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Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
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Preoperatory imaging evaluation in primary hyperparathyroidism and associated thyroid disease.

Paolo Del Rio, Greta Tosi, Tommaso Loderer

    Annali Italiani Di Chirurgia
    |November 19, 2021
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    Summary

    SPECT-CT and ultrasound are effective imaging techniques for primary hyperparathyroidism surgery. Intraoperative parathormone (IOPTH) levels predict successful patient healing after parathyroidectomy.

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    Area of Science:

    • Endocrinology
    • Surgical Oncology
    • Radiology

    Background:

    • Primary hyperparathyroidism (pHPT) involves excessive parathormone secretion.
    • Minimally invasive surgery is increasingly used for pHPT, aided by advanced imaging and intraoperative parathormone (IOPTH) monitoring.
    • This study evaluates various imaging techniques for pHPT localization.

    Purpose of the Study:

    • To compare the effectiveness of different preoperative imaging modalities for primary hyperparathyroidism.
    • To assess the correlation between intraoperative parathormone levels and patient healing outcomes.
    • To evaluate the impact of concurrent thyroid disease on imaging sensitivity.

    Main Methods:

    • Retrospective analysis of 80 patients undergoing parathyroidectomy for pHPT (2012-2018).
    • Evaluation of preoperative imaging (ultrasound, scintigraphy, SPECT-CT), intraoperative findings, and follow-up data.
    • Assessment of imaging concordance, thyroid disease presence, and IOPTH levels.

    Main Results:

    • SPECT-CT demonstrated high positivity (93.1%), sensitivity (88.9%), and accuracy (82.8%).
    • Neck ultrasound yielded the highest positive predictive value (94.4%).
    • Decreased IOPTH correlated with successful patient healing (p <0.05), as did age <70 and favorable post-operative calcium/PTH levels.

    Conclusions:

    • The combination of ultrasound and scintigraphy is effective for preoperative evaluation.
    • SPECT/CT serves as an optimal complementary examination.
    • Thyroid disease presence reduces imaging sensitivity, while IOPTH is a key predictor of healing.