Surgical implications of recent modalities for parathyroid imaging

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder.
• Parathyroidectomy is the standard treatment for symptomatic PHPT, preventing complications from parathyroid hormone (PTH) excess.
• Surgical approaches have advanced from open exploration to minimally invasive techniques.

Purpose of the Study:

• To review the evolution of parathyroid surgical techniques.
• To highlight the importance of accurate parathyroid gland localization for surgical success.
• To discuss the role of various imaging modalities in PHPT management.

Main Methods:

• Review of current literature on parathyroidectomy and imaging techniques.
• Comparison of traditional and advanced noninvasive imaging modalities.
• Discussion of emerging technologies like 4D-CT, PET/CT, and PET/MR.

Main Results:

• Minimally invasive parathyroidectomy requires precise preoperative localization.
• Established noninvasive imaging includes ultrasound (US), CT, MR, and MIBI scintigraphy with SPECT/CT.
• Novel techniques such as 4D-CT, PET/CT, and PET/MR show significant promise for future surgical guidance.

Conclusions:

• Accurate localization of abnormal parathyroid glands is essential for successful parathyroid surgery.
• Advancements in imaging are critical for the increasing adoption of minimally invasive approaches.
• Emerging technologies like 4D-CT and PET-based imaging are expected to further refine surgical planning and outcomes.