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در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم

در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم. مشهد، ملاصدرا 11 ، پلاک 1/4 www.DSNMC.ir Tel:+98(51) 38411524; +98(51)38472927. Nuclear Medicine in Parathyroid Gland a brief review. V. R. Dabbagh Kakhki, M.D. Nuclear Medicine Specialist Associate Professor DSNMC

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در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم

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  1. در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم مشهد، ملاصدرا 11 ، پلاک 1/4 www.DSNMC.ir Tel:+98(51) 38411524; +98(51)38472927

  2. Nuclear Medicine in Parathyroid Gland a brief review V. R. Dabbagh Kakhki, M.D. Nuclear Medicine Specialist Associate Professor DSNMC Nuclear Medicine Research Center (NMRC; MUMS)

  3. Primary Hyperparathyroidism • Experienced hands: • Successful removal of hyperfuntiononing thyroid tissue: 85-95% • Most: Bilateral neck exploration without pre-operative localization: • >75%: more extensive surgical procedure than is necessary • From 1990: no recommendation preoperative localization but for recurrent or persistent PHPTH • Gradual shift toward preoperative localization before initial surgery. • 75% now • Avoid bilateral exploration: limited exploration • Decrease operative time • Identify ectopic glands • Cost effective: 23.5% reduction in cost

  4. Radiopharmaceutical • Selenium-75 selenomethionine • Tl-201 • Tc99m Sestamibi (choice) • Tc99m Tetrofosmine • Subtraction imaging with: • Tc99m pertecnetate and Tl-201 thyroidthyroid and parathyroid

  5. Tc99m-Sestamibi Parathyroid Imaging • Patient preparation: None • Tracer : Tc99m-Sestamibi, 20 mCi, IV • Time of imaging: Early scan: 15 min Delayed scan: 2 hr • Views : ANT, LAO , RAO ( 300 k) planar SPECT may also be a consideration

  6. Tc99m-Sestamibi Parathyroid Scan • Detection of adenoma • Sensitivity: 81%-95% • Specificity>95% • PPV:97% • MIBI Uptake: • Adenoma size • Function: PTH or Ca • Proportion of oxyphil cells • False Positive: Nodular goiter

  7. Tc99m-Sestamibi Parathyroid Scan • Hyperplasic tissue • Sensitivity: <70% • Specificity and PPV>90%

  8. Tc99m-Sestamibi Parathyroid Scan • SPECT: • Increase detection rate • Better localization • Intraoperative gamma probe: • Reducing the likelihood of persistent or recurrent disease • Radioguided minimally invasive parathyroidectomy

  9. Persistent or recurrent PHPTH • 5-15% • Compromise localization: • Distorted normal tissue planes • Increased likelihood of ectopic glands, multigland and supernumerary glands • Success rate at reoperation: 60-62% • Tc99m-Sestamibi: neck and mediastinum • Specially SPECT

  10. V.R.Dabbagh; DSNMC; www.DSNMC.ir

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