Computed axial tomography–MIBI image fusion for preoperative localization in primary hyperparathyroidism

Profanter, Christoph; Prommegger, Rupert; Gabriel, Michael; Moncayo, Roy; Wetscher, Gerold J; Lang, Thomas; Bale, Reto

doi:10.1016/j.amjsurg.2003.12.012

« Previous Next »The American Journal of Surgery
Volume 187, Issue 3 , Pages 383-387, March 2004

Computed axial tomography–MIBI image fusion for preoperative localization in primary hyperparathyroidism

Christoph Profanter, M.D.
- Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
- Corresponding author. Tel.: +43-512-504-2950; fax: +43-512-504-4607.
Rupert Prommegger, M.D.
- Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
Michael Gabriel, M.D.
- Department of Nuclear Medicine, University of Innsbruck, Innsbruck, Austria
Roy Moncayo, M.D.
- Department of Nuclear Medicine, University of Innsbruck, Innsbruck, Austria
Gerold J Wetscher, M.D.
- Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
Thomas Lang
- First Department of Radiology, Interdisciplinary Stereotactic Interventional Planning Laboratory, University of Innsbruck, Innsbruck, Austria
Reto Bale, M.D.
- First Department of Radiology, Interdisciplinary Stereotactic Interventional Planning Laboratory, University of Innsbruck, Innsbruck, Austria

Received 18 December 2001; received in revised form 19 May 2002

Abstract

Background

An imaging-guided unilateral surgical approach in patients with primary hyperparathyroidism (HPTH) requires reliable preoperative localization procedures. Using present imaging techniques, 60% to 80% of patients with primary HPTH can be treated successfully with limited surgery. Thus, further improvement of diagnostic accuracy is required. Computed axial tomography (CAT)–MIBI image fusion was introduced as a new technique for localizing enlarged parathyroid glands. We describe the new method and present its first results.

Methods

Six consecutive patients with primary HPTH underwent CAT–MIBI image fusion for preoperative parathyroid localization. CAT and technetium-99m–sestamibi scan were performed separately. The patient's head and neck were fixed with the noninvasive Vogele-Bale-Hohner Head Holder (VBH HeadFIX; Medical Intelligence, Schwabmünchen, Germany) and the BodyFIX (Medical Intelligence) vacuum cushion. Radiographic and scintigraphic markers were mounted at the head holder and the patient. CAT and MIBI images were fused by overlaying radiographic markers using a commercial software and workstation.

Results

In 5 patients, localization and dimension of the solitary adenomas were exactly predicted. In 1 patient with multiglandular disease (3 enlarged glands), CAT–MIBI image fusion was not able to predict multiple gland involvement. However, in a retrospective analysis of the localization study, the other two enlarged parathyroid glands could be correctly identified regarding their site and size.

Conclusions

First results of CAT–MIBI image fusion are promising. The new technique provides a higher image resolution and better delimitation of enlarged parathyroid glands and adjacent anatomic structures than conventional scintigraphic methods.

Keywords: Computed axial tomography–MIBI image fusion, Preoperative parathyroid localization, Primary hyperparathyroidism