Better Details Of Parathyroid Disease With Molecular Imaging

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The potential use of hybrid molecular imaging to provide precise information about the location and function ofSNM a condition known as "hyperparathyroidism", a benign tumor that produces too much hormone and causes high levels of calcium in the blood, has been illustrated at The Society of Nuclear Medicine's 2010.

Approximately 100,000 Americans develop hyperparathyroidism each year. Women outnumber men by two to one, and risk increases with age. In women 60 years and older, two out of 1,000 will develop hyperparathyroidism each year, According to the National Institutes of Health. Hyperparathyroidism is usually treated by invasive, exploratory surgery. However, the chosen SNM Image of the Year shows the potential of fusion of high-resolution 3D anatomy with functional SPECT images to provide critical information to help physicians to diagnose and treat hyperparathyroidism. With these fusion images, physicians can obtain detailed information about the anatomical localization, blood supply and metabolism of the overactive parathyroid adenoma."Each year, SNM chooses an image that exemplifies the most cutting-edge molecular imaging research today, as well as illustrates the potential of molecular imaging to provide physicians with a critical component for the detection and diagnosis of disease," said Michael M. Graham, Ph.D., M.D., immediate past-president of SNM. "This year's Image of the Year provides an example of a novel imaging presentation, using a combination of single photon emission computed tomography (SPECT) with high resolution CT angiography, which pinpoints the abnormally functioning parathyroid adenoma and the arteries feeding it. With this information, physicians may be able determine the exact location and size of the abnormal gland and plan minimally invasive surgery that reduces operative time, thus improving patient care."

The study involved 31 patients who were scanned for symptoms of primary hyperparathyroidism using a nuclear medicine technique called MIBI, combined with SPECT and multi-detector computed tomography (MDCT). After they have obtained thin-slice multi-planar reconstruction images of the neck using a 64-row MDCT and successfully enlarged the gland, and generated the volume-rendered images of the thyroid and parathyroid with feeding arteries. As well as obtaining 2- and 3-dimensional fusion images. The diagnostic value of 3-dimensional SPECT/CT fusion images was compared with those by MIBI SPECT alone and by ultrasound. It was found that the hybrid molecular imaging technique was more effective than single modality scanning alone. In addition to this study, 34 glands were identified by surgery. SPECT/CT fusion image identified 32 (94%), while MIBI SPECT and ultrasound identified 27 (79%). The fusion imaging technique identified five glands that were missed by ultrasound and MIBI SPECT. It also showed feeding arteries in 29 adenomas successfully and the operation time is decreased by approximately 82% in preliminary results of eight patients compared to studies performed without fusion images.

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