Name of the Procedure:

Parathyroid Planar Imaging (including Subtraction, when performed); with Single Photon Emission Computed Tomography (SPECT)

Summary

Parathyroid planar imaging with SPECT is a diagnostic procedure that uses a small amount of radioactive material and special imaging technology to take detailed pictures of the parathyroid glands in the neck. This helps doctors identify any abnormalities, such as overactive or enlarged glands.

Purpose

This procedure is used to detect and locate parathyroid adenomas or hyperplasia, which are often responsible for conditions like hyperparathyroidism. The goal is to accurately identify the problematic gland(s) for potential surgical intervention or other treatments.

Indications

• Elevated calcium levels in the blood
• Diagnosed or suspected hyperparathyroidism
• Symptoms such as kidney stones, bone pain, and fatigue
• Abnormal parathyroid hormone (PTH) levels

Preparation

• Patients may be asked to fast for a few hours before the procedure.
• Certain medications, especially those containing iodine or calcium, may need to be adjusted or stopped temporarily as per doctor’s advice.
• A preliminary blood test may be required to check PTH levels.

Procedure Description

1. A small amount of radioactive tracer is injected into the patient’s vein.
2. After allowing time for the tracer to accumulate in the parathyroid glands, the patient is positioned on a table.
3. Images are first captured using a gamma camera, which creates planar (2D) images.
4. SPECT is then performed, which involves the gamma camera rotating around the patient to obtain detailed cross-sectional images (3D).
5. Subtraction imaging may be used to highlight the parathyroid glands by removing background activity from surrounding tissues.

Equipment includes a gamma camera and SPECT scanner. Generally, no anesthesia or sedation is required.

Duration

The entire procedure typically takes about 1 to 3 hours, including preparation, imaging time, and waiting periods.

Setting

This procedure is performed in a hospital radiology department or a specialized outpatient nuclear medicine clinic.

Personnel

• Nuclear medicine technologist
• Radiologist or nuclear medicine physician
• Sometimes, a nurse for patient preparation and care

Risks and Complications

• Exposure to a small amount of radiation, though generally considered to be low and safe
• Minor discomfort at the injection site
• Rarely, allergic reaction to the radioactive tracer
• False positives or negatives leading to further diagnostic testing

Benefits

• Non-invasive and highly effective in identifying abnormal parathyroid glands
• Helps in planning surgical or therapeutic interventions
• Can lead to targeted and effective treatment

Recovery

• Patients can usually resume normal activities immediately after the procedure.
• It is recommended to drink plenty of fluids to help flush the radioactive material from the body.
• Follow-up appointments may be scheduled to discuss the results and potential treatment options.

Alternatives

• Ultrasound imaging
• MRI or CT scans
• Blood tests measuring calcium and PTH levels
• The benefits of parathyroid imaging with SPECT include higher accuracy and better localization of abnormal glands compared to some other imaging modalities.

Patient Experience

During the procedure, the patient may feel a slight sting from the needle used for the injection. Lying still on the imaging table can sometimes cause discomfort, but the technologist will ensure the patient is as comfortable as possible. Afterward, there may be no significant pain or discomfort, and normal activities can be resumed quickly.