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TumorDiagnostik & Therapie 2007; 28(1): 21-25
DOI: 10.1055/s-2006-927325
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Präoperative Bildgebung bei primärem Hyperparathyreoidismus

Preoperative Imaging in primary HyperparathyroidismL. S. Freudenberg1 , A. Frilling2 , S.-Y Sheu4 , E. G. Eising1 , O. E. Janssen3 , A. Bockisch1 , R. Görges1
  • 1Klinik für Nuklearmedizin (Direktor: Prof. Dr. med. Dr. rer nat. A. Bockisch)
  • 2Klinik und Poliklinik für Allgemein- und Transplantationschirurgie (Direktor: Prof. Dr. med. Dr. hc mult. C.E. Broelsch)
  • 3Klinik für Endokrinologie im Zentrum für Innere Medizin (Direktor: Prof. Dr. med. K. Mann)
  • 4Institut für Pathologie (Direktor: Prof. Dr. med. K. W. Schmid)
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Publication History

Publication Date:
21 February 2007 (online)

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Zusammenfassung

Mit der Änderung der chirurgischen Taktik bei Patienten mit primärem Hyperparathyreoidismus zugunsten einer minimalinvasiven Vorgehensweise gewinnt die präoperative Darstellung von pathologisch veränderten Nebenschilddrüsen an Bedeutung. Neben anatomischen Lokalisationsmethoden bietet die Nebenschilddrüsenszintigrafie die Möglichkeit, morphologisch schwer erkennbare Strukturen zu detektieren, da die Lokalisation hier primär auf funktionellen Eigenschaften des Zielgewebes beruht. Ziel der Arbeit ist es, einen aktuellen Überblick über die Möglichkeiten der Nebenschilddrüsenlokalisationsdiagnostik zu geben. Insbesondere werden die diagnostischen Möglichkeiten bei kombinierter Verwendung von synergistischen Verfahren im Sinne einer anatomisch-funktionellen Bildgebung dargestellt. In Conclusio empfehlen wir vor einer minmalinvasiven Intervention zur Sanierung eines Hyperparathyreoidismus die kombinierte sonografisch-szintigrafische Nebenschilddrüsenlokalisationsdiagnostik, bestehend aus sequenzieller 99 mTc-Sestamibi-Szintigrafie inklusive SPECT plus Schilddrüsenszintigrafie und hochauflösender zervikaler Sonografie.

Abstract

In patients with primary hyperparathyroidism (pHPT) considered for surgery there has been increasing stress laid upon minimally invasive procedures in recent years. Precise localization prior to surgery is crucial in this context. Besides high-resolution ultrasonography, functional imaging using 99 mTc-Sestamibi is gaining importance as scintigraphic localization primarily relays on functional features than on morphologic appearance. The purpose of this review is to summarize the accuracy of different diagnostic imaging methods in pHPT with respect to synergistic anatomic and functional imaging. In conclusion we recommend prior to minimally invasive treatment of hyperparathyroidism combined localization studies, consisting of sequential 99 mTc-Sestamibi scintigraphy, additional SPECT plus thyroid gland scintigraphy, plus high-resolution cervical ultrasonography.

Schlüsselwörter

Primärer Hyperparathyreoidismus - Lokalisationsdiagnostik - 99 mTc-Sestamibi-Szintigrafie - Ultraschall - minimalinvasive Chirurgie

Key words

hyperparathyroidism - 99 mTc-Sestamibi scintigraphy - ultrasound - minimal-invasive surgery

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Dr. med. Lutz S. Freudenberg, M.A., M.B.A.

Klinik für Nuklearmedizin, Universität Essen

Hufelandstraße 55

45122 Essen

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Fax: ++ 49/2 01/7 23 59 64

Email: lutz.freudenberg@uni-essen.de

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