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Intraoperative 3-D mapping of parathyroid adenoma using freehand SPECT.

Rahbar K, Colombo-Benkmann M, Haane C, Wenning C, Vrachimis A, Weckesser M, Schober O - EJNMMI Res (2012)

Bottom Line: Freehand single photon emission computed tomography (fSPECT) is a three-dimensional (3-D) tomographic imaging modality based on data acquisition with a handheld detector that is moved freely, in contrast to conventional, gantry-mounted gamma camera systems.Two patients were referred with persistent hyperparathyroidism after conventional parathyroidectomy.Parathyroid hormone level decreased intraoperatively in all three patients, on average, by 79% (range 72% to 91%).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, Muenster, 48149, Germany. rahbar@uni-muenster.de.

ABSTRACT

Background: Freehand single photon emission computed tomography (fSPECT) is a three-dimensional (3-D) tomographic imaging modality based on data acquisition with a handheld detector that is moved freely, in contrast to conventional, gantry-mounted gamma camera systems. In this pilot study, we evaluated the feasibility of fSPECT for intraoperative 3-D mapping in patients with parathyroid adenomas.

Methods: Three patients (range 30 to 45 years) diagnosed with hyperparathyroidism (one primary and two tertiary) underwent parathyroid scintigraphy with technetium-99m sestamibi (99mTc-MIBI) to localize parathyroid adenomas. Two patients were referred with persistent hyperparathyroidism after conventional parathyroidectomy. In all three patients, a planar scintigraphy of the neck was performed 10 min after injection (p.i.) followed by SPECT/CT (Symbia T2, Siemens Healthcare) and a correlative ultrasound 2 h p.i. 99mTc-MIBI scan was performed the day before surgery in two patients and at the same day in one patient. fSPECT images were acquired intraoperatively using declipse SPECT (SurgicEyeTM).

Results: A total of five parathyroid adenomas were successfully located with SPECT/CT. fSPECT allowed intraoperative detection of all adenomas, and successful parathyroidectomy was accomplished. Parathyroid hormone level decreased intraoperatively in all three patients, on average, by 79% (range 72% to 91%).

Conclusion: In this preliminary study, we could demonstrate that intraoperative localization of parathyroid adenomas is feasible using the freehand SPECT technology, thus allowing an image-guided parathyroidectomy.

No MeSH data available.


Related in: MedlinePlus

Freehand SPECT in the OR and scan area (green) and protocol. (A) Freehand SPECT device in the operating room. The device is placed next to the operating table with its stereostatic monitoring means (infrared cameras) looking at the operating field (red arrow). A touch screen enables user interaction and visualization of the reconstructed images (yellow arrow). (B) Scan area (in green) for a side of the neck including also the clavicular region. Scan protocol consists of painting this area with the gamma probe from the two different directions (red arrow) shown in the figure.
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Figure 1: Freehand SPECT in the OR and scan area (green) and protocol. (A) Freehand SPECT device in the operating room. The device is placed next to the operating table with its stereostatic monitoring means (infrared cameras) looking at the operating field (red arrow). A touch screen enables user interaction and visualization of the reconstructed images (yellow arrow). (B) Scan area (in green) for a side of the neck including also the clavicular region. Scan protocol consists of painting this area with the gamma probe from the two different directions (red arrow) shown in the figure.

Mentions: Technetium-99m sestamibi (99mTc-MIBI) scan is the procedure of choice for the localization of parathyroid adenomas with improved accuracy using single photon emission computed tomography (SPECT) [1]. SPECT/CT has contributed to the localization of parathyroid adenomas by providing an anatomical context to scintigraphic images and correcting for attenuation effects [2]. Intraoperative localization using gamma probes has been proposed especially in minimally invasive surgery. This concept was the basis for the development of handheld imaging devices [3,4]. Freehand single photon emission computed tomography (fSPECT) was introduced lately as a three-dimensional (3-D) imaging and navigation technique designed for use in the operating room [5]. The technique is based on the use of a gamma probe, the position and orientation of which is stereotactically monitored while scanning an area of interest [5] (Figure 1A). ‘Scanning’ here means moving the gamma probe freely with the hand pointing at the body of the patient from different directions, i.e., ‘painting’ the surface of the patient with the gamma probe (Figure 1B). Each count rate acquired at a certain position can be seen as a one-pixel projection acquired by a one-pixel gamma camera (the gamma probe). A set of these one-pixel projections can be reconstructed into a 3-D image as in SPECT using also the information on its position and orientation. For visualization, the reconstructed images are then superimposed on a conventional video of the body surface, which is simultaneously recorded. The superimposition succeeds using augmented reality means, where virtual data (here, SPECT/CT or fSPECT images) are overlaid on the live video of an optical video camera. The use of intraoperative 3-D imaging for navigated extirpation of parathyroid adenomas might change the operation time and potentially the morbidity related to exploratory search of these adenomas using just the gamma probe. Furthermore, the possibility of controlling parathyroidectomy may reduce the need for reoperation. In this preliminary study, we apply the technique of fSPECT for the localization of parathyroid adenomas and evaluate its feasibility.


Intraoperative 3-D mapping of parathyroid adenoma using freehand SPECT.

Rahbar K, Colombo-Benkmann M, Haane C, Wenning C, Vrachimis A, Weckesser M, Schober O - EJNMMI Res (2012)

Freehand SPECT in the OR and scan area (green) and protocol. (A) Freehand SPECT device in the operating room. The device is placed next to the operating table with its stereostatic monitoring means (infrared cameras) looking at the operating field (red arrow). A touch screen enables user interaction and visualization of the reconstructed images (yellow arrow). (B) Scan area (in green) for a side of the neck including also the clavicular region. Scan protocol consists of painting this area with the gamma probe from the two different directions (red arrow) shown in the figure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472282&req=5

Figure 1: Freehand SPECT in the OR and scan area (green) and protocol. (A) Freehand SPECT device in the operating room. The device is placed next to the operating table with its stereostatic monitoring means (infrared cameras) looking at the operating field (red arrow). A touch screen enables user interaction and visualization of the reconstructed images (yellow arrow). (B) Scan area (in green) for a side of the neck including also the clavicular region. Scan protocol consists of painting this area with the gamma probe from the two different directions (red arrow) shown in the figure.
Mentions: Technetium-99m sestamibi (99mTc-MIBI) scan is the procedure of choice for the localization of parathyroid adenomas with improved accuracy using single photon emission computed tomography (SPECT) [1]. SPECT/CT has contributed to the localization of parathyroid adenomas by providing an anatomical context to scintigraphic images and correcting for attenuation effects [2]. Intraoperative localization using gamma probes has been proposed especially in minimally invasive surgery. This concept was the basis for the development of handheld imaging devices [3,4]. Freehand single photon emission computed tomography (fSPECT) was introduced lately as a three-dimensional (3-D) imaging and navigation technique designed for use in the operating room [5]. The technique is based on the use of a gamma probe, the position and orientation of which is stereotactically monitored while scanning an area of interest [5] (Figure 1A). ‘Scanning’ here means moving the gamma probe freely with the hand pointing at the body of the patient from different directions, i.e., ‘painting’ the surface of the patient with the gamma probe (Figure 1B). Each count rate acquired at a certain position can be seen as a one-pixel projection acquired by a one-pixel gamma camera (the gamma probe). A set of these one-pixel projections can be reconstructed into a 3-D image as in SPECT using also the information on its position and orientation. For visualization, the reconstructed images are then superimposed on a conventional video of the body surface, which is simultaneously recorded. The superimposition succeeds using augmented reality means, where virtual data (here, SPECT/CT or fSPECT images) are overlaid on the live video of an optical video camera. The use of intraoperative 3-D imaging for navigated extirpation of parathyroid adenomas might change the operation time and potentially the morbidity related to exploratory search of these adenomas using just the gamma probe. Furthermore, the possibility of controlling parathyroidectomy may reduce the need for reoperation. In this preliminary study, we apply the technique of fSPECT for the localization of parathyroid adenomas and evaluate its feasibility.

Bottom Line: Freehand single photon emission computed tomography (fSPECT) is a three-dimensional (3-D) tomographic imaging modality based on data acquisition with a handheld detector that is moved freely, in contrast to conventional, gantry-mounted gamma camera systems.Two patients were referred with persistent hyperparathyroidism after conventional parathyroidectomy.Parathyroid hormone level decreased intraoperatively in all three patients, on average, by 79% (range 72% to 91%).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, Muenster, 48149, Germany. rahbar@uni-muenster.de.

ABSTRACT

Background: Freehand single photon emission computed tomography (fSPECT) is a three-dimensional (3-D) tomographic imaging modality based on data acquisition with a handheld detector that is moved freely, in contrast to conventional, gantry-mounted gamma camera systems. In this pilot study, we evaluated the feasibility of fSPECT for intraoperative 3-D mapping in patients with parathyroid adenomas.

Methods: Three patients (range 30 to 45 years) diagnosed with hyperparathyroidism (one primary and two tertiary) underwent parathyroid scintigraphy with technetium-99m sestamibi (99mTc-MIBI) to localize parathyroid adenomas. Two patients were referred with persistent hyperparathyroidism after conventional parathyroidectomy. In all three patients, a planar scintigraphy of the neck was performed 10 min after injection (p.i.) followed by SPECT/CT (Symbia T2, Siemens Healthcare) and a correlative ultrasound 2 h p.i. 99mTc-MIBI scan was performed the day before surgery in two patients and at the same day in one patient. fSPECT images were acquired intraoperatively using declipse SPECT (SurgicEyeTM).

Results: A total of five parathyroid adenomas were successfully located with SPECT/CT. fSPECT allowed intraoperative detection of all adenomas, and successful parathyroidectomy was accomplished. Parathyroid hormone level decreased intraoperatively in all three patients, on average, by 79% (range 72% to 91%).

Conclusion: In this preliminary study, we could demonstrate that intraoperative localization of parathyroid adenomas is feasible using the freehand SPECT technology, thus allowing an image-guided parathyroidectomy.

No MeSH data available.


Related in: MedlinePlus