Title:
Pre-operative imaging in primary hyperparathyroidism with ultrasonography and sestamibi scintigraphy
Authors:
P. K. Leupe, P. R. Delaere, V. L. Vander Poorten and F. Debruyne
Institutions:
Department of Otorhinolaryngology, Head and Neck surgery, KULeuven, Leuven, Belgium
Keywords:
Primary hyperparathyroidism; ultrasonography; Technetium Tc 99m Sestamibi
Pages:
173 - 180
Abstract:
Pre-operative imaging in primary hyperparathyroidism with ultrasonography and sestamibi scintigraphy. Problem/Objective: Resection of pathological parathyroid glands is the only curative therapy in primary hyperparathy- roidism. Adequate pre-operative localization of the pathological glands is very useful, whichever surgical technique is preferred. Objectives: The aim of our study was to evaluate and compare high resolution ultrasonography and sestamibi scintigraphy as pre-operative imaging techniques and to explore their relationship with certain demographic and biochemical variables. Patients and methods: Data from 368 patients with primary hyperparathyroidism referred for surgery were retrospective- ly analysed. The results of pre-operative imaging were compared with the operative findings and the anatomopathologi- cal report. Results: In predicting the correct side of the lesion (right or left), ultrasonography had a positive predictive value (PPV) of 84%, whereas sestamibi imaging had a PPV of 93%. If both imaging techniques had a concordant positive result, the PPV was 99%. The PPV in predicting the correct quadrant, however, was only 61% for sestamibi scintigraphy and 40% for ultrasonography. Conclusions: In our study, sestamibi imaging was better than ultrasonography as a single pre-operative localization imaging method for primary hyperparathyroidism. A concordant positive result was exceedingly reliable in indicating the side of the lesion. It seemed far more difficult to predict the quadrant correctly, especially because of misinterpreta- tion of the upper adenomas.
Issue:
Vol. 7, 2011, 3rd trimester


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Pre-operative imaging in primary hyperparathyroidism with ultrasonography and sestamibi scintigraphy