Imaging techniques in parathyroid surgery for primary hyperparathyroidism

Abstract

As more patients present with the incidental diagnosis of primary hyperparathyroidism due to biochemical screening, treatment guidelines have been developed for the treatment of hyperparathyroidism. Management of primary hyperparathyroidism has evolved in recent years with considerable interest in minimally invasive approaches. Successful localization of the diseased gland(s) by nuclear imaging and anatomical studies along with rapid intraoperative parathyroid hormone assay has allowed for focused and minimally invasive surgical approaches. Patients in whom the localization studies have identified single gland adenoma or unilateral disease are candidates for such focused approaches instead of the traditional approach of bilateral exploration. These imaging techniques have also been critical in the successful management of patients with persistent or recurrent disease.

Endocrine Scintigraphy with Hybrid SPECT/CT

“…131 I SPECT/CT was used for evaluation of a wide range of cryptic findings occurring in 40/184 (22%) scans including a spectrum of physiological benign etiologies (73). While these variants are usually recognized on planar imaging, SPECT/CT resolves diagnostic uncertainty with greater confidence and improved accuracy (120,121). Numerous case reports have demonstrated the utility of SPECT/CT for confirmation of benign "mimics" of disease; eg, blocked nasolacrimal duct, lingual thyroid, thymus, struma ovarii, ovarian teratoma, menstruating uterus, and radioiodine accumulation in simple renal cysts (93,(102)(103)(104)(105)(106)(107)(108)(109)(110)(122)(123)(124)(125)(126).…”

Original technique for preoperative preparation of patients and intraoperative localization of parathyroid adenomas

“…Fundamental indications for minimally invasive surgery are the presence of a single adenoma and the precise preoperative and intraoperative localization. Most of the patients (80% to 90%) are affected by single parathyroid adenoma, so theoretically candidable to this procedure, but we must consider that there may be some contraindications, such as obesity or the presence of an enlarged thyroid (8). Tc-99 m -sestaMIBI scintigraphy is mainly performed for preoperative localization of parathyroid adenomas and it can be performed in combination with ultrasound or CT. Rubello et al (9) have suggested to perform a dual tracer scintigraphy combined with ultrasound of the neck, which allowed the identification of preoperative parathyroid adenomas, and they assigned to minimally invasive surgery only patients with normal thyroid.…”

MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

“…Ultrasound (US) and 99mTc-sestamibi scintigraphy are the dominant imaging techniques for preoperative location of PTAs [22][23][24][25][26][27][28][29][30]. A preoperative approach that combines the anatomic information of US and the functional information of scintigraphy may localise a solitary PTA more accurately (sensitivity of 95 %) than a single technique [31][32][33][34][35][36].…”