Parathyroid Imaging Techniques
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Preoperative Parathyroid Imaging and Localization
The major function of the parathyroid glands is to maintain the body's calcium level in both the blood and bones. These glands are responsible for producing the parathyroid hormone (PTH) which exists to help regulate calcium levels in the bloodstream.
Primary hyperparthyroidism is most commonly caused by one or more of the parathyroid glands forming a tumor that secretes excessive parathyroid hormone.
Preoperative parathyroid imaging and localization provides an important role in providing preoperative evaluation of patients with primary hyperparathyroidism. Finding the tumor before incision allows a surgeon to make a smaller incision without the need to do a traditional neck exploration.
Imaging studies are performed only after a diagnosis of primary hyperparathyroidism is established through biochemical findings.
Primary hyperparthyroidism is most commonly caused by one or more of the parathyroid glands forming a tumor that secretes excessive parathyroid hormone.
Preoperative parathyroid imaging and localization provides an important role in providing preoperative evaluation of patients with primary hyperparathyroidism. Finding the tumor before incision allows a surgeon to make a smaller incision without the need to do a traditional neck exploration.
Imaging studies are performed only after a diagnosis of primary hyperparathyroidism is established through biochemical findings.
Common Parathyroid Imaging Scans
The parathyroid sestamibi scan is the preferred test to find an abnormal parathyroid gland. Sestamibi is a small protein that is labeled with the radiopharmaceutical technetium-99m. Tc99m Sestamibi is a very safe and mild radioactive agent that is injected and then preferably absorbed by the abnormal parathyroid gland i.e. parathyroid adenoma. Using an advanced gamma nuclear camera, the abnormal gland can then be visualized in the neck. Normal parathyroid glands typically will not take up the radioactive particles because they are suppressed by an elevated calcium level caused by the abnormal gland.A Sestamibi scan of the parathyroid gland will show the one bad parathyroid tumor and it will NOT show normal glands. The other 3 parathyroids are essentially sleeping and not functioning at a normal state. The normal parathyroids produce relatively minimal parathyroid hormone.
The sestamibi scan procedure usually takes less than three hours. Unlike other iodine-based procedures, the Tc-99 sestamibi scan does not produce any allergies or adverse reactions.
About 97% of parathyroid disease patients have only one bad parathyroid.
Other Parathyroid Imaging Techniques
- Parathyroid ultrasound is a relatively inexpensive and non-invasive test that does not require radiation. Additionally, ultrasound of the thyroid and parathyroid glands is used preoperatively to rule out thyroid nodules that may need to be evaluated prior to parathyroid surgery. It is not particularly accurate in localizing a parathyroid adenoma.
- A high-resolution parathyroid CT scan is used to help localize a parathyroid tumor when a parathyroid scan and parathyroid ultrasound were unsuccessful at localizing the tumor. A CT scan is quicker and less expensive than an MRI. Since the introduction of Sestamibi scans, CT scans are not performed as frequently today.
- Parathyroid MRI is reserved for cases of primary hyperparathyroidism where properly performed Sestamibi scan and high-resolution parathyroid ultrasound did not localize a parathyroid adenoma.
- SPECT (Single Photon Emission Computerized Tomography) scanning is a 3-D method of Parathyroid Sestamibi Scan. With this method 3-dimensional images of the parathyroid can be taken after Technetium-99m Sestamibi is injected. This method is 2-3 percent more accurate than a standard parathyroid scan.
Is Imaging Important?
Identifying the specific diseased parathyroid gland before the operation is preferred. Advanced noninvasive parathyroid imaging techniques help determine exactly where to operate. This results in less scarring and faster patient recovery. Minimally Invasive Parathyroidectomy
About 97% of parathyroid disease patients have only one bad parathyroid. So rather than use the traditional parathyroid operation technique requiring a large neck incision to locate and examine the four parathyroid glands, the minimally invasive surgical technique simply remove the one bad gland and leave the others alone.Minimally invasive parathyroid surgery is an outpatient procedure that requires just a one-inch incision and can be performed in less than half an hour. In addition, patients recover faster with minimal scarring.
The New York Center for Advanced Parathyroid Surgery, performs the latest in minimally invasive parathyroid surgical techniques. For more information about your parathyroid surgery treatment options, visit www.advancedparathyroid.com.
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