ABSTRACT
AIM: To evaluate the value of 99mTc-MIBI double-phase scintigraphy (DPS) and early SPECT/CT in the pre-surgical assessment of patients with primary hyperparathyroidism (PHPT). Also, to calculate the correlation between uptake and some biological parameters. MATERIAL AND METHODS: Forty patients with PHPT were included: 37 solitary adenomas, 1 hyperplasia, and 2 double adenomas. Fifteen patients had ectopic glands. DPS and early SPECT/CT were acquired in all patients. Ultrasound was performed in 31/40. All patients underwent surgery, intra-operative iPTH measurements, and histopathological examinations. Qualitative DPS uptake was assessed and correlated to pre-surgical calcium, iPTH levels, gland weight, and maximum diameter. RESULTS: In the planar study, there were 23 positive cases, 8 doubtful, and 9 negatives. With the SPECT/CT, 8/9 negatives cases were located. All doubtful cases were confirmed as positives. Gland location improved in 16 cases (12 ectopic). DPS+SPECT/CT failed to detect a solitary adenoma and at least one gland in three cases of multiglandular disease (MGD). The sensitivity by patient was: DPS 72.5%, DPS+SPECT/CT 90%, and ultrasound 42%. Ultrasound and scintigraphy (DPS+SPECT/CT) were concordant in 16/31 patients. For the rest of them, scintigraphy proved correct in 14/15, and both techniques failed in one case. There was a significant correlation between level of uptake and iPTH level, gland weight, and maximum diameter. CONCLUSION: Early SPECT/CT improves sensitivity and the locating of parathyroid pathological glands and increases diagnostic confidence. iPTH level, glandular size, and weight are related to the qualitative assessment of 99mTc-MIBI uptake in early DPS.
Subject(s)
Hyperparathyroidism, Primary/diagnostic imaging , Radionuclide Imaging , Radiopharmaceuticals , Single Photon Emission Computed Tomography Computed Tomography , Technetium Tc 99m Sestamibi , Early Diagnosis , Female , Humans , Hyperparathyroidism, Primary/blood , Hyperparathyroidism, Primary/metabolism , Male , Middle Aged , Parathyroid Hormone/blood , Radiopharmaceuticals/pharmacokinetics , Retrospective Studies , Technetium Tc 99m Sestamibi/pharmacokineticsSubject(s)
Carcinoma, Ductal, Breast/secondary , Lymph Nodes/diagnostic imaging , Radiopharmaceuticals/pharmacokinetics , Single Photon Emission Computed Tomography Computed Tomography/methods , Technetium Tc 99m Medronate/pharmacokinetics , Whole Body Imaging/methods , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/diagnostic imaging , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Lymph Nodes/metabolism , Lymphatic Metastasis , Middle Aged , Tissue DistributionSubject(s)
Hernia, Hiatal/diagnosis , Iodine Radioisotopes , Leiomyosarcoma/diagnosis , Multimodal Imaging , Retroperitoneal Neoplasms/diagnosis , Thyroid Neoplasms/diagnosis , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Whole Body Imaging , Diagnosis, Differential , Female , Humans , Incidental Findings , Middle AgedABSTRACT
Between 1979 and 1986, 30 patients with chronic pleural empyema (19 with pyothorax secondary to tuberculosis and 11 with pleural empyema following pulmonary resection) underwent two-stage treatment. The first stage consisted of open thoracostomy and was followed, 2 to 7 months later, by thoracopleuromyoplasty with latissimus dorsi, serratus anterior and pectoralis major muscles either alone or in combination. There was no operative mortality in this series of 30 operated patients. Definitive obliteraion of the pleural cavity and closure of the bronchial fistulae were obtained in 26 of the 30 patients. Partial necrosis of the muscle graft in the other 4 patients required further open drainage and an additional myoplasty. The long-term functional results in the cases of post-resection empyema were compatible with the restriction created by the pulmonary resection and, in the cases of empyema with a residual lung, with the restriction of the volume and perfusion of pulmonary parenchyma.