Parathyroid imaging – implications for management of patients with primary hyperparathyroidism
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 11
Abstract
The development of imaging techniques nowadays enables localization of 80-90% of enlarged parathyroid glands. This is essential especially in the case of ectopic tumors, as their preoperative imaging implies total change in type and extent of surgical intervention. Furthermore, precise localization of the enlarged gland enables to apply minimally invasive parathyroidectomy (MIP) instead of the classic bilateral cervical exploration. The decision about surgery is not dependent on parathyroid imaging and it is based exclusively on clinical and biochemical criteria. The article discusses currently applicable parathyroid imaging techniques. The first-line imaging study is neck ultrasonography, as it is satisfactory sensitive, available, non-invasive and relatively inexpensive. The classical 99mTc-sestamibi scintigraphy plays still the primary role. Computed tomography and, in some cases, magnetic resonance imaging are used when scintigraphy and sonography fail to localize enlarged parathyroid glands, especially in persisted and recurrent hyperparathyroidism. Emerging techniques of great hopes are single-photon emission computed tomography (SPECT) and 4-dimensional computed tomography (4D-CT), which are useful especially in diagnostically difficult cases of multiglandular disease or ectopic parathyroid glands. Occasionally, in patients after a prior unsuccessful surgery, who have failed previously described imaging techniques, angiography and venous catheterization with determination of parathyroid hormone concentration gradient are performed.
Authors and Affiliations
Magdalena Kochman, Waldemar Misiorowski
Keywords
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