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.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Figure 1

Hypoechoic left lower pole (A) and behind the left lower pole (B) parathyroid adenomas identified by ultrasound

Figure 2

Image after administration of sestamibi (2-h) delay demonstrates left inferior parathyroid adenoma.

Figure 3

SPECT/CT demonstrating a right side parathyroid adenoma

Figure 4

Computed tomography demonstrating a left sided parathyroid adenoma

Figure 5

MRI demonstrating a left parathyroid adenoma