Navigating diagnostic dilemmas: Localizing parathyroid adenoma in the presence of MIBI-avid thyroid nodules: A case report and literature review

Q4 Medicine

Radiology Case Reports Pub Date : 2024-11-26 DOI:10.1016/j.radcr.2024.08.102

Zohreh Maghsoomi , Maryam Rafieemanesh , Atefeh kashanizadeh , Behnaz Boozari , Mohammad Reza Babaei , Neda Hatami , Mohammad E․ Khamseh , Mehran Arab-Ahmadi

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引用次数: 0

Abstract

Surgery is the preferred treatment for primary hyperparathyroidism (PHPT), but the presence of MIBI-avid thyroid nodules can complicate the localization of parathyroid adenoma (PA). In this case report, we discuss the role of imaging in localizing PA in a patient with concurrent thyroid nodules. A 49-year-old female presented with hypercalcemia and elevated parathyroid hormone levels. Technetium-99m-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) showed MIBI-avid enhancement in the left thyroid lobe. Neck ultrasonography revealed 3 thyroid nodules in the left lobe, categorized as Thyroid Imaging Reporting and Data System (TI-RADS) 4. Fine-needle aspiration cytology yielded indeterminate results, and iPTH washout concentration was not elevated. Parathyroid 4-dimensional computed tomography (4D CT) was performed, which revealed an extra thyroid lesion on the left side, favoring PA. Left thyroid lobectomy and parathyroidectomy were performed, and the pathology report confirmed PA and follicular thyroid carcinoma. In cases where MIBI-avid thyroid nodules mimic PA, a combination of imaging modalities including technetium-99m-sestamibi SPECT/CT, neck ultrasonography, and parathyroid 4D CT can aid in differentiating between intrathyroid PA and extrathyroidal locations. Accurate preoperative localization is crucial for successful surgical management of PHPT. These imaging techniques play a pivotal role in guiding surgical decisions and ensuring optimal patient outcomes.

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诊断困境导航：在存在MIBI-avid甲状腺结节的情况下定位甲状旁腺腺瘤：病例报告和文献综述

手术是治疗原发性甲状旁腺功能亢进症（PHPT）的首选方法，但甲状腺MIBI-avid结节的存在会使甲状旁腺腺瘤（PA）的定位复杂化。在本病例报告中，我们将讨论影像学检查在对并发甲状腺结节的患者进行 PA 定位时的作用。一名 49 岁的女性患者出现高钙血症和甲状旁腺激素水平升高。锝-99m-sestamibi单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）显示左甲状腺叶MIBI-avid增强。颈部超声检查显示左叶有3个甲状腺结节，归类为甲状腺成像报告和数据系统（TI-RADS）4级。细针穿刺细胞学检查结果不确定，iPTH冲洗浓度未升高。进行了甲状旁腺四维计算机断层扫描（4D CT），发现左侧有一个额外的甲状腺病变，倾向于 PA。患者接受了左侧甲状腺叶切除术和甲状旁腺切除术，病理报告证实患者患有PA和甲状腺滤泡癌。在MIBI-avid甲状腺结节与PA相似的病例中，包括锝-99m-sestamibi SPECT/CT、颈部超声和甲状旁腺4D CT在内的多种成像模式可帮助区分甲状腺内PA和甲状腺外位置。准确的术前定位是成功进行 PHPT 手术治疗的关键。这些成像技术在指导手术决策和确保患者获得最佳治疗效果方面发挥着关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiology Case Reports Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

1.10

自引率

0.00%

发文量

1074

审稿时长

30 days

期刊介绍： The content of this journal is exclusively case reports that feature diagnostic imaging. Categories in which case reports can be placed include the musculoskeletal system, spine, central nervous system, head and neck, cardiovascular, chest, gastrointestinal, genitourinary, multisystem, pediatric, emergency, women''s imaging, oncologic, normal variants, medical devices, foreign bodies, interventional radiology, nuclear medicine, molecular imaging, ultrasonography, imaging artifacts, forensic, anthropological, and medical-legal. Articles must be well-documented and include a review of the appropriate literature.