The imaging tree of parathyroid diseases - Improving surgical outcomes by illuminating parathyroid glands

The current thesis investigates diagnostic molecular, optical and optoacoustic imaging techniques in parathyroid diseases. These imaging modalities may support surgical planning and have the potential to provide critical anatomical and biological information before and during surgery. In the first part of this thesis, we found that employing nuclear imaging techniques according to a standardized method in patients with primary hyperparathyroidism allows for the localization of parathyroid diseases with high accuracy before surgery. As a result, a minimally invasive surgical intervention is sufficient in these patients with fewer complications.The second part of this thesis focuses on preserving parathyroid glands during thyroid surgery to prevent hypoparathyroidism using optical fluorescence and optoacoustic imaging. Optical fluorescence imaging, where a fluorescent imaging agent lights up blood vessels during surgery, can assist in this clinical challenge. Moreover, optoacoustic imaging, an imaging modality that uses light to generate ultrasound waves, thereby providing both anatomical and biological information about the tissue, may be of help. We show the potential of standardized and quantitative optical and optoacoustic imaging in thyroid surgery patients to support clinical decision-making and ultimately prevent parathyroid function impairment. To incorporate these imaging techniques into the standard of care, we need to collaborate internationally to standardize evidence-based imaging and treatment guidelines. Eventually, illuminating parathyroid glands using these different techniques on the imaging tree of parathyroid diseases may guide surgical decision-making and improve surgical outcomes

The imaging tree of parathyroid diseases - Improving surgical outcomes by illuminating parathyroid glands

The current thesis investigates diagnostic molecular, optical and optoacoustic imaging techniques in parathyroid diseases. These imaging modalities may support surgical planning and have the potential to provide critical anatomical and biological information before and during surgery. In the first part of this thesis, we found that employing nuclear imaging techniques according to a standardized method in patients with primary hyperparathyroidism allows for the localization of parathyroid diseases with high accuracy before surgery. As a result, a minimally invasive surgical intervention is sufficient in these patients with fewer complications. The second part of this thesis focuses on preserving parathyroid glands during thyroid surgery to prevent hypoparathyroidism using optical fluorescence and optoacoustic imaging. Optical fluorescence imaging, where a fluorescent imaging agent lights up blood vessels during surgery, can assist in this clinical challenge. Moreover, optoacoustic imaging, an imaging modality that uses light to generate ultrasound waves, thereby providing both anatomical and biological information about the tissue, may be of help. We show the potential of standardized and quantitative optical and optoacoustic imaging in thyroid surgery patients to support clinical decision-making and ultimately prevent parathyroid function impairment. To incorporate these imaging techniques into the standard of care, we need to collaborate internationally to standardize evidence-based imaging and treatment guidelines. Eventually, illuminating parathyroid glands using these different techniques on the imaging tree of parathyroid diseases may guide surgical decision-making and improve surgical outcomes

Secondary and Tertiary Hyperparathyroidism:A Narrative Review

End-stage renal disease is often complicated by the occurrence of secondary and eventually tertiary hyperparathyroidism, characterized by increased parathormone, calcium, and phosphate concentrations. Related symptoms include pruritus and osteodynia, concentration difficulties, and feelings of depression may be present. In the long-term, end-stage renal disease patients with hyperparathyroidism have an increased risk of all-cause and cardiovascular mortality. Among treatment options are vitamin D supplements, phosphate binders, calcimimetics, and surgical parathyroidectomy. Determining the optimal treatment for the individual patient is challenging for nephrologists and endocrine surgeons. This review resumes the pathogenesis of hyperparathyroidism, clinical presentation, required diagnostic work-up, and discusses indications for the available treatment options for patients with secondary and tertiary hyperparathyroidism

Tetra­kis(diethyl ether)tetra-μ4-oxido-octa­kis­(penta­fluoro­phen­yl)octa­zinc

Mol­ecules of the title compound, [Zn8(C6F5)8O4(C4H10O)4], are located on a special position of site symmetry . As a result, there is just one quarter-mol­ecule in the asymmetric unit. The title compound features a Zn4O4 cube. Each Zn atom in the cube carries a pentafluorophenyl substituent. Each O atom is bonded to a further Zn atom, which is connected to a pentafluorophenyl substituent and the O atom of a diethyl ether mol­ecule. All ether C atoms are disordered over two sets of sites with a site occupation factor of 0.51 (2) for the major occupied site

Do blood plasma levels of oxytocin moderate the effect of nasally administered oxytocin on social orienting in high-functioning male adults with autism spectrum disorder?

The study investigated whether baseline plasma oxytocin (OXT) concentrations might moderate the effects of nasally administered OXT on social orienting.Thirty-one males with Autism spectrum disorder (ASD) and thirty healthy males participated in a double-blind placebo-controlled crossover trial. After administration of the compound, participants were viewing pictures from the International Affective Picture System that represented a systematic variation of pleasant, unpleasant and neutral scenes with and without humans. The outcome measures were a cardiac evoked response (ECR) and a cortical evoked long latency parietal positivity (LPP).Males with ASD had significantly higher plasma baseline levels than the controls. In the absence of general treatment effects, higher baseline concentrations were found to be associated with larger treatment effects, particularly in the group of males with ASD. Higher post-treatment plasma OXT concentrations were found to be associated with smaller treatment effects and larger orienting responses in the placebo situation in the group of controls.We interpret our findings as suggesting that it is the central availability of OXT determining how much of the nasally administered OXT will become centrally absorbed and how much of it will become released into the bloodstream.</p

Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands-A Meta-Narrative Review

Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation

A retrospective analysis of the diagnostic performance of 11C-choline PET/CT for detection of hyperfunctioning parathyroid glands after prior negative or discordant imaging in primary hyperparathyroidism

BACKGROUND: Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a next in-line scan after primary negative or discordant first-line imaging. METHODS: This was a retrospective single-center cohort study. All patients with pHPT that were scanned utilizing 11C-choline PET/CT, after prior negative or discordant imaging, between 2015 and 2019 and who subsequently underwent parathyroid surgery were included. The results of the 11C-choline PET/CT were evaluated lesion-based, with surgical exploration and histopathological examination as the gold standard. RESULTS: In total, 36 patients were included of which three patients were known to have Multiple Endocrine Neoplasia (MEN) syndrome. In these 36 patients, 40 lesions were identified on 11C-choline PET/CT and 37 parathyroid lesions were surgically removed. In 34/36 (94%) patients a focused parathyroidectomy was performed, in one patient a cervical exploration due to an ectopically identified adenoma, and in one patient a bilateral exploration was performed because of a double adenoma. Overall, per-lesion sensitivity of 11C-choline PET/CT was 97%, the positive predictive value was 95% and the accuracy was 94% for all parathyroid lesions. CONCLUSIONS: In patients with pHPT and prior negative or discordant first-line imaging results, pathological parathyroid glands can be localized by 11C-choline PET/CT with high sensitivity and accuracy

Non-adherence to consensus guidelines on preoperative imaging in surgery for primary hyperparathyroidism

Objective: The aim of this study was to determine the adherence to consensus guidelines on preoperative imaging of patients with primary hyperparathyroidism (pHPT) in real local practice. Methods: This was a retrospective multicenter cohort study of 411 patients undergoing parathyroidectomy for pHPT from 2007 to 2017 in three referral centers. Results: In 286/411 patients (69%) the preoperative imaging workup adhered to guidelines (utilizing ultrasound and parathyroid scintigraphy). In patients in whom guidelines were followed 63% were discharged within one day versus 37% in whom guidelines were not followed (P< .0005). The use of a bimodality imaging workup, starting with ultrasound and parathyroid scintigraphy followed by imaging upscaling aiming for anatomical and functional concordance, was a predictor for the performance of a minimally invasive parathyroidectomy (OR 4.098, 95% CI 2.296-7.315,P< .0005). Conclusion: The level of compliance to preoperative imaging guidelines is suboptimal in this population. Patients in whom adherence was achieved showed a shorter length of stay. More education of physicians is required regarding the appropriate preoperative imaging workup in pHPT