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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 of the left side of the neck of patient 2 as video overlay. The arrow shows the adenoma in the image.
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Figure 3: Freehand SPECT of the left side of the neck of patient 2 as video overlay. The arrow shows the adenoma in the image.

Mentions: During surgery, SPECT/CT images (i.e., both the SPECT hotspots as well as the anatomy using different CT windows) were projected on the patient's body surface on the live video from the perspective of an optical camera placed above the operating table (‘video overlay’) as well as from the gamma probe in real-time (3-D view; Figure 2). Subsequently, fSPECT images (1,790 ± 647 measurements, 109 ± 62 s) were acquired for each side of the neck before preparation of that side, visualizing all five adenomas (Figure 2). Depth information provided by the system was used during preparation. After extirpation of each adenoma, freehand SPECT images were acquired to validate parathyroidectomy (Figure 3). No focal accumulation of radioactivity was found in the thyroid bed after surgery.


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 of the left side of the neck of patient 2 as video overlay. The arrow shows the adenoma in the image.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Freehand SPECT of the left side of the neck of patient 2 as video overlay. The arrow shows the adenoma in the image.
Mentions: During surgery, SPECT/CT images (i.e., both the SPECT hotspots as well as the anatomy using different CT windows) were projected on the patient's body surface on the live video from the perspective of an optical camera placed above the operating table (‘video overlay’) as well as from the gamma probe in real-time (3-D view; Figure 2). Subsequently, fSPECT images (1,790 ± 647 measurements, 109 ± 62 s) were acquired for each side of the neck before preparation of that side, visualizing all five adenomas (Figure 2). Depth information provided by the system was used during preparation. After extirpation of each adenoma, freehand SPECT images were acquired to validate parathyroidectomy (Figure 3). No focal accumulation of radioactivity was found in the thyroid bed after surgery.

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