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Preoperative 11C-Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI-SPECT Negative Parathyroid Adenoma

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Abstract

Background

Precise preoperative localization is essential for focussed parathyroidectomy. The imaging standard consists of cervical ultrasonography (cUS) and 99mTc-MIBI-SPECT (MIBI-SPECT). 11C-methionine positron emission tomography/computed tomography (Met-PET/CT) is a promising method for localizing parathyroid adenomas. The objective of our study was to elucidate whether additional Met-PET/CT increases the rate of focussed parathyroidectomy.

Methods

Fourteen patients with primary hyperparathyroidism (HPT) and three patients with tertiary HPT underwent cUS and MIBI-SPECT. Met-PET/CT was carried out in patients with negative MIBI results. Subsequent surgical strategy was adapted according to imaging results.

Results

cUS localized a single parathyroid adenoma in 10/17 patients (59 %), while MIBI-SPECT/CT identified 11/17 single adenomas (65 %). In the remaining six patients, Met-PET/CT identified five single adenomas. This step-up approach correctly identified single adenomas in 16/17 patients (94 %).

Conclusion

Met-PET/CT raises the rate of correctly localized single parathyroid adenomas in patients with negative cUS and MIBI-SPECT/CT and increases the number of focussed surgical approaches.

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Abbreviations

cUS:

Cervical ultrasound

MIBI:

Methoxy-isobutyl-isonitrile

MIBI-SPECT/CT:

Tc-99m sestamibi (MIBI)-scintigraphy with SPECT/CT

Met-PET/CT:

11C-methionine positron emission tomography/computed tomography

MIVAP:

Minimally video-assisted parathyroidectomy

OMIP:

Open minimally video-assisted parathyroidectomy

pHPT:

Primary hyperparathyroidism

sHPT:

Secondary hyperparathyroidism

tHPT:

Tertiary hyperparathyroidism

iPTH:

Intraoperative parathyroid hormone assay

R:

Right

L:

Left

N/A:

Not analyzed

n.d.:

No correct detection

TH:

Thoracic vertebra

References

  1. Untch BR, Adam MA, Scheri RP et al (2011) Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years. J Am Coll Surg 212:522–529; discussion 529–531

  2. Judson BL (2008) Shaha AR Nuclear imaging and minimally invasive surgery in the management of hyperparathyroidism. J Nucl Med 49:1813–1818

    Article  PubMed  Google Scholar 

  3. Nichols KJ, Tomas MB, Tronco GG et al (2012) Sestamibi parathyroid scintigraphy in multigland disease. Nucl Med Commun 33:43–50

    Article  PubMed  Google Scholar 

  4. Bergenfelz AO, Jansson SK, Wallin GK et al (2009) Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg 394:851–860

    Article  PubMed  Google Scholar 

  5. Barczynski M, Cichon S, Konturek A et al (2006) Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30:721–731. doi:10.1007/s00268-005-0312-6

    Article  PubMed  Google Scholar 

  6. Lombardi CP, Raffaelli M, Traini E et al (2009) Video-assisted minimally invasive parathyroidectomy: benefits and long-term results. World J Surg 33(2266–228):1. doi:10.1007/s00268-009-9931-7

    Google Scholar 

  7. Tang BN, Moreno-Reyes R, Blocklet D et al (2008) Accurate pre-operative localization of pathological parathyroid glands using 11C-methionine PET/CT. Contrast Media Mol Imaging 3:157–163

    Article  CAS  PubMed  Google Scholar 

  8. Weber T, Cammerer G, Schick C et al (2010) C-11 methionine positron emission tomography/computed tomography localizes parathyroid adenomas in primary hyperparathyroidism. Horm Metab Res 42(3):209–214

  9. Gassmann P, Senninger N (2010) Colombo-Benkmann M Intraoperative calcium monitoring is insufficient to predict the surgical success of parathyroidectomy for primary hyperparathyroidism. Surg Today 40(1123–112):8

    Google Scholar 

  10. Westerdahl J, Lindblom P, Bergenfelz A (2002) Measurement of intraoperative parathyroid hormone predicts long-term operative success. Arch Surg 137:186–190

    Article  CAS  PubMed  Google Scholar 

  11. Carneiro DM, Solorzano CC, Nader MC et al (2003) Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 134:973–979; discussion 979–981

  12. Korovin LN (2013) Guerrero MA Laterality of central venous sampling: lack of effect on the accuracy of intraoperative parathyroid hormone monitoring. Am J Surg 206(883–88):7

    Google Scholar 

  13. Weber T, Maier-Funk C, Ohlhauser D et al (2013) Accurate preoperative localization of parathyroid adenomas with C-11 methionine PET/CT. Ann Surg 257:1124–1128

    Article  PubMed  Google Scholar 

  14. Witteveen JE, Kievit J, Stokkel MP et al (2011) Limitations of Tc99m-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism. World J Surg 35:128–139. doi:10.1007/s00268-010-0818-4

    Article  PubMed Central  PubMed  Google Scholar 

  15. Grant CS, Thompson G, Farley D et al (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140:472–478; discussion 478–479

  16. Shafiei B, Hoseinzadeh S, Fotouhi F et al (2012) Preoperative (9)(9)mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: comparison of SPECT-CT, SPECT, and planar imaging. Nucl Med Commun 33:1070–1076

    Article  CAS  PubMed  Google Scholar 

  17. Boi F, Lombardo C, Cocco MC et al (2013) Thyroid diseases cause mismatch between MIBI scan and neck ultrasound in the diagnosis of hyperfunctioning parathyroids: usefulness of FNA-PTH assay. Eur J Endocrinol 168(49–5):8

    Google Scholar 

  18. Reiners C, Wegscheider K, Schicha H et al (2004) Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14:926–932

    Article  PubMed  Google Scholar 

  19. Slepavicius A, Beisa V, Janusonis V et al (2008) Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial. Langenbecks Arch Surg 393:659–666

    Article  PubMed  Google Scholar 

  20. Dralle H, Sekulla C, Haerting J et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136(1310–132):2

    Google Scholar 

  21. Bergenfelz A, Kanngiesser V, Zielke A et al (2005) Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 92(190–19):7

    Google Scholar 

  22. Hellman P, Ahlstrom H, Bergstrom M et al (1994) Positron emission tomography with 11C-methionine in hyperparathyroidism. Surgery 116:974–981

  23. Kutler DI, Moquete R, Kazam E et al (2011) Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism. Laryngoscope 121:1219–1224

    Article  PubMed  Google Scholar 

  24. Schalin-Jantti C, Ryhanen E, Heiskanen I et al (2013) Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism? J Nucl Med 54:739–747

    Article  CAS  PubMed  Google Scholar 

  25. Oksuz MO, Dittmann H, Wicke C et al (2011) Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol 17:297–307

    PubMed  Google Scholar 

  26. Otto D, Boerner AR, Hofmann M et al (2004) Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET. Eur J Nucl Med Mol Imaging 31:1405–1412

    Article  CAS  PubMed  Google Scholar 

  27. Hessman O, Stalberg P, Sundin A et al (2008) High success rate of parathyroid reoperation may be achieved with improved localization diagnosis World J Surg 32; 774–781. doi:10.1007/s00268-008-9537-5; discussion 782–773

  28. Martinez-Rodriguez I, Martinez-Amador N, de Arcocha-Torres M et al (2014) Comparison of Tc-sestamibi and C-methionine PET/CT in the localization of parathyroid adenomas in primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 33(2):93–98

  29. Weber T, Luster M (2014) Localization of parathyroid adenomas with C11-methionine PET-CT. Chirurg 85:601–606

    Article  CAS  PubMed  Google Scholar 

  30. Traub-Weidinger T, Mayerhoefer ME, Koperek O et al (2014) C-methionine PET/CT imaging of Tc-MIBI-SPECT/CT negative patients with primary hyperparathyroidism and previous neck surgery. J Clin Endocrinol Metab 99(11):4199–4205

  31. Schmidt MC, Kahraman D, Neumaier B et al (2011) Tc-99m-MIBI-negative parathyroid adenoma in primary hyperparathyroidism detected by C-11-methionine PET/CT after previous thyroid surgery. Clin Nucl Med 36:1153–1155

    Article  PubMed  Google Scholar 

  32. Hermann K, Takei T, Kanegae K et al (2009) Clinical value and limitations of [11C]-methionine pet for detection and localization of suspected parathyroid adenomas. Mol Imaging Biol 11:356–363

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery and Visceral Surgery, University Hospital of Muenster, Waldeyerstrasse 1, 48149, Muenster, Germany

    Christina Lenschow, Peter Gassmann, Norbert Senninger & Mario Colombo-Benkmann

  2. Department of Nuclear Medicine, University of Muenster, Muenster, Germany

    Christian Wenning

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  1. Christina Lenschow
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  2. Peter Gassmann
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Correspondence to Christina Lenschow.

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Lenschow, C., Gassmann, P., Wenning, C. et al. Preoperative 11C-Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI-SPECT Negative Parathyroid Adenoma. World J Surg 39, 1750–1757 (2015). https://doi.org/10.1007/s00268-015-2992-x

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