Benefits of 11 C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism

[摘要] Multiple endocrine neoplasia 1 (MEN1) is a rare genetic syndrome characterized by the manifestation of tumors inendocrine 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 patientwith 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 twoleft PGs. However, a rise in plasma parathyroid hormone and ionized calcium was observed 4 years later. Preoperativenoninvasive imaging with 99mTc-sestamibi scintigraphy showed no definitive parathyroid adenoma. A 11C-methionineposition emission tomography combined with MRI (MET-PET/MRI) was then performed and detected a focus posteriorto the lower part of the right thyroid lobe. Intraoperative angiography with fluorescence and indocyanine green dye wasused to assess the vascularization of the remaining PGs. The lower right PG was removed. The patient was discharged withnormalized biochemical values and without postoperative complications. Recurrence of primary HPT is frequent in MEN1patients which often necessitates repeated operations. Our case report showed that the use of advanced noninvasivepreoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken intoconsideration in selected cases to avoid postoperative complications. To our knowledge, this is the first case where METPET/MRI has been used to detect parathyroid pathology.

[学科分类] 血液学