The EANM practice guidelines for parathyroid imaging Petranović Ovčariček, Petra; Giovanella, Luca; Carrió Gasset, Ignasi ...
European journal of nuclear medicine and molecular imaging,
08/2021, Letnik:
48, Številka:
9
Journal Article
Recenzirano
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Introduction
Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before ...surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration.
Methods
Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT.
Conclusion
These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.
Purpose
Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the ...disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results.
Methods
Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals.
Conclusion
Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (
68
Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (
123
I)/iodine-131 (
131
I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.
58-year-old female patient, who has been treated and followed-up for ovarian cancer and its colonic metastasis has also been on hemodialysis three times a week for 10 years due to chronic renal ...failure. Because of the right femoral pain, she underwent bone scintigraphy in order to evaluate the likelihood of developing metastatic disease. Diffuse Tc-99m MDP uptake in the heart was detected on her bone scan. This case was presented to highlight underlying reasons of this very rare and unexpected cardiac uptake in the patient without known heart disease.
The purpose of this work is to develop a medical system that optimizes the sensitivity of the bone scintigraphy in the diagnosis to patients with bone cancer problems, bone disease, infections, bone ...wear, or malignancies like bone metastasis which will monitor the deterioration of the bones caused by the disease in case. In this work the sensitivity of bone scintigraphy was improved to help in their interpretation and therefore we aid in the radiological digitization, which consists of a process that allows to obtain a digitalized image from an analogue image. Which means it is susceptible to being stored in the form of a number representing the position of a pixel point, elementary surface unit. This can be done using the means of digitization and digital image processing (PDI), in addition to the enhancement tools offered by various processes, a greater sensitivity is projected in the radiological images, to evaluate the results potential gain in the diagnostic probability offered by this digitization process. The picture formats that can be used are JPG, BMP or DICOM. To have an improvement in the radiological diagnostic sensitivity, a conversion of a grayscale image to the color map in RGB (Red, Green and Blue) must be done, representing the values of the pixels of the grayscale image as follows: (1) The lowest values will be displayed in shades of blue, (2) Intermediate values are represented in shades of green, and (3) The lowest values will be displayed in shades of red. When using this color map, the image will be different tones by the combination of the above-mentioned colors.
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