Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review.

Area of Science:

• Endocrinology
• Radiology
• Surgical Oncology

Background:

• Minimally invasive parathyroidectomy (PTx) is increasingly preferred for primary hyperparathyroidism (PHPT).
• Accurate preoperative localization of abnormal parathyroid glands is essential for successful PTx.
• Traditional bilateral neck exploration is being replaced by less invasive surgical approaches.

Purpose of the Study:

• To review the diagnostic performance of various imaging modalities for preoperative parathyroid localization.
• To discuss the advantages and limitations of each imaging technique.
• To inform optimal imaging strategy selection for PHPT patients.

Main Methods:

• Review of established and emerging imaging techniques: ultrasound (US), sestamibi scintigraphy (MIBI), 4D-CT, PET, and MRI.
• Discussion of parathyroid venous sampling for specific clinical scenarios.
• Analysis of diagnostic performance, efficacy, and clinical utility.

Main Results:

• US and MIBI are widely used first-line modalities.
• 4D-CT demonstrates excellent performance and is increasingly used as a first-line or adjunct tool.
• PET and MRI serve as valuable adjuncts for equivocal or failed localizations.

Conclusions:

• No definitive evidence-based guidelines exist for optimal imaging strategy.
• Clinicians must be aware of the capabilities and advancements of available imaging techniques.
• Individualized patient selection based on efficacy, expertise, and availability is key for choosing the appropriate imaging modality.