Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism
Multiple endocrine neoplasia 1 (MEN1) is a rare genetic syndrome characterized by the manifestation of tumors in endocrine glands most often in the parathyroid gland (PG). Treatment may involve several parathyroidectomies (PTX), especially in young patients, which increases the risk of postoperative...
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Bioscientifica
2020-08-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0053.xml |
| _version_ | 1818033113244106752 |
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| author | Thien Vinh Luong Lars Rejnmark Anne Kirstine Arveschoug Peter Iversen Lars Rolighed |
| author_facet | Thien Vinh Luong Lars Rejnmark Anne Kirstine Arveschoug Peter Iversen Lars Rolighed |
| author_sort | Thien Vinh Luong |
| collection | DOAJ |
| description | Multiple endocrine neoplasia 1 (MEN1) is a rare genetic syndrome characterized by the manifestation of tumors in endocrine glands most often in the parathyroid gland (PG). Treatment may involve several parathyroidectomies (PTX), especially in young patients, which increases the risk of postoperative complications. We present a 16-year-old patient with a family history of MEN1 syndrome. The patient started to show biochemical signs of hyperparathyroidism (HPT) and hypercalcemia at the age of 10. One and a half years later a PTX was successfully performed with removal of the two left PGs. However, a rise in plasma parathyroid hormone and ionized calcium was observed 4 years later. Preoperative noninvasive imaging with 99mTc-sestamibi scintigraphy showed no definitive parathyroid adenoma. A 11C-methionine position emission tomography combined with MRI (MET-PET/MRI) was then performed and detected a focus posterior to the lower part of the right thyroid lobe. Intraoperative angiography with fluorescence and indocyanine green dye was used to assess the vascularization of the remaining PGs. The lower right PG was removed. The patient was discharged with normalized biochemical values and without postoperative complications. Recurrence of primary HPT is frequent in MEN1 patients which often necessitates repeated operations. Our case report showed that the use of advanced noninvasive preoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken into consideration in selected cases to avoid postoperative complications. To our knowledge, this is the first case where MET-PET/MRI has been used to detect parathyroid pathology. |
| first_indexed | 2024-12-10T06:18:06Z |
| format | Article |
| id | doaj.art-6116ef14b474445286a4b890aa10b15e |
| institution | Directory Open Access Journal |
| issn | 2052-0573 2052-0573 |
| language | English |
| last_indexed | 2024-12-10T06:18:06Z |
| publishDate | 2020-08-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-6116ef14b474445286a4b890aa10b15e2022-12-22T01:59:24ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732020-08-01111510.1530/EDM-20-0053Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidismThien Vinh Luong0Lars Rejnmark1Anne Kirstine Arveschoug2Peter Iversen3Lars Rolighed4Department of Nuclear Medicine and PET-CentreDepartment of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DenmarkDepartment of Nuclear Medicine and PET-CentreDepartment of Nuclear Medicine and PET-CentreDepartment of OtorhinolaryngologyMultiple endocrine neoplasia 1 (MEN1) is a rare genetic syndrome characterized by the manifestation of tumors in endocrine glands most often in the parathyroid gland (PG). Treatment may involve several parathyroidectomies (PTX), especially in young patients, which increases the risk of postoperative complications. We present a 16-year-old patient with a family history of MEN1 syndrome. The patient started to show biochemical signs of hyperparathyroidism (HPT) and hypercalcemia at the age of 10. One and a half years later a PTX was successfully performed with removal of the two left PGs. However, a rise in plasma parathyroid hormone and ionized calcium was observed 4 years later. Preoperative noninvasive imaging with 99mTc-sestamibi scintigraphy showed no definitive parathyroid adenoma. A 11C-methionine position emission tomography combined with MRI (MET-PET/MRI) was then performed and detected a focus posterior to the lower part of the right thyroid lobe. Intraoperative angiography with fluorescence and indocyanine green dye was used to assess the vascularization of the remaining PGs. The lower right PG was removed. The patient was discharged with normalized biochemical values and without postoperative complications. Recurrence of primary HPT is frequent in MEN1 patients which often necessitates repeated operations. Our case report showed that the use of advanced noninvasive preoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken into consideration in selected cases to avoid postoperative complications. To our knowledge, this is the first case where MET-PET/MRI has been used to detect parathyroid pathology.https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0053.xml |
| spellingShingle | Thien Vinh Luong Lars Rejnmark Anne Kirstine Arveschoug Peter Iversen Lars Rolighed Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism Endocrinology, Diabetes & Metabolism Case Reports |
| title | Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism |
| title_full | Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism |
| title_fullStr | Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism |
| title_full_unstemmed | Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism |
| title_short | Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism |
| title_sort | benefits of 11c methionine pet mri and intraoperative fluorescence in treating hyperparathyroidism |
| url | https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0053.xml |
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