Valor de la SPECT-TAC en la localización de un adenoma de paratiroides ectópico retrofaríngeo como causa de hiperparatiroidismo primario persistente
Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.Revista española de medicina nuclear e imagen molecular 09/2012; 31(5):275-7. DOI: 10.1016/j.remn.2012.02.005
A common cause for surgical failure of primary hyperparathyroidism (pHPT) is the non-detection of an ectopic adenoma during the intervention. We present a case of a patient with pHPT in whom an ectopic gland was found in the right retropharyngeal space by means of a double phase (99m)Tc-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) scintigraphy and early SPECT-CT after several surgeries and imaging tests. The addition of a tomography to the planar scintigraphy increases its sensitivity and improves pathological parathyroid glands localization. The hybrid imaging is sometimes essential to obtain surgical success, as in the case of ectopic adenomas.
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ABSTRACT: Single Photon Emission Computed Tomography (SPECT) cameras have revolutionarily changed nuclear imaging techniques and given us new diagnostic possibilities. They provide images that reveal subtle information about physiological and pathological processes. For some indications like cardiac and brain imaging, as well as tumour imaging, the importance of SPECT compared to planar imaging is beyond words. This book covers a broad spectrum of clinical applications of SPECT in the diagnosis of benign and malignant diseases. The opening chapters discuss the technology and physics of SPECT and its use in dosimetry. Applications covered include, among others, imaging of the bone and lungs, imaging of neuroendocrine tumours, cardiac imaging and brain SPECT for different indications like brain tumours and epilepsy. In each chapter, different radiopharmaceuticals for SPECT imaging were discussed and the scan procedures described. Readers will find this book to be a useful source for often performed SPECT imaging in the clinical routine. Mehr anzeigen Weniger anzeigen
Chapter: SPECT in epilepsy
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ABSTRACT: Introduction Hyperparathyroidism due to a parathyroid ectopia is a rare disease; it is the most common cause of persistent or recurrent hyperparathyroidism. Its treatment is exclusively surgical and the results of the surgery benefit from the contribution of preoperative imaging techniques. The aim of this work is to illustrate the interest of the single photon emission computed tomography/computed tomography (SPECT/CT) in the detection and treatment of ectopic parathyroid orientation. Case report Clinical case 1: a 41-year-old patient was followed for persistent primary hyperparathyroidism revealed by brown tumors at the level of the lower extremity of the right femur and tibia. The rate of parathormone was 1987.4 pg/mL. The cervical echography and the scanning were not decisive. The SPECT/CT, performed during a 99mTc-MIBI scintigraphy and the same for the 2nd clinical case, has showed an area of high uptake projecting behind the left sternoclavicular joint. The diagnosis of ectopic parathyroid localization was retained. Resection and pathologic examination of the surgical specimen revealed parathyroid adenoma tissue. The evolution was marked by a normalization of the rate of parathormone. Clinical case 2: a 71-year-old patient who presents a clinico-biological board of primitive persistent hyperparathyroidism. A first scintigraphy (99mTc-MIBI) realized in 2010 was negative. The rate of parathormone was 969 ng/L, the rate of calcium was 2.90 mmol/L. Two cervical ultrasound were normal. The SPECT/CT has objectified an area of high uptake in projection at the upper floor of the middle mediastinum. The diagnosis of ectopic parathyroid localization was retained. Surgical resection and histological study revealed a parathyroid adenoma tissue. The evolution was marked by a normalization of the rate of parathormone. Discussion The SPECT/CT has an important role in the management of patients with persistent or recurrent hyperparathyroidism. It can usually visualize ectopic parathyroid injury, specify its size and anatomic relationships to optimize surgical management.
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