[A case of multiple bony pain due to metastatic malignant pheochromocytoma successfully treated with strontium-89].

A 50-year-old woman complaining of right flank pain visited our hospital. Computed tomography revealed adrenal gland tumor measuring 10 cm in diameter, and multiple bone and liver metastases. It was diagnosed as a malignant pheochromocytoma by means of endocrinological examination and metaiodobenzylguanidine scintigraphy. Although 8 courses of cyclophosphamide, vincristine and dacarbazine therapy were performed, the tumor grew larger gradually, and the bony pain progressed and became uncontrollable with oxycodone hydrochloride. After zoredronic acid and strontium-89 were administered, the bony pain reduced, and the opioid usage could be reduced. In accordance with disease progression, the bony pain progressed again, but the readministration of strontium-89 could diminish the pain again. To our knowledge, this is the first case of malignant pheochromocytoma which strontium-89 was administered, and was effective.

Intraoperative 99mTc-MIBI-guided detection of ectopic glands in secondary hyperparathyroidism.

99mTc-MIBI-guided detection of abnormal parathyroid glands in primary hyperparathyroidism (1-HPT) has become a popular and effective technique, but its efficacy for detecting the ectopic glands of secondary hyperparathyroidism (2-HPT) is still controversial. Of the 2-HPT cases from 2000 to 2004, 14 ectopic parathyroid glands in 11 patients were resected using intraoperative 99mTc-MIBI scintigraphy. We evaluated and compared the results of radioguided surgery with the preoperative findings from ultrasonography (US), computed tomography (CT), and scintigraphy. The overall results for intraoperative 99mTc-MIBI-guided detection of ectopic parathyroid glands were sensitivity of 100% (14/14) and accuracy of 84.2% (16/19) compared with 42.9% (6/14) and 31.6% (6/19), respectively, for preoperative US and 50.0% (6/12) and 42.9% (6/14), respectively, for preoperative 99mTc-MIBI scintigraphy. Using intraoperative 99mTc-MIBI-guided surgery in cases of 2-HPT will ensure all ectopic parathyroid glands are detected, making the surgery easier to perform and the outcome more successful.

Usefulness of intraoperative 99m Tc-MIBI-guided detection for recurrent sites in secondary hyperparathyroidism: a case-controlled study.

PURPOSE: (99m)Tc-Methoxyisobutylisonitrile ((99m)Tc-MIBI)-guided surgery for the detection of abnormal parathyroid glands in primary hyperparathyroidism (1-HPT) has gained popularity as an effective technique. However, in secondary hyperparathyroidism (2-HPT), the efficacy of this method remains controversial, especially for the recurrence sites of 2-HPT. METHODS: (99m)Tc-MIBI-guided surgery was performed for 28 recurrent sites of transplanted parathyroid tissue in 4 patients, and the detection rates of this method were compared with the results of preoperative ultrasound (US) examination and computed tomography (CT) scanning. RESULTS: The results of (99m)Tc-MIBI-guided surgery for regions of recurrence were a sensitivity of 100% (28/28) and an accuracy of 100% (29/29), compared with preoperative US and CT which had a sensitivity of 92.9% (26/28) and 0% (0/28), and an accuracy of 89.7% (26/29) and 0% (0/28), respectively. CONCLUSIONS: Intraoperative (99m)Tc-MIBI-guided surgery can identify recurrent parathyroid tissues of 2-HPT more precisely than preoperative US examination or CT scanning, and makes the surgery easier to perform.

A case of ganglioneuroma in which 131I-6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol scintigraphy showed high uptake in the adrenal gland leading to a misdiagnosis.

We experienced a case in which 131I-6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol (131I-adosterol) scintigraphy showed high uptake in the right adrenal gland. We diagnosed functional cortical adenoma because of the finding of 131I-adosterol scintigraphy. However, no positive findings for the existence of cortical adenoma were obtained in other examinations and we performed right adrenalectomy. Unexpectedly, pathological finding showed the right adrenal gland was occupied with a large ganglioneuroma. This is an instructive case in which 131I-adosterol scintigraphy showed abnormal high uptake in the adrenal gland, in spite of the fact that the adrenal gland was occupied by a tumor derived from adrenal medulla.

Usefulness of radio-guided surgery using technetium-99m methoxyisobutylisonitrile for primary and secondary hyperparathyroidism.

The efficacy of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI)-guided surgery for detecting abnormal parathyroid glands in patients with secondary hyperparathyroidism (2-HPT) was evaluated and compared with the results from the same examination in patients with primary hyperparathyroidism (1-HPT). The results were also compared with those found by ultrasonography (US) and preoperative 99mTc-MIBI scintigraphy was also made. At operation 99mTc-MIBI accumulated in 64 nodules of 15 cases of 2-HPT, and all of 60 parathyroid swellings were detected (true-positives 60, sensitivity 100%, accuracy 94%). In the cases of 1-HPT, 99mTc-MIBI revealed 11 hot nodules in 10 cases, and the evaluation was true-positive 10, sensitivity 100%, and accuracy 91%. US and preoperative 99mTc-MIBI scintigraphy in patients with 2-HPT had a sensitivity of 75% and 67% and an accuracy of 70% and 66%, respectively. The usefulness of 99mTc-MIBI-guided surgery for detecting abnormal parathyroid tissue in 2-HPT patients was similar to that in 1-HPT patients but was superior to US and preoperative 99mTc-MIBI scintigraphy. Intraoperative 9mTc-MIBI for patients with 2-HPT is effective and makes the surgery easier, especially when the parathyroid glands are ectopic or when a few glands are markedly enlarged but the other glands are atrophied.

The usefulness of radio-guided surgery in secondary hyperparathyroidism.

Recent reports have shown that radio-guided surgery with an intraoperative gamma probe (IGP) is useful for identifying parathyroid adenomas. The aim of this study was to evaluate the usefulness of IGP mapping in patients with secondary hyperparathyroidism. Seven patients with secondary hyperparathyroidism underwent technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) scintigraphy immediately before undergoing surgical resection of all parathyroid tissues. We compared the sensitivity of Tc-99m MIBI scintigraphy alone with that of the combination of Tc-99m MIBI scintigraphy and IGP mapping. The sensitivity of the combination of Tc-99m MIBI scintigraphy and IGP mapping was 100% (28 of 28 lesions) and was significantly higher than that of Tc-99m MIBI scintigraphy alone (71.4%, 20 of 28 lesions). The combination of the Tc-99m MIBI scintigraphy and IGP mapping has increased sensitivity for identifying parathyroid lesions during parathyroidectomy in patients with secondary hyperparathyroidism.

Imaging of bilateral striopallidodentate calcinosis.

Bilateral symmetric striopallidodentate calcinosis, also known as Fahr's disease, is characterized by bilateral calcifications of the basal ganglia, thalami, dentate nuclei of the cerebellum, and the white matter of the cerebral hemisphere. Intracranial calcifications are easily visible as high-density areas on computed tomographic images. On magnetic resonance images, the calcifications exhibit different signal intensities. The differences in signal intensity are thought to be related to the stage of the disease, differences in calcium metabolism, and the volume of the calcium deposit. The moderate reduction of cerebral blood flow in bilateral thalami was also identified using brain SPECT.