Virtual neck exploration in patients with hyperparathyroidism and former cervical operations

Abstract
Background  In surgery for primary hyperparathyroidism, preoperative localization together with intraoperative parathyroid hormone assay
is important when minimal invasive operations of the parathyroid glands are intended. In cases of reoperation, correct localization
of the abnormal parathyroid glands is extremely instrumental. Computed tomography (CT)–99mTc-sestamibi (MIBI)–single photon emission computed tomography (SPECT) image fusion allows for a virtual exploration of the
neck by showing the suspected gland three-dimensionally with all the anatomic landmarks in correct position. The aim of this
study was to evaluate whether CT–MIBI–SPECT image fusion is superior to MIBI–SPECT alone in detecting abnormal parathyroid
glands in patients with previous neck surgery.

Patients and methods  In a prospective study, CT–MIBI–SPECT image fusion for preoperative localization was performed in 28 patients with hyperparathyroidism
and previous neck surgery. Twenty-one patients had thyroidectomy and seven patients had surgery for hyperparathyroidism. The
results of MIBI–SPECT alone and CT–MIBI–SPECT image fusion were compared in these patients. The outcome and the exact predicted
position, not just the predicted side, were correlated with intraoperative findings.

Results  CT–MIBI–SPECT image fusion was able to predict the exact position of the abnormal gland in 24 of 28 patients (86%), whereas
MIBI–SPECT alone was successful in 12 of 28 cases (43%, p < 0.004) only. CT–MIBI–SPECT image fusion detected all three pathologic glands in their ectopic position. With MIBI–SPECT
alone, just one ectopic pathologic gland was found.

Conclusion  This study provides evidence that CT–MIBI–SPECT image fusion is superior to MIBI–SPECT alone in preoperative localization
of enlarged parathyroid glands in patients with hyperparathyroidism and previous neck surgery. This should be kept in mind
if the results are compared to earlier studies concerning CT–MIBI–SPECT image fusion.

Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00423-008-0359-6Authors
Gerd Wimmer, Center of Operative Medicine Department of Visceral, Transplant and Thoracic Surgery Anichstrasse 35 6020 Innsbruck AustriaReto Bale, Medical University of Innsbruck Department of Radiology Innsbruck AustriaPeter Kovacs, Medical University of Innsbruck Department of Radiology Innsbruck AustriaMichael Gabriel, Medical University of Innsbruck Department of Nuclear Medicine Innsbruck AustriaDaniel Putzer, Medical University of Innsbruck Department of Nuclear Medicine Innsbruck AustriaTonja Sauper, Center of Operative Medicine Department of Visceral, Transplant and Thoracic Surgery Anichstrasse 35 6020 Innsbruck AustriaMichael Sieb, Center of Operative Medicine Department of Visceral, Transplant and Thoracic Surgery Anichstrasse 35 6020 Innsbruck AustriaChristoph Profanter, Center of Operative Medicine Department of Visceral, Transplant and Thoracic Surgery Anichstrasse 35 6020 Innsbruck AustriaRaimund Margreiter, Center of Operative Medicine Department of Visceral, Transplant and Thoracic Surgery Anichstrasse 35 6020 Innsbruck AustriaRupert Prommegger, Center of Operative Medicine Department of Visceral, Transplant and Thoracic Surgery Anichstrasse 35 6020 Innsbruck Austria

Journal Langenbeck's Archives of SurgeryOnline ISSN 1435-2451Print ISSN 1435-2443 (Source: Langenbeck's Archives of Surgery)