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Hyperparathyroidism- Imaging techniques |
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Hyperparathyroidism- Imaging techniques
General
Fell out of favour to image pre op but “focused approach” is becoming popular again. The main reason quoted was that without imaging you need to explore both sides.
All but the sestamibi scan were poor pre op investigations. Sestamibi study 6331 patients showed this to be cost and time effective as pre op scanning allows exploration of a single side.(Gagner et al 2004)
Modalities
o But limited to 5mm
o Poor views retrosternal, retro oesophageal.
o Sensitivity 70% and best when combined with scintigraphy
o But can only localise >5mm glands and in only 59%.
o It is expensive
o The PT glands take up TH + Tc
o The thyroid takes up Tc only
o Digital subtraction produces a sensitivity 75% and false
+ve rate 25%
o Setamibi scan. (Tc99m) (GOLD STANDARD)
o A derivative of Tc and taken up into Mitochondria
o 80-100% sensitivity Specificity 90%
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