism undergoing the initial operation, and essential for patients with persistent or recurrent hyperparathyroidism undergoing reoperation. Noninvasive procedures should be performed first, and the combination of any two positive studies localizes the tumor with near certainty. Invasive procedures have a higher risk of complications and are recommended only in selected patients before reoperation.
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Fluorescence microscopy of parathyroid and thyroid tissues for localization of autofluorescent substances using near-infrared wavelengths.
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Department of Otolaryngology, Kameda Medical Hospital, Chiba, Japan.
Objective: The parathyroid gland emits autofluorescence with a peak at 822 nm when excited using near-infrared light at 785 nm; this observation of autofluorescence using a near-infrared detection device is useful for identifying the parathyroid gland during surgery. We aimed to clarify the localization of autofluorescent substances in parathyroid and thyroid tissues by observing them under a fluorescence microscope through filters that selectively pass specific near-infrared wavelengths.
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Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review).
Diagnostics (Basel)
December 2024
Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, 67200 Strasbourg, France.
Patients diagnosed with multiple endocrine neoplasia type-1 (MEN1) often initially present with primary hyperparathyroidism (pHPT), and typically undergo surgical intervention. While laboratory tests are fundamental for diagnosis, imaging is crucial for localizing pathological parathyroids to aid in precise surgical planning. In this pictorial review, we will begin by comprehensively examining key imaging techniques and their established protocols, evaluating their effectiveness in detecting abnormal parathyroid glands.
View Article and Find Full Text PDFResults of F-choline and C-methionine positron emission tomography/computed tomography for the preoperative localization of hyperfunctional parathyroid glands in primary hyperparathyroidism.
Surgery
January 2025
Department of Endocrine Surgery, Marienhaus Klinikum Mainz, Germany.
Background: Preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism is essential for successful parathyroid surgery, particularly in patients with previous negative imaging or reoperations.
Methods: A multicenter registry study was performed in 776 patients with primary hyperparathyroidism from 53 hospitals in Germany and Austria who underwent parathyroid surgery after preoperative F-choline or C-methionine positron emission tomography/computed tomography (PET/CT).
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Diagnostic value of Tc-99m-MIBI SPECT/CT in parathyroid carcinoma with lung metastasis: a case report and literature review.
Front Oncol
December 2024
Department of Nuclear Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Purpose: Parathyroid carcinoma (PC) is an extremely rare disease, typically presenting with marked elevations of serum calcium concentrations and associated with significantly increased parathyroid hormone (PTH) levels. Although it progresses slowly, approximately25% of PC patients have lung metastases. In the present study, we aimed to evaluate the role of technetium-99m methoxy isobutyl isonitrile (Tc-99m-MIBI; sestamibi) SPECT/CT scintigraphy in the preoperative localization of parathyroid adenomas, incidental metastases findings of PC, and ectopic parathyroid tissue.
View Article and Find Full Text PDFAssessment of ICG fluorescence in identification and preservation of parathyroid glands in thyroid surgeries and correlation with postoperative parathormone and serum calcium levels.
Endocrine
January 2025
Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Introduction: Intraoperative parathyroid gland (PG) localization remains challenging during thyroid surgeries, contributing to postoperative hypocalcemia and hypoparathyroidism. This study assessed the efficacy of indocyanine green (ICG) fluorescence in identifying and preserving PGs during thyroid surgeries and its correlation with postoperative outcomes.
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