Imaging in primary hyperparathyroidism: focus on the evidence-based diagnostic performance of different methods

Area of Science:

• Endocrinology
• Nuclear Medicine
• Radiology

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder often caused by hyperfunctioning parathyroid glands (HP).
• Surgical removal of HP is the primary treatment for PHPT, especially in symptomatic individuals.
• Accurate detection and localization of HP are critical for guiding successful surgical intervention.

Purpose of the Study:

• To review and describe the diagnostic performance of various imaging modalities for detecting HP in PHPT patients.
• To summarize evidence-based findings, including meta-analyses, on the accuracy of imaging methods in PHPT.
• To propose an optimized imaging strategy based on diagnostic performance and clinical considerations.

Main Methods:

• Systematic review of recent evidence-based articles on imaging methods for HP detection in PHPT.
• Inclusion of findings from meta-analyses evaluating the diagnostic accuracy of imaging techniques.
• Description of a suggested imaging strategy incorporating diagnostic performance data.

Main Results:

• Cervical ultrasound (US) and 99mTc-MIBI scintigraphy are common first-line tests, with similar performance.
• Tomographic imaging (SPECT, SPECT/CT) improves HP detection rates compared to planar scintigraphy.
• 4D-CT shows comparable performance to tomographic scintigraphy but involves higher radiation; MRI and PET lack sufficient evidence for routine use but may be useful in specific cases.

Conclusions:

• Patients undergoing parathyroidectomy for PHPT should consult expert clinicians for tailored imaging recommendations.
• 99mTc-MIBI SPECT/CT and 4D-CT demonstrate superior diagnostic performance for HP detection and localization.
• An optimal first-line strategy involves combining cervical US by an experienced sonographer with 99mTc-MIBI SPECT or SPECT/CT for preoperative planning.