[Primary hyperparathyroidism: ultrasonography and scintigraphy]

Primary hyperparathyroidism is nowadays frequently diagnosed from screening biological work-up: it is due to a single parathyroid adenoma in nearly 90% of cases. There is increasing interest in the minimally invasive surgical approach with unilateral neck exploration. For such approaches preoperative localizing studies are mandatory. Ultrasound and radionuclide imaging are the most widely used procedures for this purpose. Ultrasound offers detailed anatomic imaging of the adenoma but may not be not able to detect some ectopic glands. Sonographic imaging features, as well as pitfalls and diagnostic difficulties are described. Radionuclide scanning using Tc-99m-Sestamibi is able to localize parathyroid adenomas even in the case of ectopic localization with the help of SPECT-CT.