Intraoperative near-infrared fluorescence imaging of parathyroid adenomas with use of low-dose methylene blue
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Joost R van der Vorst1, Boudewijn E Schaafsma, Floris P R Verbeek
1Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Background:
Intraoperative identification of parathyroid adenomas can be challenging. We hypothesized that low-doses methylene blue (MB) and near-infrared fluorescence (NIRF) imaging could be used to identify parathyroid adenomas intraoperatively.
Methods:
MB was injected intravenously after exploration at a dose of 0.5 mg/kg into 12 patients who underwent parathyroid surgery. NIRF imaging was performed using the Mini-FLARE imaging system.
Results:
In 10 of 12 patients, histology confirmed a parathyroid adenoma. In 9 of these patients, NIRF could clearly identify the parathyroid adenoma during surgery. Seven of these 9 patients had a positive preoperative (99m) Tc-sestamibi single photon emission CT (SPECT) scan. Importantly, in 2 patients, parathyroid adenomas could be identified only using NIRF.
Conclusion:
This is the first study to show that low-dose MB can be used as NIRF tracer for identification of parathyroid adenomas, and suggests a correlation with preoperative (99m) Tc-sestamibi SPECT scanning.
Insights
Low-dose methylene blue (MB) and near-infrared fluorescence (NIRF) imaging effectively identified parathyroid adenomas in most patients. This technique offers a novel approach for intraoperative parathyroid adenoma localization.
Area of Science:
- Endocrinology
- Surgical Oncology
- Medical Imaging
Background:
- Intraoperative localization of parathyroid adenomas presents a significant surgical challenge.
- Accurate identification is crucial for successful parathyroidectomy and preventing complications.
Purpose of the Study:
- To evaluate the efficacy of low-dose methylene blue (MB) as a near-infrared fluorescence (NIRF) tracer for intraoperative parathyroid adenoma identification.
- To assess the correlation between NIRF imaging findings and preoperative diagnostic scans.
Main Methods:
- Twelve patients undergoing parathyroid surgery received an intravenous injection of low-dose MB (0.5 mg/kg).
- Near-infrared fluorescence (NIRF) imaging was performed using the Mini-FLARE system to visualize parathyroid adenomas.
- Histopathological confirmation of parathyroid adenoma was obtained for all patients.
Main Results:
- Histology confirmed parathyroid adenomas in 10 out of 12 patients.
- NIRF imaging successfully identified parathyroid adenomas in 9 of these 10 patients.
- In two cases, parathyroid adenomas were exclusively identified using NIRF imaging, highlighting its unique diagnostic capability.
Conclusions:
- Low-dose MB serves as an effective NIRF tracer for intraoperative parathyroid adenoma identification.
- The study suggests a potential correlation between NIRF imaging results and preoperative (99m)Tc-sestamibi SPECT scans.
- This novel application of MB and NIRF imaging offers a promising tool to improve surgical outcomes in parathyroid surgery.
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