Virtual neck exploration in patients with hyperparathyroidism and former cervical operations

Background In surgery for primary hyperparathyroidism, preoperative localization together with intraoperative parathyroid hormone assay is important when minimal invasive operations of the parathyroid glands are intended. In cases of reoperation, correct localization of the abnormal parathyroid glands is extremely instrumental. Computed tomography (CT)– 99m Tc-sestamibi (MIBI)–single photon emission computed tomography (SPECT) image fusion allows for a virtual exploration of the neck by showing the suspected gland three-dimensionally with all the anatomic landmarks in correct position. The aim of this study was to evaluate whether CT–MIBI–SPECT image fusion is superior to MIBI–SPECT alone in detecting abnormal parathyroid glands in patients with previous neck surgery. Patients and methods In a prospective study, CT–MIBI–SPECT image fusion for preoperative localization was performed in 28 patients with hyperparathyroidism and previous neck surgery. Twenty-one patients had thyroidectomy and seven patients had surgery for hyperparathyroidism. The results of MIBI–SPECT alone and CT–MIBI–SPECT image fusion were compared in these patients. The outcome and the exact predicted position, not just the predicted side, were correlated with intraoperative findings. Results CT–MIBI–SPECT image fusion was able to predict the exact position of the abnormal gland in 24 of 28 patients (86%), whereas MIBI–SPECT alone was successful in 12 of 28 cases (43%, p