Humans ; Parathyroid Neoplasms/diagnostic imaging* ; Single Photon Emission Computed Tomography Computed Tomography ; Parathyroid Glands/diagnostic imaging* ; Technetium Tc 99m Sestamibi ; Radiopharmaceuticals ; Hyperparathyroidism, Primary

OBJECTIVE: To compare the diagnostic value among the single photon emission computed tomography/computerized tomography (SPECT/CT), (99m)Tc-sestamibi (MIBI) planar scintigraphy, ultrasonography (US) and computerized tomography (CT) in diagnosis of patients with hyperparathyroidism (HPT).
 METHODS: A total of 59 patients were retrospectively recruited for this study. The patients received parathyroidectomy and were verified by pathological examination. Among them, 31, 28 and 26 patients received SPECT/CT, (99m)Tc-MIBI planar scintigraphy, US and CT, respectively, before the parathyroidectomy. The sensitivity for localization or qualitation was compared between SPECT/CT and (99m)Tc-MIBI planar scintigraphy; the sensitivity, specificity and accuracy were compared among the SPECT/CT, (99m)Tc-MIBI planar scintigraphy, US and CT.
 RESULTS: There was no statistical difference in the sensitivity of localization between SPECT/CT and (99m)Tc-MIBI planar scintigraphy (P>0.05); however, the SPECT/CT exhibited more sensitive than the (99m)Tc-MIBI planar scintigraphy in detection of hyperplastic lesions (P<0.05). Among the four imaging modalities, SPECT/CT had advantages over (99m)Tc-MIBI planar scintigraphy in terms of accuracy (P<0.05). In contrast, the sensitivity of CT was not as good as that of SPECT/CT and US (both P<0.05). For the diagnosis of lesions with a diameter more than 1 cm, the sensitivity of SPECT/CT was the best (all P<0.05). However, the sensitivity of US was the best in diagnosis of lesions with a diameter less than 1 cm (all P<0.05).
 CONCLUSION The SPECT/CT is more effective than (99m)Tc-MIBI planar scintigraphy in diagnosis of HPT, especially in diagnosis of hyperplastic lesions. Both of SPECT/CT and US are recommended to localize the target parathyroid lesions of HPT before the parathyroidectomy.
Humans ; Hyperparathyroidism ; diagnosis ; diagnostic imaging ; Hyperplasia ; Parathyroid Glands ; diagnostic imaging ; pathology ; Parathyroidectomy ; Radionuclide Imaging ; Retrospective Studies ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVE: The purpose of this study was to discuss the role of the combination of carbon nanoparticles and medical imaging to manage the cervical lymph nodes in patients with thyroid carcinoma. METHOD: Eighty one patients with thyroid carcinoma that primary treated were divided into two groups: trial group and control group. Carbon nanoparticles were injected into the thyroid gland of trial group patients. Central compartment (level VI) dissection, levels IIl and IV dissection, lateral node (levels II-V) dissection were performed respectively in all the patients on the basis of medical imaging and pathology. Total lymph nodes, metastasis lymph nodes, black stained lymph nodes and black stained metastasis lymph nodes of trial group were counted respectively in different dissection specimens. Total lymph nodes and metastasis lymph nodes of control group were counted respectively in different dissection specimens. Parathyroid glands of thyroid or central compartment dissection specimens were counted in two groups. RESULT: In trial group, rate of staining lymph node was 80.0% in central neck dissection tissue, 54.9% in levels III and IV dissection specimen, 39.1% in lateral node dissection specimen. In central compartment dissection tissue, lymph nodes on average in control group were less than in trial group (3.03 ± 2.07 vs. 4.72 ± 2.97) (P < 0.01). The same was in levels III and lV dissection specimen (5.53 ± 3.78 vs. 10.29 ± 3.36) (P < 0.01). As for lateral node dissection specimen,there was no statistic difference in the two group (13.4 ± 9.67 vs. 14.56 ± 6.28) (P > 0.05). There was no statistic difference between control group and trial group for the metastasis lymph nodes in difference dissection specimens. Parathyroid gland was found in 3 thyroid or central compartment dissection specimens among trial group, which was found in 9 specimens among control group, the difference had statistical significance (P < 0.05). CONCLUSION During levels III and IV dissection in cN0 patients or central compartment dissection, lymph nodes can be signed well by carbon nanoparticles, which can improve the lymph node detection rate, but can not increase the lymph node detection rate in cN+ patients. Parathyroid gland can be preserved by carbon nanoparticles during the thyroid gland resection and central neck dissection.
Carbon ; administration & dosage ; Diagnostic Imaging ; methods ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Nanoparticles ; administration & dosage ; Neck ; Neck Dissection ; methods ; Parathyroid Glands ; Staining and Labeling ; Thyroid Neoplasms ; diagnosis ; pathology ; Thyroidectomy

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.
Calcium ; blood ; Female ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; diagnosis ; Hypocalcemia ; drug therapy ; etiology ; Mediastinal Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Middle Aged ; Parathyroid Glands ; pathology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Postoperative Complications ; Technetium Tc 99m Sestamibi ; pharmacology ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUNDDrug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism.

METHODSFrom September 1999 through September 2006, parathroidectomy and autotransplantation was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone (iPTH) were monitored preoperatively, intraoperatively, and postoperatively.

RESULTSA total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperative exploration was 94.4%. The average iPTH value was (110.90 +/- 67.42) ng/L, (433.80 +/- 243.72) ng/L, (48.80 +/- 42.69) ng/L, (229.04 +/- 172.68) ng/L and (232.39 +/- 224.05) ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2 years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients.

CONCLUSIONSThe total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.

Adult ; Aged ; Calcium ; blood ; Female ; Follow-Up Studies ; Forearm ; Humans ; Hyperparathyroidism, Secondary ; blood ; surgery ; Male ; Middle Aged ; Parathyroid Glands ; diagnostic imaging ; transplantation ; Parathyroid Hormone ; blood ; Parathyroidectomy ; methods ; Transplantation, Autologous ; Ultrasonography

OBJECTIVETo evaluate the sensitivity and usefulness of 99mTc-sestamibi scintigraphy (SS) and neck ultrasonography (US) as preoperative localization procedures in patients with primary hyperparathyroidism (pHPT).

METHODS160 patients with proved pHPT in Peking Union Medical College Hospital from June 1983 to June 2002 were studied. There were 107 women(66.9%) and 53 men (33.1%), with a mean age of 38.9 years (10-73 years). 100 patients were underwent SS and 148 patients were underwent US prior to surgery, and the results were compared with operative and histological findings.

RESULTSThe sensitivity of SS and US in localization of the enlarged parathyroid glands was 94.0% and 85.1% respectively, and the positive predictive value of SS and US was 100% and 89.1% respectively, the overall sensitivity was 98.9% by combination of SS and US. In solitary parathyroid adenomas group (n = 145), the sensitivity of SS and US was 93.3% and 84.7% respectively; There was no significant difference (P = 0.428) in sensitivity of SS between the parathyroid glands correctly identified and undetected in classical neck location as compared with ectopic parathyroid glands, whereas significantly (P = 0.026) influenced by the US sensitivity.

CONCLUSIONSDifferent sensitivity exit between SS and VS in preoperative localization in patients with pHPT undergoing parathyroidectomy. The combined use of SS and US could increase the sensitivity of localization technique. Ectopic parathyroid had no influence on the sensitivity of 99mTc-MIBI scanning, but decreased the sensitivity of ultrasonography. The size of parathyroid tumors had effects on the sensitivity of ultrasonography. Otherwise, various conditions causing SS false negative were observed. Some interfere factors should be excluded when SS negative results were encountered in clinical practice.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Hyperparathyroidism ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neck ; diagnostic imaging ; Parathyroid Glands ; diagnostic imaging ; pathology ; Preoperative Care ; Radionuclide Imaging ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi ; therapeutic use ; Ultrasonography